1. Problems with which vaccine led to the “Cutter Incident”?

1. Polio vaccine
2. Haemophilus influenzae type B (Hib) vaccine
3. Measles vaccine
4. Rotavirus vaccine

Supplementary information: The correct answer is A. The “Cutter Incident” occurred in 1955 when Cutter Laboratories in Berkeley, California produced polio vaccine that contained live polio virus. More than 120,000 people received the vaccines and as a result, 40,000 of them were temporarily paralyzed; 200 were permanently paralyzed and 10 died.

2. What is the difference in immunity from breastfeeding and immunity from vaccination?

1. Vaccines provide long-term immunologic memory whereas breastfeeding provides short-term immunologic memory.
2. There is no difference – breastfeeding and vaccination both provide long-term immunologic memory.
3. Vaccines provide short-term immunologic memory whereas breastfeeding provides long-term immunologic memory.
4. There is no difference – breastfeeding and vaccination both provide short-term immunologic memory.

Supplementary information: The correct answer is A. When a baby is breastfed, he gets antibodies from his mother’s milk; however, these antibodies only last a few weeks or months. Conversely, when a baby is vaccinated, his own immune system responds; therefore, immunologic memory is created, which is much longer lasting.

3. In what city did people first organize to voice their concerns about vaccinations?

1. Paris, France
2. Venice, Italy
3. London, England
4. Sydney, Australia

Supplementary information: The correct answer is C. The Anti-Vaccination League began in London, England, in 1853 and was the first organization for people to voice their concerns about vaccine safety.

4. What committee licenses vaccines?

1. The American Association of Vaccine Safety (AAVS)
2. The Scientific Study Investigators of America (SSIA)
3. The Food and Drug Administration (FDA)
4. The Center for Vaccine Safety (CVS)

Supplementary information: The correct answer is C. Before a company can market a vaccine, it must be licensed by the Food and Drug Administration (FDA). During the licensing process, the FDA closely evaluates the data generated during clinical trials to ensure the vaccine is safe and effective in the target population.

5. What committee makes recommendations for vaccines?

1. The Committee for Vaccine Recommendations
2. The Advisory Committee on Immunization Practices
3. Vaccine Recommendations Committee
4. Vaccine Recommenders International

Supplementary information: The correct answer is B. The Advisory Committee on Immunization Practices (ACIP), as well as the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP), make the vaccine recommendations that result in the vaccine schedule.

6. An early version of what vaccine was discontinued because some infants experienced intestinal blockages?

1. Shingles vaccine
2. MMR vaccine
3. Rotavirus vaccine
4. DTaP vaccine

Supplementary information: The correct answer is C. An early version of the rotavirus vaccine, known as RotaShield®, was discontinued because it was a rare cause of intussusception, a form of intestinal blockage that can cause massive bleeding and serious infection.

7. Vaccines were shown to cause what disease?

1. Asthma
2. Diabetes
3. Multiple Sclerosis
4. None of these

Supplementary information: The correct answer is D. Numerous scientific studies have shown no link between vaccines and asthma, diabetes, or multiple sclerosis.

8. What is added during the manufacturing of vaccines to prevent contamination with bacteria?

1. Antibiotics
2. Adjuvants
3. Gelatin
4. Water

Supplementary information: The correct answer is A. Antibiotics are added to vaccines during manufacture to prevent contamination with bacteria. Some antibiotics that are commonly added to vaccines include neomycin, streptomycin and amphotericin B.

9. What additive commonly found in vaccines is a rare cause of allergic reactions?

1. Water
2. Penicillin
3. Gelatin
4. Amoxicillin

Supplementary information: The correct answer is C. Gelatin is used in vaccines as a stabilizer and is a very rare cause of allergic reactions.

10. What is not a reason why we give vaccines?

1. To prevent common infections
2. To dampen the immune system
3. To prevent infections that could easily reemerge
4. To prevent infections that are common in other parts of the world

Supplementary information: The correct answer is B. Vaccines are given to prevent common infections and prevent infections from re-emerging. Some infections, although eliminated in the U.S., are still common in other countries. Because international travel to these parts of the world is common, vaccines to prevent these diseases are still given.

