VACCINATIONS IN PREGNANCY BY DR SHASHWAT JANI

VACCINATIONS IN
PREGNANCY
Dr SHASHWAT JANI
M.S. ( OBS - GYN ).
Diploma in Advanced Endoscopy.
Assistant Professor, Sheth V. S. General hospital.
Smt. N.H.L. Municipal Medical College,
Ahmedabad.
Mobile : +91 99099 44160.
E- mail : drshashwatjani@gmail.com
Dr. Shashwat K. Jani. 99099 44160 1

OBJECTIVE
 To induce a state
of immunity in the
patient so that
confrontation with
offending organism
can be successful
in protecting the
host.

 The vaccines are prepared from
inactivated, live attenuated , modified or
mutant forms of the causative agents.
 Live vaccines induce prompt but
transient production of Abs. while
Inactivated vaccines and Toxoids
produce a less complete response and
several doses are required.

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

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

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

The risk of transmitting
a virus to a developing
fetus is
Primarily
Theoretical…!!!

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

IImmmmuunniizzaattiioonn dduurriinngg
bbrreeaassttffeeeeddiinngg iiss ssaaffee
Physicians should reassure their
patients that
NO vaccines are
contraindicated
during breastfeeding.

Routine vaccines that generally are
Safe during pregnancy include:
1.Diphtheria 5.Meningococcal
2.Tetanus 6. Rabies.
3.Influenza
4.Hepatitis B.

Vaccines that are contraindicated
Live virus vaccine include:,
1.Measles, Mumps, and Rubella ( MMR )
2.Varicella
3.(BCG) Bacille Calmette-Guérin
4.Yellow vaccine
5.Polio.
BBeeccaauussee ooff tthhee tthheeoorreettiicc rriisskk ))
((ooff ffeettaall ttrraannssmmiissssiioonn

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.

Measles,
Mumps,
Rubella.

Measles
( Rubi virus)
Typically presents with:
1.Fever, red eyes
2.Coryza )inflammation of mucosal mem.
Lining the nasal cavity(
3.Generally ill appearance, and
4.maculopapular rash start at face to
chest

Measles
 Risk from disease to pregnant woman:
Causes significant morbidity and low
mortality
 Risk from disease to fetus or neonate:
Sign. Increase in abortion rate
May cause fetal malformation

Measles
 Mortality occurs in
1-2 per 1,000 cases
often secondary to
pneumonia or
encephalitis.

Mumps
 Mumps results from infection with
the paramyxovirus and can lead to
parotitis, meningoencephalitis, and
orchitis.
 Neurologic complications such as
deafness, can also occur as a result
of mumps infection.

Mumps
- Contraindicated because it’s a live
attenuated vaccine, carrying a risk of
causing the mump infection
- Can cause early miscarriage or birth
defects
- Most common birth defect is - deafness

Rubella
( Toga virus )
Crosses the placenta barrier and
cause congenital rubella
syndrome.
It can cause 20% spontaneous
abortion in the 1st trimester.

Congenital Rubella syndrome
Can result in defects such as:
* Malformations of the heart (especially PDA), eyes
or brain
* Deafness
* Spleen, liver or bone marrow problems (some of
which may disappear shortly after birth)
* Mental retardation
* Small head size (microcephaly)
* Eye defects - cataracts
* Low birth weight
* Hepatomegaly.

 Measles, mumps, and rubella
vaccine should not be given
to pregnant women, because
of potential adverse effects on
the fetus.
But
should be vaccinated post partum.

Polio
 RNA Enterovirus with three different strains
that cause disease.
 Exposure may result in asymptomatic
infection as well as non paralytic and paralytic
disease.
 Asymptomatic patients can transmit the
disease to susceptible persons.

Polio
 The disease continues to be a
problem worldwide, but all
recent domestic polio cases
have been caused by the
strains of virus found in the
oral polio vaccine (OPV).

Polio
 This situation has resulted in a
change in the recommendation for
use of inactivated polio vaccine (IPV),
instead of OPV or a combination of
OPV-IPV for all routine vaccinations.
 IPV is inactivated by formaldehyde,
and its use has eliminated vaccine-associated
polio infection.

Polio
 Although no adverse effects
have been documented with
OPV or IPV in pregnant
women or their fetuses, both
vaccines should be avoided
during pregnancy on a
theoretic basis.

Polio
 The CDC states that IPV may
be administered in
accordance with the
recommended schedules for
adults if a pregnant woman is
at increased risk for infection
and requires immediate
protection against polio.

YELLOW FEVER
 Yellow fever is a viral hemorrhagic
fever syndrome spread by
mosquitoes in parts of South
America and Africa.
 The yellow fever vaccine is a live,
attenuated virus grown in chick
embryos.

YELLOW FEVER
 It is indicated for use in
laboratory workers
involved with the virus and
in persons planning to
travel to endemic areas.

YELLOW FEVER
 No specific evidence is available to
demonstrate the safety of yellow
fever immunization during pregnancy.
 Since theoretic concerns of fetal
infection exist, however, vaccination
is generally not recommended during
pregnancy.

YELLOW FEVER
When travel cannot be
postponed and mosquito
exposure is likely,
Yellow fever vaccination
may be considered.

Inactivated vaccines:
Inactivated Viral Vac. Inactivated bacteria Vac.
- Influenza -Cholera
- Rabies -Typhoid
- Hepatitis B -pneumococcus

Influenza
 Fever, malaise, myalgia, and
upper respiratory tract
symptoms or infections
characterize influenza infection.
 Most severe complications are
the result of pneumonia
secondary to influenza infection.

Influenza
 The influenza vaccine is
a killed virus preparation
with an annually
adjusted antigenic
makeup.

