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| 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 47thNational 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.
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| 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)
[1] https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html
[2] http://www.uptodate.com/contents/vaccination-during-pregnancy-beyond-the-basics