11. Which side effect is known to be caused by vaccines?

1. Fever
2. Hair loss
3. Decrease in shoe size
4. Profuse sweating

Supplementary information: The correct answer is A. Fever is a common side effect caused by vaccines. Fevers typically develop after a vaccine is given because the immune system is responding to the vaccine. Other common side effects that can occur after a vaccine include pain, redness or tenderness at the injection site.

12. Which people are negatively affected by aluminum?

1. People whose kidneys are not working properly or at all
2. People who have never been in contact with aluminum
3. People who eat fish
4. People who do not receive aluminum in their diet

Supplementary information: The correct answer is A. For people to be negatively affected by aluminum, two criteria must be met: Having ill-functioning kidneys and being exposed to high quantities of aluminum over an extended period of time. In these people, because their kidneys don’t effectively clear the aluminum, it accumulates and causes damage.

13. Infants are exposed to the greatest amount of aluminum from what?

1. Vaccines
2. Breast milk
3. Soy-based formulas
4. Regular formula

Supplementary information: The correct answer is C. Infants are exposed to about 120 milligrams of aluminum during the first 6 months of life if they are fed soy-based formulas.  In comparison, vaccines given during the first 6 months of life contain about 4 milligrams, breast-milk contains about 10 milligrams, and regular infant formula about 40 milligrams.

14. Well-controlled, reproducible scientific studies did not find a link between autism and what?

1. MMR vaccine, thimerosal and receiving too many vaccines
2. Genetics
3. Thalidomide
4. Rubella

Supplementary information: The correct answer is A. Well-controlled, scientific studies completed in multiple countries have found no link between the MMR vaccine and autism. Thimerosal and receiving too many vaccines do not cause autism either, as concluded by other well-controlled, reproducible scientific studies.

15. Why is separating, spacing out or withholding some vaccines detrimental?

1. Infants will be susceptible to disease for longer periods of time
2. It can increase the amount of stress a child may experience if they must return to the doctor more frequently than they would if the recommended vaccine schedule was followed
3. There is an increased potential for administration errors
4. All of the these

Supplementary information: The correct answer is D. Separating, spacing out or withholding some vaccines can be detrimental because infants will be susceptible to diseases for longer periods of time. The recommended vaccine schedule is designed to make sure that vaccines are given at times that will allow infants and children to be protected when they are most likely to get the diseases. Administration errors, such as giving the wrong vaccine or not allowing enough time between doses, may also occur if vaccines are separated, spaced out or withheld.

16. Measurements of what hormone associated with stress have been studied in children receiving vaccinations?

1. Cortisol
2. Progesterone
3. Testosterone
4. Stressol

Supplementary information: The correct answer is A. Scientific studies measuring cortisol allowed scientists to determine that children do not experience more stress when receiving two shots at once as compared to receiving only one shot. If vaccines are separated or spaced out, a child may experience more stress because they have to return to the doctor more frequently than they would if the recommended schedule was followed.

17. What are the chemical agents in vaccines that allow for lesser quantities of active ingredients and in some cases, fewer doses, while maintaining the ability of the vaccine to be protective?

1. Adjuvants
2. Helper proteins
3. Booster proteins
4. Chemicals

Supplementary information: The correct answer is A. Adjuvants are chemicals in vaccines that allow them to generate protective immunity despite lesser quantities of active ingredients and in some cases, fewer doses. An adjuvant commonly found in vaccines in the U.S. is aluminum salts.

18. What is a commonly used adjuvant?

1. Aluminum
2. Water
3. Plastic
4. Carbon

Supplementary information: The correct answer is A. Aluminum in the form of aluminum salts is one example of a commonly used adjuvant. Adjuvants are used to boost a person’s immune response to a vaccine. Another adjuvant approved for use in the U.S. is monophosphoryl lipid A.

19. What is added to vaccines to protect the active ingredients from degrading during manufacture, transport and storage?

1. Adjuvants
2. Stabilizers
3. Solvents
4. Detergents

Supplementary information: The correct answer is B. Stabilizers are chemicals added to vaccines to protect active ingredients from degrading during manufacture, transport and storage. A stabilizer commonly added to vaccines is gelatin.

