power point presentation

1. Immunisation during Pregnancy
and
post partum period
Dr Shivamurthy H M ,Prof in OBGYN
Dr Aishwarya Hitii, Dr Deepa,
Dr Divya , Dr Hima, Dr Shama, Dr Swarali
S N Medical College, Bagalkot,
Karnataka , India

2. Contents
• Introduction
• What is immunisation, types of immunisation.
• Type of vaccines.
• Scenario of immunisation during pregnancy.
• Problems met with for immunisation during pregnancy , how to over come.
• Brief historical about vaccine development
• Vaccines safe and unsafe in in pregnancy
• Individual vaccines
• ACOG guidelines for vaccinmation during pregnancy
• Travellers immunisation
• Likely future vaccine developments
• Conclusion

3. Introduction
• Maternal immunization provides important health benefits to both pregnant
women and to their fetus.
• Vaccine-preventable diseases cause significant morbidity and mortality
among maternal, neonatal, and young infant.
• Some infections are so serious even they can waste pregnancy, harm her
baby during pregnancy or after delivery.
• These complications can be prevented by vaccination.

4. Introduction contd...
• At present Fetus getting any risk after vaccination of the mother during
pregnancy primarily is theoretical.
• Globally, no scientific study exists which shows the risk for fetus after
vaccination of pregnant women with inactivated vaccines or bacterial
vaccines or toxoids.
• Even live vaccines causing risk to fetus is theoretical.

5. Introduction contd
• Benefits of vaccinating pregnant women usually outweigh potential
risks, when the likelihood of disease exposure is high, when infection
would pose a risk to the mother or fetus, and when the vaccine is
unlikely to cause harm.
• How ever not all vaccinations are safe during pregnancy but some of
inactivated vaccines are considered safe which can be give to
pregnant women who might be at risk of infection.

6. 1 What is immunisation ?
 Immunisation is process to induce a state of immunity in the
patient so that confrontation with offending organism can be
successful in protecting the host.
 Live vaccines induce prompt but transient production of Antibodies.
while Inactivated vaccines and Toxoids produce a less complete
response and several doses are required.

7. Types of immunisation
•Active by vaccination
•Passive by immunoglobulins

8. 3 Types of vaccines
• Bacterial
• Viral
• Live attinuated ( contraindiacated in pregnany)
• Killed

9. The scenario of Vaccination
• Despite the evidence of gains from immunisation programmes there is resistance
to vaccines in some groups.
• 1970s and 1980s showed increasing litigation and decreased profitability for
vaccine manufacture.
• The decline was arrested in part by the implementation of the National Vaccine
Injury Compensation programme in the US in 1986.
• 90s era lived on supply crises and continued media efforts by a growing
• anti-vaccination lobby.
• The past two decades have seen the application of molecular genetics and its
increased insights into immunology, microbiology and genomics applied to
vaccinology.

10. The current scenario in Vaccination
Currently there is successes in the development of
• Recombinant Hepatitis B vaccines,
• the less reactogenic acellular pertussis vaccine,
• and new techniques for seasonal influenza vaccine
Molecular genetics has a bright future for vaccinology.

11. 5 What are problems in immunisation in pregnancy ?
• Adult immunization rates have fallen short of national goals, partly
because of misconceptions about the safety and benefits of current
vaccines.
• The danger of these misconceptions is magnified during pregnancy,
when: 1.Concerned physicians are hesitant to administer vaccines.
• Patients are reluctant to accept them.
• The vaccination during pregnancy poses a number of concerns about
the risk of transmitting a virus to a developing fetus.

12. How to overcome these Problems contd Shama
 The risk of transmitting a virus to a developing fetus is Primarily
Theoretical…!!!
 Theoretic risks of vaccination must be weighed against the risks of
the disease to mother and fetus.
• Immunization durring breast feeding is safe
• Physicians should reassure their patients that NO vaccines are
contraindicated during breastfeeding.

13. 6 How a vaccine is it produced ?
• The vaccines are prepared from inactivated, live attenuated,
modified or mutant forms of the causative agents.

