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Vaccination
in
pregnancy is recommended against certain infections when the
risk to the pregnant woman and/or her fetus of acquiring the
infection is high. In such cases, vaccines are administered
after the first trimester when possible.
Hepatitis B vaccine is
recommended for everyone under the age of 18 and for
unvaccinated or incompletely vaccinated women who have risk
factors for getting hepatitis B virus (HBV) infection. HBV during pregnancy may lead to severe illness
in both mother and fetus and ultimately is likely to cause
severe chronic illness in the newborn. All pregnant women
should undergo screening for HBV at the first antenatal
visit. Women who do not have immunity to HBV and who have a
risk factor for acquiring HBV should be vaccinated.
Risk factors for acquiring HBV
infection include:
-
Close contact with HBV carriers
(for example household or sexual contact)
-
Being in a special patient risk
group (for example those having hemodialysis)
-
Infection with another sexually
transmitted disease
-
Being in prison
-
Being an intravenous drug user
-
Travel to areas of the world where
the infection is endemic
Screening for
this infection allows the newborn infant at risk of HBV to receive
birth doses of HBV vaccine and hepatitis B immune globulin (HBIG).
Meningococcal vaccine is
recommended for pregnant women who are at increased risk of getting
meningococcal disease. The available meningococcal vaccines licensed
for use in adults (meningococcal polysaccharide vaccine [MPSV4] and
meningococcal conjugate vaccine [MCV4]) protect against 4 types of
meningococcal disease: types A, C, Y and W135. Two of these types (C
and Y) cause more than two-thirds of all cases in women of
child-bearing age in the United States. These vaccines are not
recommended routinely for pregnant women but should be given
in unvaccinated pregnant women for whom the risk of
meningococcal disease is high. These include:
-
people living where there is a
meningococcus outbreak
-
college freshmen, especially those who will live in dormitories
-
military recruits
-
people traveling to parts of the
world where meningococcal disease is common
-
microbiologists who could be
exposed to meningococcus
-
people who have damaged spleens or
have had their spleens removed
-
people with certain immune
deficiencies
Two
published studies of MPS4 vaccine in pregnant women demonstrated it
was safe and stimulated the production of antibodies that were
transferred to newborn infants. No studies of MCV4 have been
performed in pregnant women.
Pneumococcal polysaccharide vaccine
(PPV23) protects against twenty three types of
pneumococcal disease. This vaccine is different from the
pneumococcal conjugate vaccine (PCV7) recommended for
children. PPV23 is recommended for women of child-bearing
age who are at increased risk of getting pneumococcal
disease, including those who:
-
have damaged spleens or have had
their spleens removed
-
have certain cardiac, respiratory, metabolic and kidney diseases
-
have certain immune system
deficiencies
-
take medications that depress the
immune system.
In
general, this vaccine is best administered before pregnancy
occurs, but if a pregnant woman with risk factors has not
received it, it should be administered during pregnancy.
Studies of PPV23 have shown that it is safe and stimulates
the production of antibodies in pregnancy.
Hepatitis A
vaccine
is indicated for pregnant women who are at increased risk of
acquiring hepatitis A virus (HAV) because HAV infection in
pregnancy can be severe and cause spontaneous abortion or
premature delivery of the infant.
Examples of pregnant women at increased risk of HAV include
those who have:
-
Household or occupational exposure
to a person infected with HAV
-
Traveled to an area where HAV is
endemic
Pregnant
women exposed to hepatitis A also should receive immunoglobulin
(purified antibodies given by injection into the muscle). The safety
of hepatitis A vaccine in pregnancy has not been studied; because it
is made from an inactivated virus the theoretical risk to the fetus
is very small and should be weighed against the risks to mother and
fetus of acquiring HAV infection.
Inactivated
poliovirus vaccine is
recommended for pregnant women traveling to areas of the
world where polio infection still occurs (for example,
certain countries in Africa). Because polio has been eradicated from the developed world, it is not administered routinely during pregnancy. The oral poliovirus vaccine (OPV) that contains
live, attenuated poliovirus is not recommended for use in
pregnancy.
Rabies vaccine
is
recommended for pregnant women who have been exposed to
rabies because the consequences of inadequately treated
rabies exposure far outweigh any theoretical risk from the
vaccine. There is no indication that rabies vaccine is
associated with fetal abnormality. When the risk that a
pregnant woman will be exposed to rabies is high, rabies
vaccine can be administered.
Anthrax vaccine
has
been given inadvertently to pregnant women who subsequently
had normal infants, but no studies have been published on
the use of this vaccine in pregnancy. The CDC recommends
this vaccine only be administered to pregnant women when the
risks of acquiring anthrax are far greater than the
theoretical risks of the vaccine (for example exposure to
aerosolized anthrax).
Japanese encephalitis vaccine
should be administered only to
pregnant women who must travel to an area where Japanese
encephalitis is endemic and the risks of exposure outweigh
the theoretical risk of vaccination.
 
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