20. What is a stabilizer that is commonly used in vaccines to protect the active ingredients from degradation?

1. Aluminum
2. Monophosphoryl lipid A
3. Gelatin
4. Sodium Dodecyl Sulfate

Supplementary information: The correct answer is C. Gelatin is commonly used in vaccines as a stabilizer to protect active ingredients from degradation. The gelatin used in vaccines is made by extracting collagen from the skin and hooves of pigs.

21. What animal does the gelatin used in vaccines come from?

1. Horses
2. Cows
3. Pigs
4. Ducks

Supplementary information: The correct answer is C. Gelatin used in vaccines comes from pigs.

22. Which religious groups prohibit the use of vaccines because gelatin from pigs is used?

1. Jewish
2. Muslims
3. Seventh Day Adventists
4. None of the these

Supplementary information: The correct answer is D. Although gelatin from pigs is used, Jewish, Muslim and Seventh Day Adventists religious communities do not prohibit the use of vaccines because (1) vaccines are injected (by shot) and not ingested (by mouth), (2) gelatin used in vaccines is modified so that it is very different from naturally occurring gelatin, (3) the benefits of vaccines clearly outweigh the dietary principles of each religion.

23. Which religious groups prohibit the use of vaccines made using fetal tissue?

1. Jewish
2. Catholics
3. Muslims
4. None of the these

Supplementary information: The correct answer is D. Jewish, Catholic and Muslim religions do not prohibit the use of vaccines that are made using fetal tissue because they can save lives by preventing life-threatening infections. Some people question whether Catholics are able to use these vaccines, but the Vatican Council declared that parents who give their children vaccines are not committing an immoral act.

24. Why are some vaccines made using fetal cells?

1. Fetal cells were the only cells available at the time some vaccines were made.
2. Human cells are often better at supporting the growth of human viruses than animal cells are.
3. Fetal cells are mortal, like humans.
4. No vaccine is made using fetal cells.

Supplementary information: The correct answer is B. Some vaccines are made using fetal cells because viruses require cells to grow and human cells are often better at supporting the growth of human viruses than animal cells are. Fetal cells are also immortal, meaning they can reproduce forever so the same source of cells can be used indefinitely. Therefore, additional abortions are not needed.

25. What vaccine is not made using fetal cells?

1. Rubella vaccine
2. Chickenpox vaccine
3. HPV vaccine
4. Hepatitis A vaccine

Supplementary information: The correct answer is C. The HPV vaccine is not made using fetal cells; however, vaccines against chickenpox, hepatitis A, rubella, rabies and shingles are made using this technology.

26. What chemical compound is used during the manufacture of vaccines to inactivate viruses or bacterial toxins?

1. Water
2. Formaldehyde
3. Aluminum
4. Gelatin

Supplementary information: The correct answer is B. Formaldehyde is used during vaccine manufacturing to inactivate viruses and bacterial toxins. Some concern surrounds the use of formaldehyde in vaccines because it is also used to preserve dead bodies. However, the amount of formaldehyde in vaccines is minimal because of purification processes used during the manufacturing process.

27. What is added to some multi-dose preparations of vaccines to prevent contamination with bacteria?

1. Adjuvants
2. Stabilizers
3. Preservatives
4. Solvents

Supplementary information: The correct answer is C. Preservatives are added to some multi-dose vaccine preparations in order to prevent contamination with bacteria. Thimerosal is an example of a preservative that is used in some multi-dose preparations of the seasonal influenza vaccine.

28. What is a common mercury-containing preservative that is used in some multi-dose preparations of influenza vaccines to prevent contamination with bacteria?

1. Thimerosal
2. Yeast
3. Gelatin
4. Adjuvants

Supplementary information: The correct answer is A. Thimerosal is a mercury-containing preservative that is commonly used in some multi-dose preparations of influenza vaccine to prevent contamination with bacteria. It was previously used in many childhood vaccines but concerns about the quantity of mercury that children were being exposed to led to its removal from vaccines. However, subsequent studies found that the quantity of mercury contained in vaccines was not harmful.

29. The symptoms of mercury poisoning were proven to be different from the symptoms of autism by studies that looked at what?

