Professor Lopalco suggests the vaccines to be considered for pregnant women and the ones recommended for health care workers (Influenza, HBV, dTap, MMR-V, meningococcal).

1. VACCINATION OF PREGNANT WOMEN
AND HEALTH CARE WORKERS
Pier Luigi Lopalco
Milan, 18 February 2016

2. Rationale of pregnant women vaccination
woman’s
protection
foetus’ protection

3. Rationale of pregnant women vaccination
neonate’s
protection

4. Effectiveness and Safety issues
of pregnant women vaccination
• Peculiar hormonal and
immunological situation
• Lack of data from clinical trial
• Most information from
observational studies
• Safety data coming from
inadvertent administration of
vaccines during pregnancy
• Immunogenicity assessed
during neonatal vaccination

5. Vaccines to be considered for pregnant
women vaccination
• Recommended
• influenza
• dTap
• To be considered
• pneumococcal
• meningococcal
• HAV
• HBV
• Contraindicated
• LAIV
• MMR – V
• Not recommended
• HPV

6. Influenza vaccination during the pregnancy
• All women who will become pregnant, or who will be pregnant,
during the influenza season are advised to receive the
inactivated trivalent or quadrivalent influenza vaccine at any
time during the pregnancy

7. dTap vaccination in pregnant women
• The best time to administer the vaccine is between 27 and 36
weeks of gestation.
• If the woman has not previously received dTap, and if dTap is
not administered during the pregnancy, dTap should be
administered immediately post-partum.
• Pregnant women who have never been vaccinated against
tetanus should receive three vaccinations containing tetanus
and reduced diphtheria toxoids in either the form of dT or
dTap. However, dTap should replace one dose of dT, preferably
between 27 and 36 weeks’ gestation.

8. Rationale of health care workers (HCW)
vaccination
HCW’s protection
maintenance of essential
healthcare services
patient’s protection

9. Rationale of health care workers (HCW)
vaccination
Role Model

10. Influenza
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

11. Hepatitis B
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

12. Diphtheria Tetanus
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

13. Pertussis
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

14. Measles
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

15. Varicella
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

16. Meningococcal
Galanakis et al. Expert Rev. Vaccines 13(2), (2014)

17. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal

18. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal
• it is recommended that all HCWs
receive the influenza vaccine every
influenza season
• The LAIV may be administered only to
non-pregnant, healthy HCWs aged 49
years and younger
• The inactivated trivalent or
quadrivalent vaccine is preferred over
the LAIV for HCWs who are in close
contact with severely
immunosuppressed patients when
they require protective isolation

19. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal
• HCWs are recommended to receive
complete 3-dose vaccine series of HBV
vaccine if there is no documentation
of prior HBV vaccination or if there is
no serologic evidence of immunity .
• HCWs should be tested for anti-HBs 1-
2 months after the third dose to
document immunity
• HCWs whose anti-HBs are less than 10
mIU/mL should be re-vaccinated with
a second 3-dose series

20. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal
• All HCWs who have not, or are unsure
if they have, previously received a
dose of dTap are advised to receive a
dose of dTap immediately, without
regard to when the previous dose of
dT was given.
• All HCWs are then recommended to
receive dT boosters every 10 years

21. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal
• HCWs with no serologic evidence of
immunity to MMR or documentation
of prior vaccination are recommended
to receive two doses of MMR vaccine
at least 28 days apart
• HCWs are recommended to receive
two doses of varicella vaccine, 4
weeks apart, if there is no knowledge
of prior chickenpox (or herpes zoster)
infection, there is no documentation
of prior varicella vaccination, or when
there is no serologic evidence of
immunity

22. Vaccines to be considered for HCW
vaccination
• Recommended
• Influenza
• HBV
• dTap
• MMR-V
• meningococcal
• HCWs who are routinely exposed to
isolates of Neisseria meningitidis are
recommended to receive vaccination
with the tetravalent conjugated
meningococcal vaccine

23. THANK YOU
pierluigi.lopalco@uniba.it