Influenza
It should be
administered annually
between October and
December to high-risk
patients.

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.

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.
Dr. Shashwat K. Jani. 99099 44160
36

RABIES
 Rabies is a viral infection transmitted most
commonly by the saliva of infected animals.
 Nonspecific prodromal symptoms progress
to encephalitis marked by confusion,
hallucinations.
Dr. Shashwat K. Jani. 99099 44160
37

RABIES
 Dysregulation of the autonomic nervous
system and involvement of the brainstem
and cranial nerves lead to the classic
"foaming at the mouth" appearance.
 Three forms of inactivated rabies
vaccines are available, all considered
equally safe and efficacious.

RABIES
 Passive immunization is achieved
through administration of human
rabies immune globulin (HRIG).
 It may be considered in animal
workers and travelers to enzootic
areas who anticipate animal
exposure.

RABIES
 In patients who have not been immunized
previously, 20 IU per kg of HRIG is given at
the wound site for high-risk bites or if testing
is positive.
 Patients with previous vaccinations do not
need HRIG but do require revaccination on a
modified schedule.
 There have been no identified associations
between rabies vaccination and fetal
abnormalities

Hepatitis B
Transmitted through:
1.Contact with infected blood,
2.Sexual activity, and
3.Sharing of intravenous needles.

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

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.

TYPHOID
 Transmission of Salmonella
typhi is significantly increased
with travel during epidemics
and ingestion of food from
street vendors.

TYPHOID
 The two types of typhoid vaccination in use
today are a live attenuated oral vaccine and
a parenteral polysaccharide vaccine.
 Both forms require that immunization be
completed at least two weeks before
exposure.

TYPHOID
 Neither form of
typhoid vaccine is
officially
recommended during
pregnancy.

CHOLERA
 Two improved oral vaccines are available :
1. a killed, whole cell recombinant vaccine and
2. a live, attenuated strain.
 Both are more effective, better tolerated, and
longer lasting than the parenteral vaccine.
TThheessee mmaayy bbee ccoonnssiiddeerreedd ffoorr uussee iinn
ppooppuullaattiioonnss aatt iimmmmeeddiiaattee rriisskk ooff aa cchhoolleerraa
eeppiiddeemmiicc oorr ffoorr ttrraavveelleerrss ttoo aarreeaass ooff hhiigghh
eennddeemmiicciittyy..

CHOLERA
 No specific information exists on the
safety of parenteral cholera vaccination
during pregnancy.
 Because cholera during pregnancy is a
serious illness, exposure should be
minimized during pregnancy whenever
possible.

Pneumococcal
 Risk factors for pneumococcal
infection in pregnant women
include
1. Diabetes,
2. Cardiovascular disease,
3. Immunodeficiency,
4. Asthma.

Pneumococcal
 The current vaccine includes
purified capsular
polysaccharide.
 women at high risk should be
given this vaccination before,
but not during, pregnancy.

Pneumococcal
 The safety of the vaccine
during pregnancy has not
been evaluated, although no
adverse outcomes have been
reported among newborns
whose mothers were
inadvertently vaccinated.

ImG vaccines
 Specific Immune globulins
vaccine:
Hepatitis B
Rabies
Tetanus
Varicella

Varicella
( Chicken Pox )
 Varicella vaccination is a live attenuated
virus and is contraindicated during
pregnancy.
 Women who are vaccinated should avoid
becoming pregnant for one month following
each injection.
 The presence of pregnant household
members does not constitute a
contraindication to vaccination of others
within the house.

Adverse effects:
- Characterized by limb
atrophy and scarring of
the skin of the extremity,
known as congenital
varicella syndrome.
- Other manifestations
include central nervous
system and eye
abnormalities.
- Increase mortality in
neonates.

Varicella immunoglobulin
indicated:
 If a susceptible pregnant woman is exposed to
varicella, however, administration of varicella-zoster
immune globulin should be strongly
considered
 Indicated also for newborns of mothers who
developed varicella within 4 days prior to delivery
or 2 days following delivery.
 Approx. 90-95% of adults are immune
 Not indicated for prevention of congenital varicella.

Tetanus and
Diphtheria

 Diphtheria is an infection of the nasal,
pharyngeal, laryngeal, or other mucous
membranes that can cause neuritis,
myocarditis, thrombocytopenia, and
ascending paralysis.
 Tetanus infection can cause
production of a neurotoxin, leading
to tetanic muscle contractions.

 While no evidence exists to prove
that tetanus and diphtheria toxoids
are 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.

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 10 years should receive a
booster dose.
O.5 ml Intramuscular in upper arm

Tetanus and Diphtheria
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.

Other Vaccinations . .
.

HPV VACCINE
 Not recommended for use in pregnancy.
 If patient becomes pregnant - Delay remaining
doses till delivery.
 If vaccinated during pregnancy - No intervention
(MTP) needed.
 Lactating women can receive the HPV vaccine
(Gardasil) and still continue breastfeeding as it
is a vaccine without live viral DNA.
( FOGSI Recommendations: Pregnancy & Lactation.)

Hepatitis A
 Administration of immune globulin
is strongly recommended which is
considered safe during pregnancy
and is more than 85 % effective in
preventing acute hepatitis

Meningococcal
 Studies have shown that the
meningococcal vaccine is safe
and efficacious when given to
pregnant women

BCG VACCINE
 BCG (Bacille Calmette-Guérin) vaccine is a live
vaccine derived from a strain of Mycobacterium
bovis.
 Use of the BCG vaccine is NOT recommended
during pregnancy.
 Pre conceptional immunization of pregnant
women to prevent disease in the offspring is
preferred to vaccination of pregnant women.

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