1. Head size, speech patterns and coordination
2. Running speed and maximum weight lifted
3. Reading speed and the ability to answer critical thinking questions
4. Hand and foot size in relation to size of handwriting

Supplementary information: The correct answer is A. Studies looking at head size, speech patterns and coordination proved that the symptoms of mercury poisoning are different from the symptoms of autism. Additional studies replicated these findings.

30. What form of mercury is typically used in vaccines?

1. Di-ethylmercury
2. Ethylmercury
3. Methylmercury
4. Tri-methylmercury

Supplementary information: The correct answer is B. Scientific studies have shown that ethylmercury, the form of mercury in vaccines, is processed differently in the body than methylmercury, which is commonly found in the environment. For this reason, ethylmercury is much less likely to accumulate in the body and cause harm.

31. Which of the following has been found to NOT be a cause of autism?

1. Vaccines
2. Rubella
3. Thalidomide
4. Genetics

Supplementary information: The correct answer is A. Multiple well-controlled, scientific studies have found no link between vaccines and autism. However, rubella infection during pregnancy, thalidomide (a medicine previously used for morning sickness) and genetics have all been shown to potentially cause autism.

32. The MMR vaccine-autism controversy was started by a British researcher. What is one flaw found in his work?

1. False data
2. Large numbers of patients
3. It was reproducible
4. There were no flaws in the study

Supplementary information: The correct answer is A. False data was just one flaw in the report that caused the MMR vaccine-autism controversy. Many other groups tried to repeat the British researcher’s experiments, but were unable to do so. Small number of patients and lack of controls were also found to be issues. The study was subsequently retracted.

33. Which vaccine can cause a temporary decrease in the number of cells needed to stop bleeding (platelets)?

1. Rubella vaccine
2. DTaP vaccine
3. Measles vaccine
4. HPV vaccine

Supplementary information: The correct answer is C. The measles vaccine is a rare cause of thrombocytopenia, a temporary decrease in the number of cells needed to stop bleeding (platelets). However, thrombocytopenia is much more common, and can be more severe, when it occurs as a result of natural measles infection.

34. How many different antibodies can a person make?

1. Thousands
2. Hundreds of thousands
3. Millions
4. Billions

Supplementary information: The correct answer is D. Susumu Tonegawa, a Nobel Prize-winning immunologist, determined that antibodies are made by rearranging and recombining many different genes. From his work, he discovered that one person is capable of making about 10 billion different antibodies.

35. What is the name for the part of a bacteria or virus that induces an immune response?

1. Bacterial factor
2. Immunologic component
3. Modules
4. Viral factor

Supplementary information: The correct answer is B. Immunological components are the parts of bacteria and viruses that induce an immune response. Vaccines are created using these immunological components in a way that they induce an immune response without causing illness.

36. What is the total number of immunological components received in the 14 childhood vaccines that are given today?

1. About 10
2. About 150
3. About 500
4. About 1,000

Supplementary information: The correct answer is B. Children born in 1942 received four vaccines that contained more than 3,000 immunologic components. However, improvements in lab techniques have allowed scientists to use only the parts of viruses and bacteria that are needed to generate immunity. So, the 14 childhood vaccines that are given today contain only about 150 immunological components.

37. What is the number of immunological challenges a baby can handle in a given day?

1. 1,000
2. 5,000
3. 10,000
4. 15

Supplementary information: The correct answer is C. A baby can handle at least 10,000 immunological challenges on a given day, which is much less than the total number of immunological challenges provided by the 150 immunological components present in today’s 14 childhood vaccines.

38. What type of study must be performed before two vaccines can be given at the same time?

1. Dual vaccination studies
2. AddaVax studies
3. Concomitant use studies
4. Affiliated vaccination studies

Supplementary information: The correct answer is C. Concomitant use studies, as required by the Food and Drug Administration (FDA), must be performed before two vaccines are given at the same time to ensure that each vaccine does not affect the effectiveness and safety of the other.

39. Who determines if a vaccine should be added to the recommended immunization schedule?

1. The Centers for Disease Control and Prevention (CDC)
2. The American Academy of Family Physicians (AAFP)
3. The American Academy of Pediatrics (AAP)
4. All of the these

Supplementary information: The correct answer is D. Experts from the American Academy of Family Physicians (AAFP), as well as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), independently review data from scientific experiments to determine if a vaccine should be added to the recommended immunization schedule.

