APHA Immunization Questions with Answers (100% Correct
Answers)
When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she received
PPSV23. Which of the following represents appropriate pneumococcal coverage for Mary. —
Answer: Administer PCV13 at age 65, then PPSV23 at age 69.
LO 3.4; Module 3— Pneumococcal Disease, Vaccine Recommendations Immunocompetent
adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13)
followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after
PCV13. However, if an individual is a candidate for PPSV23 prior to age 65 due to high-risk
conditions (in this case diabetes), then another dose of PPSV23 would be recommended after
the individual turns 65, but should be given 5 years after the 1st dose. Since Mary received
PPSV23 prior to PCV13, then PCV13 should be administered at least one year after PPSV23.
According to ACIP recommendations, HZV is indicated for the prevention of herpes zoster in
adults aged: —Answer: 60
LO 3.2; Module 3—
Herpes Zoster, Target Groups for VaccinationEven though the herpes zoster vaccine (Zostavax)
is FDA approved for individuals aged 50 and older, the ACIP recommends this vaccine for
individuals aged 60 and older. There are concerns about waning immunity with this vaccine. If
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
In which publication does the CDC initially publish new or updated vaccine recommendations?
—Answer: Morbidity and Mortality Weekly Report (MMWR)
LO 1.6; Module 1—Vaccine Recommendation SourcesThe Advisory Committee on
Immunization Practices (ACIP) develops vaccine recommendations and guidelines. These are
reviewed and approved by the CDC Director and the U.S. Department of Health and Human
© 2025 All rights reserved
,Services. Once approved, they are published in the CDC's Morbidity and Mortality Weekly
Report (MMWR). The Epidemiology and Prevention of Vaccine-Preventable Diseases
(commonly referred to as the Pink Book) provides comprehensive information about vaccines
and the diseases they prevent. Content published in the MMWR regarding vaccines is often
incorporated into this resource. Needle Tips is a newsletter published multiple times
throughout the year by the Immunization Action Coalition. It provides timely updates and
answers to frequently asked questions. Vaccine is a journal affiliated with the Edward Jenner
Society and The Japanese Society for Vaccinology. It is a forum for the publication of research,
reviews, and commentaries related to vaccines.
Which of the following best describes how to administer MMR vaccine to an adult patient
weighing 210 lb? —Answer: Inject subcutaneously at a 45° angle in the outer aspect of the
upper arm.
LO 4.10; Module 4— General Injection Principles The MMR vaccine is administered
subcutaneously at a 45 degree angle into the outer aspect of the upper arm. Vaccines that are
given intramuscularly are administered into the deltoid muscle at a 90 degree angle. The weight
of the patient does not matter with regard to route of administration.
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which
of the following diseases? —Answer: Measles
Module 3—Measles, Mumps, Rubella. MeaslesThe classic symptoms of measles include fever,
cough, coryza (runny nose), conjunctivitis, Koplik spots (a bluish-white rash on mucous
membranes, especially the mouth), followed by the development of a maculopapular rash
approximately 14 days after exposure. Individuals infected with mumps may not have
symptoms. Others may have nonspecific symptoms, such as headache, fever, myalgia, and
malaise. About 30% to 40% of individuals may experience inflammation of the parotid glands.
Rubella symptoms tend to be relatively mild and may present as a maculopapular rash that
occurs approximately 14 days after exposure. Others may experience arthritis and arthralgia.
Varicella presents as a generalized vesicular rash.
Which entity determines the specific vaccines that a pharmacist may administer? —Answer:
State and yada
Module 1—Expanding Vaccination Offerings
© 2025 All rights reserved
,A pharmacist's scope of practice and immunization authority are determined by the
pharmacist's state practice act. As such the laws and regulations for pharmacists as immunizers
vary by state. The U.S. Food and Drug Administration provides the regulatory oversight for the
approval of vaccines. The Advisory Committee on Immunization Practices is the leading
authority in the U.S. that provides comprehensive vaccination recommendations and
guidelines. These recommendations are reviewed and approved by the CDC. The local health
departments do not have any oversight regarding a pharmacist's immunization practices.
However, pharmacists often work with their local health departments to provide vaccines and
public health services.
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any
adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the
following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of the
following tetanus-containing vaccines would be appropriate for him? —Answer: DTaP
LO 3.4; Module 3—Target Groups for Vaccination. DTaP VaccineDTaP is a five-dose series
given at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is due for his 5th and
final dose of DTaP. DTaP is appropriate for children less than 7 years of age. DT is only
reserved for children who have a contraindication to the pertussis component in DTaP.
Children, adolescents, and adults 7 years of age and older who require protection against
tetanus, diphtheria, and pertussis would receive Tdap. Following the one-time dose of Tdap, a
Td booster should be given every 10 years.
