all vaccines recommended in pregnancy

2. VACCINATION
S IN
PREGNANCY
-DR.DIVYA JAIN
CHOITHRAM HOSPITAL
INDORE.

3. WHAT IS VACCINE????????
 A vaccine is a substance that is introduced
into the body to prevent Infection or a
certain pathogen
 The vaccines are prepared from
inactivated, live attenuated , modified or
mutant forms of the causative agents.
3
Dr.ShashwatK.Jani.9909944160

4. OBJECTIVE
Dr.ShashwatK.Jani.9909944160
4
 To induce a state of
immunity in the
patient so that
confrontation with
offending organism
can be successful in
protecting the host.

6. Achievements:
The biggest achievement of the immunization
program is the eradication of small pox.
India is free of Poliomyelitis caused by Wild Polio
Virus (WPV) on 27 march 2014.
India declared free of maternal and neonatal TT
in June 2015
Besides, vaccination has contributed
significantly to the decline in the cases and deaths
due to the Vaccine Preventable Diseases (VPDs).

7. Adult immunization rates have
fallen short of national goals,
partly because of
misconceptions about the safety
and benefits of current
vaccines.

8.  The danger of these misconceptions
is magnified during pregnancy,
when:
1. Concerned physicians are hesitant
to administer vaccines and
2. Patients are reluctant to accept
them.

9. The administration of vaccines
during pregnancy poses a
number of concerns about the
risk of transmitting a virus to a
developing fetus.

10.  The risk of transmitting a
virus to a developing fetus
is primarily
Theoretical

11. Theoretic risks of
vaccination must be
weighed against the risks
of the disease to mother
and fetus.

12. MAJOR CONTENT OF VACCINES
1. Toxoids
2. Inactivated vaccines.
3. Attenuated vaccines
4. Subunit vaccines
5. Hyper immune globulins.

13.  Routine vaccines that generally
are safe during pregnancy
include-
1. Tetanus
2. Influenza
3. Hepatitis B
4. Meningococcal
5. Rabies

14. SPECIAL CONSIDERATIONS
1. Pneumococcal vaccine
2. Typhoid
3. Cholera
4. Hepatitis A
5. Yellow fever
6. Japanese encephalitis
7. Polio

15.  Vaccines that are contraindicated live
attenuated vaccine include:
1. Measles, Mumps, and Rubella;
2. Varicella
3. (BCG) bacille Calmette-Guérin
4. Oral Polio

16. If a live-virus vaccine is inadvertently
given to a pregnant woman, or if a
woman becomes pregnant within
four weeks after vaccination,
she should be counseled
about potential effects on the fetus.

17. INFLUENZA

18. INFLUENZA
The influenza vaccine is a
killed virus preparation with
an annually adjusted
antigenic makeup.

19. INFLUENZA
It should be administered
annually between October
and December to high-risk
patients.

20. INFLUENZA
The vaccine should be
administered to all pregnant
women who will be in the second
or third trimester of pregnancy
during the influenza season

21. INFLUENZA
Women in their second or third
trimesters have higher morbidity, from
influenza infection.
Immunization should be avoided in most
patients during the first trimester to avoid
a coincidental association with
spontaneous abortion, which is common in
the first trimester.

22. INFLUENZA VACCINE
 Trivalent inactivated influenza vaccine (TIV),live attenuated
influenza vaccine (LAIV),recombinant quadrivalent vaccines
are available in India.
 TIV is annual, single IM dose of 0.5 ml.also known as flu
shot(H1N1,H3N2,influenza B)
 LAIV is administered by the intranasal route is approved
for use in adults upto 50 years of age. Evidence recommends
people at high risk for influenza related complication.
 Recombinant quadrivalent vaccine is given, intradermal 0.5
ml single dose.saftey in pregnancy is under trial.
08/20/17VSGH

23. RABIES

25. Three forms of inactivated rabies
vaccines are available, all considered
equally safe and efficacious

26. RABIES
Passive immunization is achieved through
administration of human rabies immune
globulin (HRIG).
 20 IU per kg of HRIG is given at the wound
site.
There have been no identified associations
between rabies vaccination and fetal
abnormalities

27. ACTIVE IMMUNISATION
Cell-culture vaccine is used for post-
exposure prophylaxis in pregnancy.
A five-dose i.m. regimen is recommended
for post-exposure vaccination
It is administered on days 0, 3, 7, 14 and
28 into the deltoid muscle.

28. PRE-EXPOSURE PROPHYLAXIS
 Indications for pre-exposure immunization
depend on the likelihood of exposure.
 It may be considered in animal workers and
travelers to enzootic areas who anticipate animal
exposure.
 3 intramuscular 0.1ml dose of cell-culture-based
vaccine given on days 0, 7 and 21 or 28

29. TETANUS

30. Tetanus toxoid is
routinely recommended
for susceptible
pregnant women.

31. While no evidence exists to prove
that tetanus toxoid is teratogenic,
waiting until the
second trimester of pregnancy to
administer toxoids is a
reasonable precaution,
minimizing any concern about
the theoretic possibility of such
reactions.

