Correct Answer: C. TT/Td
At age 10 years, a child in India is in the school-age group and falls under the school immunization programme as per IAP (Indian Academy of Pediatrics) and NTEP (National Immunization Programme) guidelines. By this age, primary immunization with BCG, DPT, and OPV has already been completed in infancy (at 6 weeks, 10 weeks, 14 weeks, and 18 months). The key vaccines given during school age (5–10 years) are TT (Tetanus Toxoid) or Td (Tetanus-diphtheria) as booster doses. In India, the school immunization programme mandates TT/Td boosters at age 5 years (school entry) and age 10 years to maintain immunity against tetanus and diphtheria. This is a booster dose, not a primary series. The TT/Td vaccine is given intramuscularly and is part of the routine school health programme conducted by ASHA workers and ANMs. By age 10, the child has already received primary DPT series and first booster (DPT booster at 18 months), so TT/Td is the appropriate vaccine for this age group in the school setting.
Why the other options are wrong
A. BCG — BCG is given at birth or within the first 2 weeks of life as part of the primary immunization schedule. By age 10 years, BCG has already been administered and provides lifelong immunity against tuberculosis. Revaccination is not recommended in India's NTEP guidelines. This is a trap for students who confuse primary immunization with school-age booster schedules. B. MMR — MMR (Measles, Mumps, Rubella) is not part of the routine NTEP/IAP immunization schedule in India for school-age children, though it may be given in private practice. The routine vaccine for measles is MR (Measles-Rubella) given at 9–12 months and 16–24 months. MMR is not a government-mandated school vaccine in India. This option exploits confusion between private and public immunization schedules. D. DPT — DPT (Diphtheria-Pertussis-Tetanus) is given in the primary series at 6, 10, 14 weeks and booster at 18 months. By age 10 years, the DPT series is complete. The school-age booster is TT or Td (without pertussis component), not full DPT, because pertussis immunity wanes and acellular pertussis is not routinely boosted in school-age children in India's NTEP. This is a common trap confusing primary DPT with school-age TT/Td boosters.
High-Yield Facts
- School immunization programme (age 5–10 years): TT/Td booster doses are mandatory; BCG, DPT, and OPV are already completed in infancy.
- TT/Td schedule: First booster at school entry (5 years), second booster at age 10 years; subsequent boosters every 10 years until age 50 (as per NTEP).
- NTEP vs. IAP: NTEP (government) uses TT; IAP (private) may recommend Td (diphtheria-tetanus without pertussis) for school-age boosters.
- Pertussis immunity: Wanes by age 5–7 years; school-age boosters do not include pertussis component in India's routine schedule.
- BCG revaccination: Not recommended in India even if tuberculin test is negative; single dose at birth provides lifelong protection.
Mnemonics
School Vaccines = TT/Td Only By school age (5–10 years), all primary vaccines (BCG, DPT, OPV) are done. School programme = TT/Td boosters only. Remember: 'School = Tetanus Booster.' DPT → TT/Td Transition DPT (infancy) → TT/Td (school age). Pertussis wanes; no booster needed. Diphtheria and tetanus need lifelong boosters every 10 years.
NBE Trap
NBE exploits confusion between primary immunization schedule (infancy) and school immunization programme (5–10 years). Students who memorize only the primary DPT series may incorrectly select DPT, forgetting that school-age boosters exclude pertussis and use TT/Td instead.
Clinical Pearl
In Indian schools, ASHA workers administer TT/Td boosters during school health camps at age 5 and 10 years. A 10-year-old presenting to a clinic should have received TT/Td at school entry; if not, it must be given immediately to prevent tetanus and diphtheria in case of injury or wound exposure.
_Reference: Park's Textbook of Preventive and Social Medicine (NTEP/IAP Immunization Schedule); IAP Blue Book on Immunization_