Which of the following documents must be given to every patient or patient's caregiver before
administration of a vaccine covered under the National Childhood Vaccine Injury Act
(NCVIA)? —Answer: VIS
Module 4— Providing Vaccine Information StatementsVaccine information statemetns (VISs)
are standardized forms that provide an overview of the risks and benefits of vaccines. Health
care providers who administer vaccines are required by law to provide patients with the most
up-to-date version of the VIS for any vaccine covered under the National Childhood Vaccine
Injury Act (NCVIA). The CMS-1500 and CMS-855B are forms required by the Centers for
Medicare and Medicaid Services (CMS) for billing and enrolling as a Medicare provider,
respectively. The PHS-731 is now the CDC 731 form and is the International Certificate of
Vaccination or Prophylaxis as Approved by the World Health Organization (the Yellow Card).
© 2025 All rights reserved
, Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living
in dormitories, who have not been previously vaccinated? —Answer: MCV4,
LO 3.4; Module 3— Meningococcal Disease, Target Groups for Vaccination Routine vaccination
with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at
ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21 years
or younger living in residential housing who has not been previously vaccinated with MCV4 is
considered high-risk for meningococcal disease. One dose should be administered. Living in
dormitories on a college campus is not considered a risk factor for pneumococcal disease, HPV,
or varicella.
Which of the following tetanus booster vaccines would be most appropriate for administration
to a 12-year-old boy who has completed a primary series with DTaP and has no known
allergies? —Answer: Tdap
LO 3.4; Module 3— Pertussis. Target Groups for Vaccination. Tdap Vaccine
One dose of Tdap is routinely recommended for all adolescents who have completed the
primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher
amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years
of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of
Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of
diphtheria toxin is only reserved for children who have a contraindication to the pertussis
component in DTaP.
Which of these vaccines is a live attenuated vaccine? —Answer: Zoster
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine
(LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox),
varicella, and yellow fever. All other vaccines are inactivated.
Which of the following immunization strategies is preferred for adults under the age of 65 years
with immunocompromising conditions who require both PCV13 and PPSV23? —Answer:
PCV13 first, followed by PPSV23 at least 8 weeks later.
© 2025 All rights reserved
Answers)
When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she received
PPSV23. Which of the following represents appropriate pneumococcal coverage for Mary. —
Answer: Administer PCV13 at age 65, then PPSV23 at age 69.
LO 3.4; Module 3— Pneumococcal Disease, Vaccine Recommendations Immunocompetent
adults aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13)
followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after
PCV13. However, if an individual is a candidate for PPSV23 prior to age 65 due to high-risk
conditions (in this case diabetes), then another dose of PPSV23 would be recommended after
the individual turns 65, but should be given 5 years after the 1st dose. Since Mary received
PPSV23 prior to PCV13, then PCV13 should be administered at least one year after PPSV23.
According to ACIP recommendations, HZV is indicated for the prevention of herpes zoster in
adults aged: —Answer: 60
LO 3.2; Module 3—
Herpes Zoster, Target Groups for VaccinationEven though the herpes zoster vaccine (Zostavax)
is FDA approved for individuals aged 50 and older, the ACIP recommends this vaccine for
individuals aged 60 and older. There are concerns about waning immunity with this vaccine. If
given too soon (before age 60), it may not afford protection in older individuals who are at
higher risk of herpes zoster.
In which publication does the CDC initially publish new or updated vaccine recommendations?
—Answer: Morbidity and Mortality Weekly Report (MMWR)
LO 1.6; Module 1—Vaccine Recommendation SourcesThe Advisory Committee on
Immunization Practices (ACIP) develops vaccine recommendations and guidelines. These are
reviewed and approved by the CDC Director and the U.S. Department of Health and Human
© 2025 All rights reserved
,Services. Once approved, they are published in the CDC's Morbidity and Mortality Weekly
Report (MMWR). The Epidemiology and Prevention of Vaccine-Preventable Diseases
(commonly referred to as the Pink Book) provides comprehensive information about vaccines
and the diseases they prevent. Content published in the MMWR regarding vaccines is often
incorporated into this resource. Needle Tips is a newsletter published multiple times
throughout the year by the Immunization Action Coalition. It provides timely updates and
answers to frequently asked questions. Vaccine is a journal affiliated with the Edward Jenner
Society and The Japanese Society for Vaccinology. It is a forum for the publication of research,
reviews, and commentaries related to vaccines.
Which of the following best describes how to administer MMR vaccine to an adult patient
weighing 210 lb? —Answer: Inject subcutaneously at a 45° angle in the outer aspect of the
upper arm.
LO 4.10; Module 4— General Injection Principles The MMR vaccine is administered
subcutaneously at a 45 degree angle into the outer aspect of the upper arm. Vaccines that are
given intramuscularly are administered into the deltoid muscle at a 90 degree angle. The weight
of the patient does not matter with regard to route of administration.
