Vaccinations before, during and after pregnancy.

Prenatal screening

Women who are planning to become pregnant should make sure that they are up to date on their immunizations. This will protect them and the unborn child from many diseases.

The measles, mumps, rubella, and chickenpox (varicella) vaccines are particularly important for women of childbearing age, as these cannot be given when pregnant. If a woman is infected with any of this in pregnancy, particularly first trimester, it results in adverse pregnancy outcome. 

Patients should check with their physician, who can request a blood test to see the blood levels of antibodies against these viruses, because of prior vaccination or prior history of disease itself.

MMR- If you need to get the vaccine for Rubella, avoid getting pregnant for at least a month after receiving the MMR.

Varicella- Similarly, if you are not immune to chickenpox, get vaccinated at least a month before getting pregnant.

HPV Vaccine- The human papillomavirus (HPV) vaccine is recommended for nonpregnant girls and women 9 to 26 years of age. It is contraindicated during pregnancy, although evidence suggests it is safe if pregnant women receive it inadvertently.

Hepatitis B- A woman should get tested for anti-HBs before she is pregnant to see whether the vaccine was well taken and she is immune to infection.

Vaccines during pregnancy

The tetanus, diphtheria, acellular pertussis (Tdap) vaccine is recommended for every pregnant woman during each pregnancy. It should be given as early as possible between 27 and 36 weeks of gestation, to facilitate the passive transfer of maternal antibodies. Infants exposed in utero to Tdap vaccine were better protected against pertussis during the first year of life than infants not exposed in utero.

Influenza (flu)- Every pregnant woman who is pregnant around the influenza season should be vaccinated against the seasonal flu as she is at high risk for developing flu complications. The vaccine has no adverse effect on fetus, on the contrary the unborn baby is protected against flu for first 6 months of life, till the baby is eligible to receive the vaccine.

The nasal spray influenza vaccine is contraindicated as it is made of live virus.

Vaccines for special circumstances

Hepatitis A- Pregnant woman who is at risk for developing Hepatitis A should receive the vaccine as the virus can be passed on to fetus.

Hepatitis B- It is only recommended for pregnant women who are at high risk for developing the infection like unimmunized women who live with someone infected with hepatitis B and for completing the series if started before becoming pregnant.

Poliomyelitis- Although polio has been eradicated from most developed and some developing countries, polio vaccine is usually not given in pregnancy unless travel to an area where polio is prevalent is unavoidable. In such circumstances, she may receive the inactivated polio vaccine (IPV). 

Pneumococcus- Ideally the vaccine is given before pregnancy, but  if woman is at high risk for pneumococcal infection, the vaccine appears to be safe if given in second and third trimester.

Varicella- Because the effects of the varicella virus on the fetus are unknown, it is contraindicated in pregnant women.

Vaccines for travel

Yellow fever- May be given if benefit outweigh risk. 

BCG- contraindicated

Typhoid- Inadequate data to make any recommendations

Rabies – Pregnancy is not considered a contraindication for post-exposure prophylaxis. If risk of exposure is substantially high, pre-exposure prophylaxis could be considered.

Passive Immunization during pregnancy

No known risk exists for the fetus from passive immunization of pregnant women with immune globulin preparations.

Prenatal screening

Every Pregnant woman should be tested for immunity to rubella and varicella and be tested for the presence of HBsAg during every pregnancy. Women who are found susceptible to rubella and varicella should be vaccinated immediately after delivery.

If a woman is found to be HBsAg positive, the infant should receive HBIG and begins the hepatitis B vaccine series no later than 12 hours after birth.

Breastfeeding and vaccines.

Inactivated and live-virus vaccines are not contraindicated in pregnant woman, although the virus can replicate in mother, it is not excreted in human milk.

Small pox and yellow fever vaccines are contraindicated in lactating mother, although if travel to an area where Yellow fever is endemic is imminent, it can be given. 

Source: CDC Guidelines for Vaccinating Pregnant Women

FDA approves Roche’s COBAS HPV Test for use with SurePath Preservative Fluid.

  

The SurePath kit for collecting and transporting the cervical specimens.  

Clinical pearls:

• HPV testing can now be performed on samples collected for liquid based pap test in the BD SurePath preservation fluid using the SurePath vial. 
• Before the approval, healthcare providers have to collect two different samples in two different collecting fluids according to the specification of the testing labs.
• It is not approved as a first line primary screening test.

The U.S. FDA today approved the Roche COBAS test as the first test for Human Papilloma Virus(HPV) from cervical samples collected for Pap Test in BD SurePath Preservative fluid.[1]

COBAS HPV test is a qualitative in vitro test for the detection of Human Papillomavirus in patient specimens. The test utilizes amplification of target DNA by the Polymerase Chain Reaction (PCR) and nucleic acid hybridization for the detection of 14 high-risk (HR) HPV types in a single analysis.

BD SurePath is a liquid based pap test and the test pack includes collection kit, along with storage and transportation components with a vial of preservative liquid.

Some other properties of BD SurePath liquid-based Pap test are ease of transportation, have less than 24% Ethanol which results in immediate and complete cell fixation, preserving the morphology. It also has the ability to preserve the sample for 4 weeks at room temperature, 6 weeks refrigerated.[2]    

The kit comes with specific instructions on how to collect samples to minimize the risks of false negative results.

Till date FDA has not approved any HPV test that can be used with the preservation liquids. Healthcare providers have to collect two different samples, in two different collecting fluids before the announcement was made.

Now, a single sample collected can be used for carrying out both the tests. The test has been approved in women 21 years and more, and helps to determine additional follow-up and diagnostic procedures after ASC-US (Atypical Squamous Cells of Undetermined Significance) Pap cytology results. It has also been approved for use is patients 30 years and older as a primary screening test for HPV along with pap cytology. It detects 14 high-risk HPV types, including HPV 16 and 18, which are responsible for causing 70% of cervical cancer worldwide.

According to the National Cancer Institute, there will be an estimated 12,990 new cases and 4,120 deaths from cervical cancer in the United States during 2016.[3]

"Many labs have a preference in how samples are collected for processing, and this additional approval gives them another clinically validated option for the Cobas HPV test," Uwe Oberlaender, head of Roche Molecular Diagnostics, said in a statement.

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[1] http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm510251.htm

[2] http://www.bd.com/tripath/products/outside_us/outside_us_sp.asp

[3] http://www.cancer.gov/types/cervical/hp