14. 4 Historical about immunization
• The practice of immunisation dates back hundreds of years.
• In 17th century, a China Buddhist monks drank snake venom to confer
immunity to snake bite
• Variolation done by smearing of a skin tear with cowpox to confer immunity
to smallpox was practiced
• 1796. Edward Jenner is considered the founder of vaccinology in and
demonstrated immunity to smallpox.
• In 1798, the first smallpox vaccine was developed.
• 1890 and 1950, saw bacterial vaccine development, including BCG
vaccination, which is still in use today.

15. 4 Historical about pregnancy immunization
• 1897 and 1904 Louis Pasteur developed live attenuated cholera vaccine and inactivated
anthrax vaccine in humans .
• 19th Century Plague vaccine was also invented
• 1923, Alexander Glenny found inactivation of Tetanus toxin with formaldehyde.
• 1926.The same method was used to develop a vaccine against Diphtheria
• 1948 Pertussis vaccine development took long time vaccine first licensed for use
in the US

16. 4 Historical about immunization
• 1950-1985 Polio Viral tissue culture methods were developed and led to the advent
of the Salk (inactivated) polio vaccine and the Sabin (live attenuated oral) polio
vaccine.
• 18th and 19th centuries, systematic implementation of mass smallpox immunisation
culminated in its global eradication in 1979.
• Mass polio immunisation has now eradicated the disease from many regions around
the world
• Progess of polio elimination 1988 and 2014 (CDC)
• Attenuated strains of measles, mumps and rubella were developed for inclusion in
vaccines. Measles is currently the next possible target for elimination via vaccination.

17. 8 What are the vaccines safe during pregnancy
1.Diphtheria
2.Meningococcal
3.Tetanus
4.Rabies.
5.Influenza
6 Hepatitis B.

18. 9 What are the vaccines unsafe during pregnancy
Because of the the theoretic risk of fetal transmission,thses vaccines are
contraindiacted during pregnancy
1 .Measles, Mumps, and Rubella ( MMR )
2 .Varicella
3. (BCG) Bacille Calmette-Guérin
4. Yellow vaccine
5. Polio.
But If a live-virus vaccine is inadvertently given to a pregnant woman, or if a
woman becomes pregnant within four weeks after vaccination, she should be
counseled about potential effects on the fetus.

19. INDIVIDUAL VACCINES
The disease
The transmission
Its effect
Vaccination status

20. M M R VACCINE

21. 11 Measles
Measles is a Rubi virus Typically presents with:
• 1.Fever, red eyes
• 2.Coryza )inflammation of mucosal mem. Lining the nasal cavity
• 3.Generally ill appearance,
• 4.maculopapular rash start at face to chest

22. 11 Measles contd
• May cause fetal malformation Sign.
 Increase in abortion rate
 Risk from disease to fetus or neonate:
 Causes significant morbidity and low mortality
 Risk from disease to pregnant woman:
• Mortality occurs in 1-2 per 1,000 cases often secondary to pneumonia or
encephalitis.
• Neurologic complications such as deafness, can also occur as a result of
mumps infection.

23. 12 Mumps
• Caused by paramyxovirus and can lead to parotitis,
meningoencephalitis, and orchitis
• Mumps vaccine - Contraindicated because it’s a live attenuated
vaccine, carrying a risk of causing the mump infection
• Can cause early miscarriage or birth defects
• Most common birth defect is - deafness

24. 14 Rubella
• virus Crosses the placenta barrier.
• It can cause 20% spontaneous abortion in the 1st trimester.
Can result in defects such as: Congenital Rubella syndrome
• Malformations of the heart (especially PDA), eyes or brain
and Deafness

25. 14 Rubella Contd
• Hepato-speenomegaly and bone marrow problems (some of which
may disappear shortly after birth)
• Mental retardation
• Small head size (microcephaly)
• Eye defects - cataracts
• Low birth weight
• Hepatomegaly

26. M M R vaccine is contraindicated in pregnancy
Need to be given before pregnancy

27. 15 Polio
 Poliomyelitis seen in susceptible persons.
 The disease continues to be a problem worldwide, but all
recent domestic polio cases have been caused by the strains
of virus found in the oral polio vaccine (OPV).
 IPV is inactivated by formaldehyde, and its use has eliminated
vaccine-associated polio infection.