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which
of the following diseases? —Answer: Measles
Module 3—Measles, Mumps, Rubella. MeaslesThe classic symptoms of measles include fever,
cough, coryza (runny nose), conjunctivitis, Koplik spots (a bluish-white rash on mucous
membranes, especially the mouth), followed by the development of a maculopapular rash
approximately 14 days after exposure. Individuals infected with mumps may not have
symptoms. Others may have nonspecific symptoms, such as headache, fever, myalgia, and
malaise. About 30% to 40% of individuals may experience inflammation of the parotid glands.
Rubella symptoms tend to be relatively mild and may present as a maculopapular rash that
occurs approximately 14 days after exposure. Others may experience arthritis and arthralgia.
Varicella presents as a generalized vesicular rash.
Which entity determines the specific vaccines that a pharmacist may administer? —Answer:
State and yada
Module 1—Expanding Vaccination Offerings
© 2025 All rights reserved
,A pharmacist's scope of practice and immunization authority are determined by the
pharmacist's state practice act. As such the laws and regulations for pharmacists as immunizers
vary by state. The U.S. Food and Drug Administration provides the regulatory oversight for the
approval of vaccines. The Advisory Committee on Immunization Practices is the leading
authority in the U.S. that provides comprehensive vaccination recommendations and
guidelines. These recommendations are reviewed and approved by the CDC. The local health
departments do not have any oversight regarding a pharmacist's immunization practices.
However, pharmacists often work with their local health departments to provide vaccines and
public health services.
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any
adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the
following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of the
following tetanus-containing vaccines would be appropriate for him? —Answer: DTaP
LO 3.4; Module 3—Target Groups for Vaccination. DTaP VaccineDTaP is a five-dose series
given at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. Kyle is due for his 5th and
final dose of DTaP. DTaP is appropriate for children less than 7 years of age. DT is only
reserved for children who have a contraindication to the pertussis component in DTaP.
Children, adolescents, and adults 7 years of age and older who require protection against
tetanus, diphtheria, and pertussis would receive Tdap. Following the one-time dose of Tdap, a
Td booster should be given every 10 years.
Which of the following documents must be given to every patient or patient's caregiver before
administration of a vaccine covered under the National Childhood Vaccine Injury Act
(NCVIA)? —Answer: VIS
Module 4— Providing Vaccine Information StatementsVaccine information statemetns (VISs)
are standardized forms that provide an overview of the risks and benefits of vaccines. Health
care providers who administer vaccines are required by law to provide patients with the most
up-to-date version of the VIS for any vaccine covered under the National Childhood Vaccine
Injury Act (NCVIA). The CMS-1500 and CMS-855B are forms required by the Centers for
Medicare and Medicaid Services (CMS) for billing and enrolling as a Medicare provider,
respectively. The PHS-731 is now the CDC 731 form and is the International Certificate of
Vaccination or Prophylaxis as Approved by the World Health Organization (the Yellow Card).
© 2025 All rights reserved
, Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living
in dormitories, who have not been previously vaccinated? —Answer: MCV4,
LO 3.4; Module 3— Meningococcal Disease, Target Groups for Vaccination Routine vaccination
with the quadrivalent meningococcal conjugate vaccine (MenACWY or MCV4) is one dose at
ages 11 to 12 years and a booster dose at age 16 years. A first-year college student aged 21 years
or younger living in residential housing who has not been previously vaccinated with MCV4 is
considered high-risk for meningococcal disease. One dose should be administered. Living in
dormitories on a college campus is not considered a risk factor for pneumococcal disease, HPV,
or varicella.
Which of the following tetanus booster vaccines would be most appropriate for administration
to a 12-year-old boy who has completed a primary series with DTaP and has no known
allergies? —Answer: Tdap
LO 3.4; Module 3— Pertussis. Target Groups for Vaccination. Tdap Vaccine
One dose of Tdap is routinely recommended for all adolescents who have completed the
primary series of DTaP. This should be given at 11 to 12 years of age. DTaP contains higher
amounts diphtheria toxoid and pertussis than Tdap. It is only used in children less than 7 years
of age to avoid injection site reactions in adolescents and adults. Following the one-time dose of
Tdap, a Td booster should be given every 10 years. DT, which has a higher amount of
diphtheria toxin is only reserved for children who have a contraindication to the pertussis
component in DTaP.
Which of these vaccines is a live attenuated vaccine? —Answer: Zoster
The live attenuated vaccines include cholera, herpes zoster, live attenuated influenza vaccine
(LAIV), MMR, MMRV, rotavirus, tuberculosis (BCG), typhoid (Ty21a), vaccinia (smallpox),
varicella, and yellow fever. All other vaccines are inactivated.
Which of the following immunization strategies is preferred for adults under the age of 65 years
with immunocompromising conditions who require both PCV13 and PPSV23? —Answer:
PCV13 first, followed by PPSV23 at least 8 weeks later.
© 2025 All rights reserved
