5. Objectives of Maternal Vaccination
Protects both the mother and fetus from the morbidity
Provide the infant passive protection
Passive immunity by trans-placental transfer of antibodies
Vaccinating pregnant women in third trimester for influenza
63% decreased incidence of lab-confirmed influenza in infant
Decreased respiratory illness 36% within first 6 months of life
Zaman K et al, 2008
6. Vaccine recommendations in Pregnancy
by ACIP(Advisory committee on immunization practice)
Vaccines
Recommended
Consider if otherwise indicated
Recommended to avoid
ACIP:
7. Types of Immunization
Live vaccines (Varicella, MMR, Zoster, LAIV)
Potential for infecting fetus
No harm ever reported
Discouraged unless at high risk for exposure and suboptimal
morbidity/mortality from infection
If pregnancy occurs within 4 weeks of immunization
Counsel woman on theoretical risk
Termination : Not indicated
8. Types of Immunization
Toxoids, inactivated vaccines, immune globulin preparations
Considered safe
Wait until 2nd trimester (except flu)
Fetal development
Adverse first trimester events (miscarriage, birth defects)
9. Vaccine General Recommendation for Use in Pregnant Women
Hepatitis A Recommended if otherwise indicated.
Hepatitis B Recommended in some circumstances.
Human Papillomavirus (HPV) Not recommended.
Influenza (Inactivated) Recommended.
Influenza (LAIV) Contraindicated.
MMR Contraindicated.
MCV4 (MenACWY) May be used if otherwise indicated.
PCV13 Inadequate data for specific recommendation.
PPSV23 Inadequate data for specific recommendation.
Polio May be used if needed.
Td Should be used if otherwise indicated.
Tdap Recommended.
Varicella Contraindicated.
Zoster Contraindicated.
Guidelines for Vaccinating Pregnant Women by CDC
10. Timing of maternal immunization
Pre-conception counseling on immunizations is ideal
Prenatal counseling
High risk of exposure
Infection would be hazardous to mother or fetus
Immunizing agent if benign
13. Preconception vaccination
MMR
Measles
More serious measles infection, higher risk of complications
Preterm birth, low birth weight, and miscarriage
no definite evidence of a higher rate of birth defects among offspring
of infected gravida
Mumps
Miscarriage and fetal death in first trimester
Endocardial fibroelastosis
14. Preconception vaccination
Rubella
Miscarriage and fetal death
Congenital rubella syndrome
hearing loss, cataracts, cardiac abnormalities, bone lesions, growth
restriction, and neurologic abnormalities including intellectual
disability
Document immunity via IgG
15. Preconception vaccination
Varicella
congenital varicella syndrome
limb hypoplasia, microcephaly, dermal scarring, ocular defects
2 percent of fetuses infected in first 20 weeks of gestation
9 cases : 20 and 28 weeks of gestation
In utero exposure to maternal varicella
Herpes zoster in infancy or early childhood
16. Antenatal vaccination
Benefits to both mother and fetus should outweigh the risks
Live vaccines should be avoided during pregnancy
Minimize their risk of exposure to infections
avoiding travel to high risk locations
Household members are immunized
Maintaining good hygienic practices
17. Tetanus
Infection caused by ClostridiumTetani. Found in soil, dust, and animal feces
Enters in body by puncture wounds, splinters, insect bites, burns etc.
Causes uncontrollable muscle spasms, Bacteria binds to motor nerve, spinal
cord and brain stem leading to lock jaw, coma and DEATH!!!
18. Tetanus Vaccine
Vaccine given to infants at 2 months, 4 months, and 6 months.
Children get a booster at 4 or 5 years of age prior to school.
Additional booster given at age 12.This should be aTdap.
Continued boosters every 10 years or every 5 year if puncture
wound/burn
19. Antenatal vaccination
Pertussis
Bordetella pertussis.
Life threatening to newborns and infants
May start as a runny nose, low grade fever or cough.
Immunity wanes and disease is increasing
House members can transmit, especially mothers (50%)
Tdap during each pregnancy, optimally between 27 and 36 weeks of
gestation
20. Recommendation of Tdap
No, incomplete, or unknown immunization against tetanus and diphtheria
Start or complete the series at 0, 4 weeks and 6-12months
A dose ofTdap should replace one of theTd doses
Between 27 and 36 weeks of gestation.
Td immunization complete and up to date
Tdap at 27 to 36 weeks of gestation
More than 5 or 10 years since lastTd booster
Tdap at 27 to 36 weeks of gestation
21. Antenatal vaccination
Influenza
Serious morbidity / mortality in pregnant and postpartum women
Vaccination
Reduce risk of medical and pregnancy complication
Provides passive protection to the neonate
Inactivated influenza vaccine in October or the first half of November
Regardless of gestational age
22. Selective immunization of high risk groups
Occupation, habits, travel plans, or the area in which they reside
No immunization is more harmful than the disease
23. Hepatitis B
selective immunization
Recombinant vaccine
Complete a series
High risk women
Sexually active individuals and/or partner
Intravenous drug users
Healthcare workers
Having a hepatitis B Ag-positive sex partner
24. Hepatitis A
selective immunization
Preterm delivery
In utero infection
Meconium peritonitis, fetal ascites, and polyhydramnios
Can give passive immunization with immune globulin for postexposure
prophylaxis
25. Other disease
selective immunization
Pnemococcus : Give after 1st trimester
Yellow fever : mosquito-borne viral hemorrhagic fever
South America and sub-Saharan Africa
Avoid travel
Yellow fever vaccine can cause serious adverse effects in the mother
Poliovirus
Haemophilus influenza: Give for prior splenectomy
Meningococcal
26. Other diseases
selective immunization
Typhoid:Travel
Small pox: Live virus vaccine
Not recommended
Rabies
Give if exposed
Cholera, plague, Japanese encephalitis
Give if high risk of exposure
Tuberculosis
Not recommended
27. Postpartum vaccination
Both inactivated and live vaccines( except smallpox and yellow fever) are
safe for lactating mothers
Two vaccines that should be given before discharge to protect mother and
newborn
MMR
Varicella
Tdap
28. Summary and Recommendation
Nonpregnant women of childbearing age who may become pregnant
Clinically indicated immunizations at least one month prior to
conception
Before administering any vaccine,
if she is pregnant or could become pregnant in the next four weeks and
counseling her about the potential risks of vaccination during pregnancy
or just before conception.
During influenza season
Influenza vaccination regardless of trimester of pregnancy
29. Summary and Recommendation
Pregnant women should minimize their risk of exposure to infections
Avoiding travel to high risk locations
Immunization of household members
Maintaining good hygienic
Pregnancy within 1month of immunization with the live vaccine
Termination of pregnancy for this indication is unwarranted.
Toxoids, inactivated virus vaccines, or immune globulin preparations
Conception
30. Summary and Recommendation
MMR and varicella vaccines
Postpartum women who are breastfeeding
Tdap
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine
All pregnant women in each pregnancy between 27 and 36 weeks of
gestation
Passive immunity 2 to 6 months
