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Tetanus, which is now uncommon 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 the preferred
choice 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 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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