40. How do companies know the dose of vaccine that should be given?

1. They study different doses to determine the lowest effective dose for the target group.
2. They study different doses for the highest dose possible for the target group.
3. They use doses used for other vaccines.
4. The dose of the vaccine is chosen randomly.

Supplementary information: The correct answer is A. Studies are performed to determine the lowest dose that will still provide enough immunity to prevent illness.

41. What does an epidemiological study determine?

1. The groups of people most likely to get a disease
2. The age group most likely to get a disease
3. The number of people who get the disease and the number who die from it
4. All of the these

Supplementary information: The correct answer is D. Epidemiological studies determine who gets a disease (susceptibility), when a person gets a disease (seasonality) and the number of people who get a disease (morbidity). Epidemiological studies also determine the number of people who die from a disease (mortality).

42. After considering the health and safety of a vaccine, the Centers for Disease Control and Prevention (CDC) issues vaccine ______?

1. Requirements
2. Recommendations
3. Mandates
4. Laws

Supplementary information: The correct answer is B. Once it’s been determined that a vaccine is safe and effective, the Centers for Disease Control and Prevention (CDC) issue vaccine recommendations. These recommendations are based on what is best for the health of individuals and the community.

43. State governments make laws that determine which vaccines a child must get before entering school. These are called _______?

1. Requirements
2. Recommendations
3. Commendations
4. Proclamations

Supplementary information: The correct answer is A. Requirements are laws made by state governments that determine which vaccines a child should get before entering school. These decisions are often based not only on the health of the citizens, but also economic factors. In additions, because these requirements are made by state governments, vaccine requirements vary from one state to another.

44.  “Who gets a disease” is known as what?

1. Susceptibility
2. Seasonality
3. Morbidity
4. Mortality

Supplementary information: The correct answer is A. Not only do epidemiological studies determine when a disease occurs, they also determine susceptibility, or who gets a disease. People may be susceptible to certain diseases due to existing health conditions, lifestyle choices, or type of employment.

45. “When a person gets a disease” is known as what?

1. Susceptibility
2. Seasonality
3. Morbidity
4. Mortality

Supplementary information: The correct answer is B. Not only do epidemiological studies determine who gets a disease, they also determine whether a disease occurs in seasonal patterns. For example, rotavirus tends to start on the west coast and spreads to the east each year.

46. “The number of people who get a disease” is known as what?

1. Susceptibility
2. Seasonality
3. Morbidity
4. Mortality

Supplementary information: The correct answer is C. The number of people who become ill with a disease is known as morbidity.

47. “The number of people who die from a disease” is referred to as what?

1. Susceptibility
2. Seasonality
3. Morbidity
4. Mortality

Supplementary information: The correct answer is D. The number of people who die after getting a disease is known as mortality.

48. Why are multiple doses of some vaccines necessary?

1. The vaccine doesn’t work for all people after one dose.
2. Frequent outbreaks of disease are circulating in the community.
3. Doctors prefer to give multiple doses of those vaccines.
4. Increasing doses works the best.

Supplementary information: The correct answer is A. Because a vaccine might not work for all people after one dose, multiple doses of vaccines are sometimes necessary. If a disease is rare in a community, multiple doses of a vaccine may also be needed to enhance immunity.

49. A reason to not get a vaccine is called a (n)?

1. Contraindication
2. Precaution
3. Excuse
4. Fib

Supplementary information: The correct answer is A. Contraindications are reasons why a person should not get a vaccine. Having an allergic reaction to a previous dose of a vaccine is one example of a contraindication.

50. What are reasons to delay getting one or more doses of a vaccine?

1. Contraindications
2. Precautions
3. Excuses
4. Fibs

Supplementary information: The correct answer is B. Precautions are reasons to delay getting one or more doses of a vaccine, either because a situation might compromise a vaccine’s ability to work or there is an increased risk of experiencing a side effect. Moderate or severe illness is one example of a precaution.