28. 15 Polio contd
 This situation has resulted in a change in the recommendation for use of
inactivated polio vaccine (IPV), instead of OPV or a combination of OPV-
IPV for all routine vaccinations.
 Although no adverse effects have been documented with OPV or IPV in
pregnant women or their fetuses, both vaccines should be avoided during
pregnancy on a theoretic basis.
 The CDC states that IPV may be administered in accordance with the
recommended schedules for adults if a pregnant woman is at increased
risk for infection and requires immediate protection against polio.

29. 16 Yellow fever
 It is a live, attenuated virus grown in chick embryos.
 Yellow fever is a viral hemorrhagic fever syndrome spread by
mosquitoes in parts of South America and Africa.
 It is indicated for use in laboratory workers involved with the virus
and in persons planning to travel to endemic areas.

30. 16 Yellow fever contd...
 Since theoretic concerns of fetal infection exist, however, vaccination is
generally not recommended during pregnancy.
 No specific evidence is available to demonstrate the safety of yellow
fever immunization during pregnancy.
 When travel cannot be postponed and mosquito exposure is likely,
Yellow fever vaccination may be considered.

31. 17 Influenza
 Most severe complications are the result of pneumonia secondary
to influenza infection.
 Fever, malaise, myalgia, and upper respiratory tract symptoms or
infections characterize influenza infection.
 The influenza vaccine is a killed virus preparation with an annually
adjusted antigenic makeup.
• Influenza It should be administered annually between October and
December to high-risk patients

32. 17 Influenza contd
 Nonspecific prodromal symptoms progress to encephalitis marked
by confusion, hallucinations
 The vaccine should be administered to all pregnant women who will
be in the second or third trimester of pregnancy during the influenza
season
 Immunization should be avoided in most patients during the first
trimester to avoid a coincidental association with spontaneous
abortion, which is common in the first trimester.
 Women in their second or third trimesters have higher morbidity,
from influenza infection.

33. 18 Rabies
 Rabis is a viral infection transmitted most commonly by the saliva of
infected animals.
 Three forms of inactivated rabies vaccines are available, all
considered equally safe and efficacious
 Dysregulation of the autonomic nervous system and involvement of
the brainstem and cranial nerves lead to the classic "foaming at the
mouth" appearance.
 It may be considered in animal workers and travelers to enzootic
areas who anticipate animal exposure

34. 18 Rabies contd
 Passive immunization is achieved through administration of human
rabies immune globulin (HRIG).
 There have been no identified associations between rabies vaccination
and fetal abnormalities
 Patients with previous vaccinations do not need HRIG but do require
revaccination on a modified schedule.
 In patients who have not been immunized previously, 20 IU/ kg of HRIG
is given at the wound site for high-risk bites or if testing is positive.

35. 19 Hepatitis A Immunoglobulins
Hep A Transmitted through:
1.Contact with infected blood,
2 .Sexual activity,
3.Sharing of intravenous needles
Hep A Ig- Administration of is strongly recommended which is
considered safe during pregnancy and is more than 85 %
effective in preventing acute hepatitis

36. 20 Hep B...
• Hepatitis B Risk factors for a pregnant woman include:
1. Having multiple sexual partners,
2. Using or abusing intravenous drugs,
3. Having occupational exposure,
4. Being a household contact of acutely infected persons or persons with a
chronic carrier state.
• Because it contains non-infectious hepatitis B surface antigen particles and
cause no risk to the fetus, vaccine is given during pregnancy and lactation

37. 21 Salmonella
 Transmission of Salmonella typhi is significantly increased with
travel during epidemics and ingestion of food from street vendors.
 The two types of typhoid vaccination in use today are a live
attenuated oral vaccine and a parenteral polysaccharide vaccine.
 Immunisation be completed at least two weeks before exposure.

