# Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners. A 12-year-old boy in Grade 7 has a complete infant immunization record under the National Immunization Program (NIP), including all of his measles-containing vaccine doses. He also received school-based vaccines in Grade 1. Under the school-based immunization program, which vaccines should he receive this school year?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629438  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The school nurse of a public school that serves Grades 1 to 10 provides health appraisal, screening, and health education for the learners.

A 12-year-old boy in Grade 7 has a complete infant immunization record under the National Immunization Program (NIP), including all of his measles-containing vaccine doses. He also received school-based vaccines in Grade 1. Under the school-based immunization program, which vaccines should he receive this school year?

## 보기

1. Tetanus-diphtheria vaccine only, as his measles doses are complete
2. Human papillomavirus and tetanus-diphtheria vaccines
3. Measles-rubella and tetanus-diphtheria vaccines **✔ 정답**
4. Measles-rubella, tetanus-diphtheria, and human papillomavirus vaccines

**정답: 3**

## 해설

School-based immunization gives measles-rubella (MR) and tetanus-diphtheria (Td) vaccines in Grade 1 and again in Grade 7. These doses are part of the program even when the infant and Grade 1 doses are complete. Human papillomavirus (HPV) vaccine is given to girls in Grade 4.

## 심화 해설

Understanding the school-based schedule

The Grade 7 visit is not a “catch-up only” visit. In the school-based immunization program, measles-rubella (MR) and tetanus-diphtheria (Td) vaccines are scheduled again in Grade 7, even when the child completed the infant series and received the Grade 1 school doses. A complete infant measles-containing vaccine record therefore does not remove the Grade 7 MR dose, because the school program uses a two-dose school-based strategy at Grade 1 and Grade 7 to maintain population immunity and protect against rubella in both sexes.

The Grade 7 school-based doses are part of the routine schedule, not replacements for missed infant doses. This is why option 1, which gives only Td, is incomplete: the boy still needs the scheduled MR dose in Grade 7.

Why HPV is not given to this learner

Human papillomavirus (HPV) vaccine is part of school-based immunization, but it is directed to girls in Grade 4 in this program. The learner is a 12-year-old boy in Grade 7, so HPV vaccine is not indicated for him under this school-based schedule. Options 2 and 4 include HPV and are therefore incorrect.

The evidence supports that HPV school-based programs are often sex-specific and grade-specific. In the Palau program, HPV vaccination was delivered to girls beginning in 5th grade through schools [1]. Policy analyses of HPV vaccination across countries also show that school-based delivery is commonly targeted by sex and grade, with girls prioritized in the initial rollout [2]. These sources reinforce the principle that HPV vaccine is not automatically given to every Grade 7 learner; eligibility depends on the specific school program’s sex and grade criteria.

Applying the school schedule to this learner

For a Grade 7 boy with complete infant immunizations and prior Grade 1 school doses, the correct school-based vaccines this year are MR and Td. The school record should be checked to confirm the Grade 1 doses, but the Grade 7 doses are still due because they are scheduled independently of the infant series.

| Vaccine | Grade 1 | Grade 7 | Key point |
| --- | --- | --- | --- |
| Measles-rubella (MR) | Given | Given again | Scheduled even with complete infant measles doses |
| Tetanus-diphtheria (Td) | Given | Given again | Booster dose in Grade 7 |
| Human papillomavirus (HPV) | Not given | Not for boys in this program | Given to girls in Grade 4 |

Watch out! A complete infant immunization record can mislead you into thinking the school doses are optional. The Grade 7 MR and Td doses are still required because they are part of the school-based schedule, not a catch-up for missed infant doses.

Key point! HPV vaccine is not given to this Grade 7 boy. The school-based HPV dose is for girls in Grade 4, so any option containing HPV is incorrect for this learner.

Why school-based delivery matters

School-based immunization programs are designed to reach large cohorts at predictable ages, which improves coverage and reduces missed opportunities. The hepatitis B school program in Ontario showed high uptake when immunization was offered at school clinics, with 90% of eligible students immunized at the school clinic and an additional 4% at community catch-up clinics . This illustrates why school-based doses such as Grade 7 MR and Td are scheduled even for children with complete infant records: the school visit is a reliable point of contact for maintaining immunity across the population.

For this learner, the Grade 7 visit provides the scheduled MR and Td doses. The HPV vaccine is not part of his school-based schedule because it is directed to girls in Grade 4 in this program.References (research sources)

- [1]Investigating HPV Vaccination in the Republic of Palau: Assessment of the School-Based Program from 2020 to 2024.Research articleDecherong LK, Basilius MB, Cash McGinley HL, Kern-Allely S. (2026) · DOI: 10.62547/nnih2392

- [2]A Comparative Policy Analysis of HPV Vaccination Guidelines: Actors, Context, Content, and Process Across Eight Countries.GuidelineKyei GK, Zhang L. (2026) · DOI: 10.1111/jnu.70131

## 임상 시나리오

Grade 7 School-Based ImmunizationMR and Td boosters are routine, not catch-up
In the school-based immunization program, measles-rubella (MR) and tetanus-diphtheria (Td) vaccines are scheduled in Grade 1 and again in Grade 7. A complete infant record does not remove the Grade 7 MR dose because the school program uses a two-dose school-based strategy to maintain population immunity and protect against rubella in both sexes.

Human papillomavirus (HPV) vaccine is given to girls in Grade 4 in this program. A 12-year-old boy in Grade 7 is not eligible for HPV under this schedule.

CautionDo not treat the Grade 7 visit as catch-up only. Omitting MR because infant doses are complete will leave the learner without the scheduled school-based booster.

## 핵심 개념

- **School-based immunization** — A program delivering vaccines at schools to reach children and adolescents at scheduled grade levels.
- **Measles-rubella (MR) vaccine** — A combined live attenuated vaccine protecting against measles and rubella; given in Grade 1 and Grade 7 in the school program.
- **Tetanus-diphtheria (Td) vaccine** — A booster vaccine against tetanus and diphtheria; given in Grade 1 and Grade 7 in the school program.
- **Human papillomavirus (HPV) vaccine** — A vaccine preventing HPV-related cancers; in this school program it is directed to girls in Grade 4.
- **National Immunization Program (NIP)** — A country's routine immunization schedule for infants, children, and adolescents.

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