51. What is a pandemic?

1. A state of confusion
2. A worldwide epidemic
3. A disease
4. A state of concentration and clarity

Supplementary information: The correct answer is B. Epidemics occur when the number of cases of a particular disease in an area exceeds what is expected. When the epidemic spreads to other countries or continents, it is called a pandemic. In 2009, the novel H1N1 strain of influenza virus emerged and caused an influenza pandemic.

52. Why are people 60 years of age and older recommended to get the shingles vaccine when most of them have had chickenpox?

1. The virus that causes chickenpox remains in the nerves and can reawaken as a person ages, causing shingles.
2. Because anyone over 60 years old can get shingles, even if they haven’t had chickenpox.
3. Because exposure to chickenpox only provides immunity during youth
4. Because shingles virus is different enough that having chickenpox previously doesn’t matter.

Supplementary information: The correct answer is A. People 60 years of age and older are recommended to receive the shingles vaccine because the virus that causes chickenpox remains in the nerves after the initial infection subsides. As a person ages and their immune system weakens, the virus can reawaken and cause shingles.

53. Out of every 100 people who get shingles, how many will get it again?

1. 0
2. 5
3. 10
4. 20

Supplementary information: The correct answer is B. Five of every 100 people who get shingles will get it for a second time. This is why even people over 60 who’ve had shingles are still recommended to get the shingles vaccine.

54. What are potential complications that could occur with chickenpox disease, but not with the chickenpox vaccine?

1. Pneumonia, encephalitis (inflammation of the brain) and bacterial infections
2. Overexposure to the active ingredient in calamine lotion
3. Weight loss associated with decreased meal consumption
4. There are no complications that could occur with chickenpox disease

Supplementary information: The correct answer is A. Being naturally infected with chickenpox is more dangerous than receiving the chickenpox vaccine because of the possible complications that can occur, including pneumonia (inflammation of the lungs), encephalitis (inflammation of the brain) and bacterial infections.

55. What does the “acellular” pertussis vaccine offer as compared to the older version, known as the “whole-cell” pertussis vaccine?

1. Lower rates of side effects and decreased immunity
2. Higher rates of side effects and increased immunity
3. Lower rates of side effects and increased immunity
4. Higher rates of side effects and decreased immunity

Supplementary information: The correct answer is A. The “whole-cell” pertussis vaccine was made in the 1920s and contained whole, killed pertussis bacteria; however, this version was also a rare cause of severe side effects, including high fever, seizures and persistent and inconsolable crying. In the 1990s, a safer pertussis vaccine, known as the “acellular” pertussis vaccine, was made by inactivating and purifying pertussis proteins. Although fewer and less severe side effects are associated with the “acellular” pertussis vaccine, the immunity provided by this vaccine wanes more quickly.

56. Why do adolescents receive the Tdap vaccine instead of the DTaP vaccine?

1. To confuse the parents of the adolescent receiving the vaccine
2. To reduce the occurrence of side effects that would typically occur in adolescents after receiving the DTaP vaccine
3. To receive more diphtheria component
4. To receive more pertussis component

Supplementary information: The correct answer is B. Side effects associated with the DTaP vaccine were more common in people 7 years of age and older. By reducing the quantity of diphtheria and pertussis components, researchers found that side effects occurred less frequently. For this reason, adolescents now receive the Tdap vaccine instead of the DTaP vaccine.

57. What is the name of the public health measure in which adults who are going to be around young infants are immunized against pertussis in order to protect the babies who are too young to be vaccinated?

1. Hovering
2. Overactive parenting
3. Cocooning
4. Swaddling

Supplementary information: The correct answer is C. Cocooning protects babies who are too young to be immunized against pertussis because it decreases the spread of the disease in the community, making it less likely that the baby will be exposed.

58. In 1916, rumors circulated that candy was the cause of what infectious disease?

1. Measles
2. Smallpox
3. Polio
4. Influenza

Supplementary information: The correct answer is C. In 1916, rumors circulated that candy caused polio. Candy was also rumored as the cause other infectious diseases, such as cerebrospinal meningitis. In fact, candy was so frequently blamed for poisonings and injuries that the National Confectioners Association thoroughly investigated almost every report on “candy poisonings”. The investigators found that out of the hundreds of reports of “candy poisonings”, very few were based upon facts.