38. 21 Salmonella
 These maybe considered for use in populations at immediate risk of a
cholera epidemic or fo travellersto areas of high endemicity
 Two improved oral vaccines are available :
1 a killed, whole cell recombinant vaccine
2 a live, attenuated strain.
• Both are more effective, better tolerated, and longer lasting than the parenteral
vaccine.
• Neither form of typhoid vaccine is officially recommended
during pregnancy

39. 22 Cholera
 Because cholera during pregnancy is a serious illness,
exposure should be minimized during pregnancy whenever
possible.
 No specific information exists on the safety of parenteral
cholera vaccination during pregnancy.

40. 23 Pneumococcal
• Risk factors for pneumococcal infection in pregnant women include
1. Diabetes, 2. Cardiovascular disease, 3. Immunodeficiency, 4. Asthma.
• The current vaccine includes purified capsular polysaccharide.
• The safety of the vaccine during pregnancy has not been evaluated, although no
adverse outcomes have been reported among newborns whose mothers were
inadvertently vaccinated.
• Women at high risk should be given this vaccination
before pregnancy but not during, pregnancy.

41. COVID VACCINATION DURING PREGNANCY 2021
PREGNANNT WOMEN ARE ELIGIBLE FOR 2 DOSES OF COVID -19 VACCINES ANY
TIME DURING PREGNANCY
Ministry of Health and Family Welfare
Pregnant Women now eligible for COVID-19 Vaccination
Ministry of Health and Family Welfare has accepted the recommendations of NTAGI
Pregnant women may now register on CoWIN or walk-in to the nearest COVID
Vaccination Centre (CVC) to get themselves vaccinated
Operational Guideline for vaccinating pregnant women, Counselling Kit for Medical
Officers and FLWs, and IEC material for general public shared with States/UTs for its
implementation

42. Can you get a COVID-19 vaccine with other vaccines ?
• The CDC is learning more about how safe and effective the COVID-
19 vaccine is when it’s given at the same time as other vaccines, such
as the flu or Tdap vaccine.
The CDC currently recommends:
• That you wait at least 14 days after getting the COVID-19 vaccine to
get any other vaccine.
• That you wait at least 14 days before getting a COVID-19 vaccine
after getting other vaccines.
• That you complete your vaccinations on schedule even if you’ve
gotten a COVID-19 vaccine.

43. Q Word of caution during immunisation for household members
• The household members of pregnant lady does not constitute a
contraindication to vaccination of others within the house.
 Women who are vaccinated should avoid becoming pregnant for one
month following each injection.
 Varicella vaccination is a live attenuated virus and is contraindicated
during pregnancy.

44. 24 Passive Immunisation (Specific Immune globulins)
 Varicella
 Tetanus
 Rabies
 Hepatitis B

45. 26 Varicella
• Approx. 90-95% of adults are already immune to Varicella by early exposure.
• But if infected it causes congenital varicella syndrome. Charectorised by by limb
atrophy and scarring of the skin of the extremity,
• Other manifestations include CNS and eye abnormalities.
• Increase Neonatal mortality
• Varicella immunoglobulin Indicated for newborns of mothers who developed
varicella within 4 days prior to delivery or 2 days following delivery.
 If a susceptible pregnant woman is exposed to varicella, however, administration of
varicella immune globulin should be strongly considered

46. 27 Tetanus Toxoid
• Tetanus infection can cause production of a neurotoxin, leading
to tetanic muscle contractions.
• Where tetanus infection is common in neonates and Antenatal
visits are not regular in rural areas.
• 1st dose at 1st ANC visit
• 2nd after 4-6 weeks

47. 28 Tetanus and Diphtheria (td)
 Diphtheria is an infection of the nasal, pharyngeal, laryngeal, or
other mucous membranes that can cause neuritis, myocarditis,
thrombocytopenia, and ascending paralysis.
• While no evidence exists to prove that Tetanus and Diphtheria
Toxoids are teratogenic, waiting until the second trimester of
pregnancy to administer toxoids is a reasonable precaution,
minimizing any concern about the theoretic possibility of such
reactions.

48. 28 Tetanus and Diphtheria contd
• According to CDC Td guidelines :
• For who need the Tetanus and Diphtheria vaccine
• Dose O.5 ml Intramuscular in upper arm
1ST dose between 16 -20 weeks
2nd dose after 4 – 6 weeks .
• Previously vaccinated pregnant women who have not received a Td
vaccination within the past 10 years should receive a booster dose.

