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Tetanus,
which is now rare in the developed world, can cause severe illness around the time of delivery in pregnant women and is usually fatal when it occurs in the newborn infant.
At the end of the 1980s, the
World
Health Organization
(WHO) estimated that 6.5
cases of tetanus occurred for every 1,000 live infants born
worldwide and called for its elimination. Tetanus is
preventable by vaccination of mothers either before or
during pregnancy because tetanus antibodies are transferred
very efficiently from mother to fetus and prevent the
newborn from acquiring the infection during non-sterile
delivery. Tetanus vaccination also has been shown to be safe
in pregnancy. Through an initiative of immunizing pregnant
women against tetanus in the developing world, the WHO
successfully reduced the number of countries where newborn
tetanus affects greater than one infant per 1,000 born to 49
by 2005.
In the developed world, tetanus
vaccination is recommended every 10 years after the primary
childhood vaccination. Pregnant women who have not been vaccinated
within the previous 10 years or whose status is not certain should
be immunized, and this is most commonly administered in a combined
vaccine with diphtheria toxoid (Td) vaccine. In 2006, a new vaccine
containing tetanus, diphtheria toxoid and acellular pertussis
(Tdap)
was
licensed for use in adolescents and adults. Current CDC recommendations are that this vaccine is preferred in women of child-bearing age who are not pregnant. It should also be
administered after delivery to all women who have received their
last dose of tetanus toxoid-containing vaccine two or more years
previously.
Inactivated influenza (TIV) Vaccine (the “flu shot”) is recommended for all women who will be pregnant during the influenza season (October through March). This
recommendation is based on reports that pregnant women have
significantly higher rates of severe illness and death than the
remainder of the population and are likely to be in contact with
children of school age who often infect them with influenza virus.
During
the influenza pandemics of 1918 and 1957, influenza-related
complications affected as many as 50 percent of women infected with
the virus. Vaccination has the benefit of preventing illness in
pregnancy but may also have the advantage of providing young infants
(for whom no vaccine is available but who are likely to need
admission to hospital if infected) with protective antibodies
against influenza. During the 1950s and 1960s, TIV was administered
to 2,291 pregnant women. No adverse effects from vaccination were
seen when mothers and infants were followed for the subsequent 7
years. Because it is a live virus vaccine, the nasal influenza
vaccine (LAIV) is not recommended in pregnancy.
 
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