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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 susceptible 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 illness allows
the newborn infant at risk of HBV to receive birth doses of
HBV vaccine and immune globulin.
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 strongly considered in
unvaccinated pregnant women for whom the risk of
meningococcal disease is high. These include:
-
people living where there is a
meningococcus outbreak
-
college students, 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 renal 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 may 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. 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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