49. 29 HPV ( FOGSI Recommendations)
During pregnancy
 If vaccinated during pregnancy - No intervention (MTP) needed.
 If patient becomes pregnant - Delay remaining doses till delivery.
 Not recommended for use in pregnancy
Lactating women
• can receive the HPV vaccine (Gardasil) and still continue
breastfeeding as it is a vaccine without live viral DNA.

50. 30 Meningococcus
 Studies have shown that the meningococcal vaccine is safe
and efficacious when given to pregnant women
 Pre conceptional immunization of pregnant women to prevent
disease in the offspring is preferred to vaccination of pregnant
women.

51. 31 BCG
 BCG (Bacille Calmette-Guérin) vaccine is a live vaccine derived
from a strain of Mycobacterium bovis
 Use of the BCG vaccine is NOT recommended during pregnancy.

52. Active immunisation by vaccination
Vaccine
(Agent)
Risk of
disease on
Pregnancy
Foetal Risk
from disease
Type of
vaccine
Risk from
vaccine
itself to
foetus
Indiacated during
Pregnancy / not
Dose Comments
Measles
Significant
Morbidity
Low Mortality
Disease
Course is not
altered by
Pregnancy
Abortion Live
attinuted
Vaccine
None Contraindicated 1 Dose S c
Vaccine Is
Given Post
Natally.
Can Give
During Breast
Feeding
Mumps Low
morbidity
Not altered by
pregnancy
Abortion Live
attenuated
None Contraindicated 1 dose sc Vaccine given
in postpartum
ACOG Guidelines immunisation in pregnancy (2003)

53. Vaccine
(Agent)
Risk of
disease on
Pregnancy
Foetal Risk
from disease
Type of vaccine Risk
from
vaccine
itself to
foetus
Indiacated during
Pregnancy / not
Dose Comments
Poliomyelitis Severe if
occurs
Anoxic fetal
damage:
50% mortality
in neonatal
Live attenuated None Not routinely
recommended except
women at increased
risk of exposure
Primary-
2doses of
enhanced
potency
inactivated
virus sc at 4-
8week intervals
and third dose
6-12months
after the 2nd
dose
Vaccine
indicated for
susceptible
pregnant
women
traveling in
endemic areas
or in other high
risk situation
Rubella
Low
moribidity:not
altered by
pregnancy
High rate of
abortion and
congenital rubella
Syndrome
Live attenuated
None Contraindicated Single dose sc
Teratogenicity of
vaccine is
theoretical and
not confirmed to
date: can be
given postpartum
ACOG Guidelines immunisation in pregnancy (2003)

54. Vaccine
(Agent)
Risk of disease
on Pregnancy
Foetal Risk
from disease
Type of vaccine Risk from
vaccine itself
to foetus
Indiacated during
Pregnancy / not
Dose Comments
Yellow fever Significant
morbidity
and
mortality
Unknown Live
attenuated
Unknown Contraindicated
Single
dose sc
Postponeme
nt of travel
preferable
to
vaccination
Varicella Possible
increase in
severe
pneumonia
Can cause
congenital
varicella in
2% of fetuses
infected
during the
second
trimester
Live
attenuated
None Contraindicated 2doses
needed with
second
given 4-8
weeks after
1st dose
Teratogenicit
y of vaccine
is theoretic,
vaccines
given in
postpartum
ACOG Guidelines immunisation in pregnancy (2003)

55. Vaccine
(Agent)
Risk of disease
on Pregnancy
Foetal Risk
from disease
Type of vaccine Risk from
vaccine itself
to foetus
Indiacated during
Pregnancy / not
Dose Comments
Yellow fever Significant
morbidity
and
mortality
Unknown Live
attenuated
Unknown Contraindicated
Single
dose sc
Postponeme
nt of travel
preferable
to
vaccination
Varicella Possible
increase in
severe
pneumonia
Can cause
congenital
varicella in
2% of fetuses
infected
during the
second
trimester
Live
attenuated
None Contraindicated 2doses
needed with
second
given 4-8
weeks after
1st dose
Teratogenicit
y of vaccine
is theoretic,
vaccines
given in
postpartum
ACOG Guidelines immunisation in pregnancy (2003)

