Maternal vaccines uptake during pregnancy remains low despite years of efforts.

 

courtesy istock. 

The development of new vaccines and the safety data now available for old vaccines ensures that more and more patients should receive the required vaccination in pregnancy. This is important in disease prevention and transfer of passive immunity to the unborn child.

The uptake of two commonly recommended influenza and the tetanus-diphtheria-acellular pertussis (Tdap) vaccine remains low despite being advised since years. The most recent national data was presented at 47^thNational Immunization Conference (NIC) hosted by CDC in Atlanta, Georgia.

The data showed that Tdap vaccination coverage is only 10% in pregnancy while the influenza vaccination rate among pregnant women is about 50%, with 14% of women being vaccinated in the 6 months before pregnancy and 36% during pregnancy.

In a survey sent out by Sean O’Leary, MD, of the department of pediatrics, section of infectious diseases, at the University of Colorado, Denver and his colleagues, it was seen that only 75% of gynecologists routinely administered the Tdap vaccine, and 85% routinely administered the influenza vaccine to their pregnant patients.

Reimbursement-related issues topped the list of barriers, while lack of time during the antenatal visits, refusal by the patients and inability to maintain the stock of vaccines were other issues.

Dr O’Leary  said “Immunization delivery in the ob.gyn. setting may present different challenges than more traditional settings for adult vaccination, such as family medicine or internal medicine offices.”

Vaccines recommended for all pregnant women

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommends a dose of Tdap during each pregnancy, irrespective of the patient’s prior history of receiving Tdap. Optimal timing for Tdap administration is between 27 weeks and 36 weeks of gestation to maximize the maternal antibody response and passive neonatal transfer.

Influenza vaccination is recommended if patient is pregnant during the flu season.

courtesy: shot of prevention 

Vaccines recommended for selected pregnant women who are at risk or  traveling to high risk areas.

Hepatitis A: The vaccine carries no known risks to the developing fetus.  

Hepatitis B: vaccine can be given in pregnancy in some circumstances. Limited data suggest that developing fetuses are not at risk for adverse events when hepatitis B vaccine is administered to pregnant women. [1]

Pneumococcus: safe if given in second and third trimester.[2]

General principles of Immunization in Pregnancy

The ACOG recommends routine assessment of immunization status of all pregnant women and administration of indicated vaccines.

Robust data and growing body of evidence demonstrate that administering inactivated virus or bacterial vaccines or toxoids is safe during pregnancy.

Live attenuated vaccines (eg, measles-mumps-rubella [MMR], varicella, and live attenuated influenza vaccine) do pose a theoretical risk (although never documented or proved) to the fetus and generally should be avoided during pregnancy.

Women who have inadvertently received immunization with live or live-attenuated vaccines during pregnancy should not be counselled to terminate the pregnancy because of a teratogenic risk.

Women who are breastfeeding can still be immunized (passive-active immunization, live or killed vaccines)

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[1] https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html

[2] http://www.uptodate.com/contents/vaccination-during-pregnancy-beyond-the-basics