32. WHO NEEDS THE TETANUS
VACCINE?
Previously vaccinated pregnant
women who have not received a
Td vaccination within the past 3
years should receive a booster
dose.

33. WHO NEEDS THE TETANUS AND
DIPHTHERIA VACCINE?
 According to CDC guidelines :
1ST
dose between 16 -20 weeks &
2nd
dose after 4 – 6 weeks .
Previously vaccinated pregnant women
who have not received a Td vaccination within
the past 3 years should receive a booster dose.
33
Dr.ShashwatK.Jani.9909944160

34. In INDIA :
Where tetanus infection is common
in neonates and Antenatal visits
are not regular in rural areas…
Govt. Of India Guidelines :
1st
dose at 1st
ANC visit &
2nd
after 4-6 weeks.
34
Dr.ShashwatK.Jani.9909944160

35. HEPATITIS B

36. HEPATITIS B
Risk factors for a pregnant woman
include:
1. Having multiple sexual partners,
2. Abusing intravenous drugs,
3. Having occupational exposure
4. Being a household contact of acutely
infected persons or persons with a
chronic carrier state.

37. HEPATITIS B
Because it contains noninfectious
hepatitis B surface antigen
particles and it cause no risk to
the fetus, neither pregnancy nor
lactation is a contraindication to
vaccination.

38.  20mcg is administered at 0, 1 and 6
months as an intramuscular injection in
the deltoid
 Antibody titres rise 20 to 30% after the
first dose, 75 to 80% after 2nd dose and 90
to 95% after 3rd dose.

39. HEPATITIS A
 A formaldehyde inactivated vaccine prepared
from HAV grown in Diploid cells.
 1ml im at 0,6 months
 A vaccination is effective for 10 years
 Advised mainly in persons entering endemic
areas with HAV Infection.

40. COMBINED VACCINATION
FOR HEPATITIS A AND B
INFECTIONS.
Now a combined vaccine is available for
prevention of Hepatitis A and B
Available as
TWINRIX ( GSK )
0.5ml im in 3 doses of 0,1,6months.

41. OTHER
VACCINATIONS

42. MENINGOCOCCAL
 Vaccination may benefit travelers to areas in which N.
meningitidis is endemic or epidemic
 3 types of vaccines-(polysachharide/protein/conjugate based)
 Only polysachharide vaccine safe in pregnancy
 85% efficacy
 0.5ml,im,single dose.
 Offers protection for 3 years

43. PNEUMOCOCCAL VACCINE
 A polyvalent polysaccharide containing capsular
antigen with 23 Sero types
 Gives 80 -90 % protection
 Used in
Dysfunctional spleen
Sickle cell diseases,
Chronic diseases of Liver, lungs, heart,
Renal failure.
HIV infection
 0.5ml im single dose.

44. TYPHOID
 3types of vaccines are available-
1)Vi polysaccharide vaccine-im
2)Ty21a-oral
3)Inactivated vaccine
 Only inactivated vaccine can be given in
pregnancy
 0.5ml,subcutaneous,6weeks apart
 ACOG recommends vaccine only when-
1)Travelling to endemic area
2)Close contact

45. YELLOW FEVER
 Inactivated vaccine
 0.5ml,im,single dose.
 Offers life long immunity.
 99% efficacy.
 ACOG recommends vaccine only in people
travelling to endemic areas.

46. JAPANESE ENCEPHALITIS
 A vero cell derived inactivated vaccine of SA14-
14-2 strain-
0.5ml,im,2 doses 4weeks apart
75%efficacy
Offers protection for 1 year
 A vero cell derived vaccine of beijing strain-
0.5ml,im,3 doses 4 weeks apart
95% efficacy.offers protection for 3 years

47. CHOLERA
 Killed bacterial vaccine
 0.5ml,im,2 doses,4weeks apart
 ACOG recommends vaccine to be given in only in
outbreaks.
 Risk to foetus is unknown
 Maternal vaccine increases IgA titres in
breastmilk

48. POLIO
• Inactivated
vaccine(salk)
• 0.5ml,im
• 3 doses at 0,4,6
months
• Recommended only in
outbreaks

49. IMMUNOGLOBULINS
Recommended for post-exposure
prophlyaxis in -
oHepatitis A
oHepatitis B
oVaricella zooster
oTetanus
oMeasles
oRabies

50.  Hepatitis A-
-within 14 days
-0.02ml/kg body weight,single dose
-90% efficacy
 Hepatitis B-
-Within 12hours of exposure
-0.05ml/kg body weight,repeat after 1 month
-For newborn-0.5 ml
-92% efficacy

51.  Varicella zooster Ig-
-within 72hours
-5ml,im,single dose
 Measles-
-Within 4 hours
0.25ml/kg body weight,im

54. The benefits of
immunization to the
pregnant woman and her
neonate usually outweigh
the theoretic risks of
adverse effects.

55. Preconceptional
immunization of pregnant
women to prevent disease in
the offspring is preferred to
vaccination of pregnant
women.

56. Whether live or inactivated
vaccines are used, vaccination of
pregnant women should be
considered on the basis of
the risk of the vaccination vs.
the benefits of protection in a
particular circumstance.

57. SPECIAL THANKS