56. Vaccine
(Agent)
Risk of
disease on
Pregnancy
Foetal Risk
from
disease
Type of
vaccine
Risk from
vaccine itself
to foetus
Indiacated
during
Pregnancy
/not
Dose Comments
Influenza Increase in
morbidity
and
mortality
during
epidemic
Abortion Inactivated
vaccine
None Women at
high risk for
pulmonary
complication
1dose IM
every year
Rabies Near 100%
fatality: not
altered by
pregnancy
Determined
by maternal
disease
Killed virus
vaccine
Unknown Indications
for
prophylaxis
not altered
by
pregnancy
ACOG Guidelines immunisation in pregnancy (2003)

57. Agent
Vaccine
Risk of
disease on
Pregnancy
Foetal Risk
from disease
Type of
vaccine
Risk from
vaccine
itself to
foetus
Indiacated
during
Pregnancy /not
Dose Comments
HEPATITIS B Possible
increased
severity during
3rd trimester
Abortion
Preterm birth
Neonatal
hepatitis
Purified surface
antigen produced
by recombinant
techonology
None Pre exposure and
post exposure for
women at risk of
infection
3 doses
im 0,1 and
6months
Used with hepatitis
b immune globulin
for some
exposures:
exposed newborn
needs birth dose
vaccination
And
Immunoglobulins
ACOG Guidelines immunisation in pregnancy (2003)

58. Govt Of India
Immunisation
During pregnancy

59. When to give Dose Route Site
Vaccine Early In Pregnancy 0.5 ml I M Upper Arm
T T - 2 4 Weeks After T T -1 0.5 ml I M Upper Arm
T T
BOOSTER
DOSE
If Received 2 T T Doses
In A Pregnancy With In
Last 3 Years
0.5 ml I M Upper Arm
T T Immunisation during pregnancy Govt of India
• GIVE T T-2 OR Booster doses before 36 weeks of pregnancy
• How ever give these even if more than 36 weeks have passed.
• Give TT to a woman in labour , if she has not taken previously

60. Vaccination during pregnancy fogsi recommendation 2020
• Live vaccines are generally contraindicated in pregnancy
• These include MMR, Varicella and BCG vaccine
• Although HPV vaccine is “subunit vaccine” (virus-like particles- VLP), its safety has
not been evaluated in pregnancy and is therefore withheld
• If a woman falls pregnant before completing the HPV vaccination regime, the
remaining vaccine should be delayed till postpartum.
• Yellow fever vaccine is an exception, although it is a live attenuated vaccine
It should be given only under supervision by the infectious disease specialist
• Toxoids, immunoglobulins and inactivated vaccines can safely be given in
pregnancy because there is no evidence of harm to the unborn fetus.
• However, unless there is any immediate concern, it is better to postpone the
administration till the second trimester when the organogenesis is completed

61. Vaccination in pregnancy fogsi recommendation 2020
• dTap : Instead of the plain TT (tetanus vaccination) Td ( diphtheria toxoid) , dTap ( tetanus toxoid and
acellular pertussis) vaccination should be offered by 28-32 weeks in each pregnancy
The importance of pertussis vaccine lies in the fact that the neonates are at risk of infection for first 2
months when they are vaccinated,maternal antibodies can protect the infants till 2 months of age
• Inactivated polio vaccine (IPV) is offered along with dTaP in the countries like the UK at 28-32 weeks .
• Inactivated influenza vaccine is given to the mother to reduce the risk of severity of the infection and
also to provide adequate antibody which can be transferred to the fetus to give adequate protection
This vaccine can be given at any time in pregnancy but can be given at the time of the dTaP for the
convenience.
However, ideally this vaccine should be administered before the influenza starts to circulate and is very
important to give between October and January
Live attenuated influenza vaccine is contraindicated in pregnancy
• Whenever indicated, pneumococcal, meningococcal, hepatitis A and B, rabies and inactivated (parenteral)
typhoid vaccines should be administered

62. Vaccination in postpartum fogsi 2020
• All vaccines including varicella and MMR can be given postpartum
• Breastfeeding is not a contraindication to any vaccination including live
vaccines because most of the viruses have not been found in the
breastmilk
• However, yellow fever vaccine should be avoided in lactating mothers

63. 35 Risk and benefits of vaccines
• No substance should be administered unnecessarily during pregnancy.
• However, when a pregnant woman is not immune to serious disease, the risk of
maternal and fetal infection must be weighed against the risk of vaccination.
• Whenever possible, an inactivated (killed) vaccine should be selected and
immunization delayed until the second trimester.
• Only rarely is an attenuated (live) vaccine indicated.

64. Routine vaccinations Recommended before pregnancy Recommended during pregnancy
Flu yes Yes . If not taken before pregnancy
Hepatitis A MAY BE MAY BE
Hepatitis B MAY BE MAY BE
Hib MAY BE MAY BE
HPV MAY BE ( THROUGH AGE 26) NO
MMR MAY BE NO
MENINGO COCCAL May be may be
PNEUMOCOCCAL May be May be
td MAY BE MAY BE (BETTER TO GET Tdap)
Tdap
MAY BE ( BETTER TO GET DURING
PREGNANCY)
Yes .During every pregnancy( if you
donot get it during pregnancy, get it
right after delivery )
VARICELLA MAY BE NO
ZOOSTER NO NO
CDC GUIDELINES FOR Vaccination During Pregnancy

65. 32 Future possible vaccines for pregnancy
• Given the potential of maternal immunization for both women and
offspring, several new vaccines designed for use in pregnancy are
currently under development.
• These maternal vaccines have the potential to change the
epidemiology of several infectious diseases in pregnancy.
• Several maternal vaccines are currently under various stages of
development and could be available within a few years
• [70].

66. 32 Future vaccines possible in pregnancy
1 Respiratory Syncytial Virus (RSV)
RSV is the first focus for a new vaccine
• RSV causes a significant global respiratory disease burden,
especially in young infants.
• RSV. vaccination of pregnant women is considered as the most
plausible strategy to protect these infants against

67. 32 Future vaccines possible in pregnancy contd
2 Group B streptococcus (GBS) for Maternal immunization
• Recently, the WHO drafted a “Group B Streptococcus Vaccine Development
Technology Roadmap” with priorities for development, testing, licensure
and global availability of GBS vaccines [73].
• For the moment,these vaccines are only in phase 1 or phase 2 clinical trials.

68. 32 Future vaccines possible in pregnancy contd
3 Cytomegalovirus (CMV)
CMV is also proceeding with potential use of the vaccine both before and during
pregnancy to benefit both mother and neonate.
• CMV infection is a major public health priority which causes substantial
long-term morbidity, particularly hearing loss in newborns [77].
• The development of a CMV vaccine has been limited due to an incomplete
understanding of protective immunity for the fetus.

69. 32 Future vaccines possible in pregnancy Contd
4 OTHER VACCINES are only in the developmental phase but
certainly have the potential to be successful when being developed and
on the market [79].
• ZIKA
• EBOLA
• HERPES SIMPLEX

70. Vaccination for International Travellers

71. • The world is becoming a smaller place
• Professional women
• Weigh risks V/s benefits
•ASK Is travel to the endemic area really necessary?
36 International Travel
Studd Vol 15

72. • Vaccinations commonly recommended for foreign travel
Cholera, Typhoid, Hepatitis A, Tetanus, Tuberculosis, Polio.
• Some destinations require vaccinations againest
Diphtheria, Meningococcal Meningitis, Rabies and Yellow Fever
36 International Travel contd

73. 37 Conclusions
• Vaccination during pregnancy is a cost-effective strategy to improve pregnancy
outcomes in India.
• Vaccination with inactivated virus, bacterial or toxoid in pregnancy is risk to a
developing fetus during pregnancy is theoretical.
• But definitely the live vaccine poses a theoretical risk to a developing fetus.
• Therefore, all live vaccines should be avoided during pregnancy.
• Common barriers regarding vaccination during pregnancy are lack of awareness
regarding benefits and lack of concerns about vaccine safety.
• The developing country like India where the people can't afford these vaccines, the
government should include these vaccines in routine immunization program

74. The End