Aboubakr Elnashar

1. Vaccination
and
pregnancy
WHO, 2014, CDC,
2017
Prof. Aboubakr
Mohamed
Elnashar
Benha university
Hospital, 2018
ABOUBBAKR ELNASHAR

2. CONTENTS
 INTRODUCTION:
1. Success of maternal immunization
2. Types of vaccines
3. Routes of administration
I. BEFORE PREGNANCY: Prenatal immunization
II. DURING PREGNANCY
1. Minimizing exposure to infection
2. Antenatal screening
3. Benefits and risks maternal immunization
4. Timing of immunization
5. Passive immunization during pregnancy
6. Vaccines indicated
7. Vaccines contraindicated
III. AFTER PREGNANCY
1. Breastfeeding and vaccination
2. Postpartum vaccination
 CONCLUSION
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3. Introduction
1. Success of maternal immunization
1. Obstetrician
1. Awareness
2. Recommendations
2. Patient
Education regarding dual health benefits for mother
and fetus.
3. Professional organizations, providers, and regulatory
agencies.
Continued collaborative relationships
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4. 2. Types of vaccines
I. Inactivated vaccines
a component of the infectious pathogen
rendered incapable of causing clinical disease.
Whole cell virus or bacteria
Fractional protein-based subunits (such as with
tetanus)
Fractional polysaccharide-based subunits.
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5. Example
Tetanus vaccine
contains the tetanus toxoid
produced by Clostridium tetani.
: humoral immune response: immunity.
Require multiple booster doses
{antibody levels diminish over time}.
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6. II. Live attenuated vaccines
Living organisms modified:
No fulminant disease.
immune response sufficient to approximate exposure
to the intended infection.
remote potential to cause clinical infection
usually mild
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7. Contraindicated in pregnancy
{theoretic risk of perinatal infection via vertical
transmission}.
Inadvertent administration of
live attenuated influenza vaccine during pregnancy:
no adverse pregnancy outcomes
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9. 3. Routes of administration
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10. I. BEFORE PREGNANCY
Preconception immunization
Women should be vaccinated
against preventable diseases in their environment
according to the recommended adult immunization
schedule
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11. Women of childbearing age who may become
pregnant, ensuring immunity against
Measles
Mumps, and
Rubella and
Varicella is important
1. These immunizations are contraindicated during
pregnancy
2. Infection in nonimmune pregnant women can
adversely affect pregnancy outcome.
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12. Before administering any vaccine:
Asking
if she is pregnant or
could become pregnant in the next 4 weeks
Counseling her about the potential risks of
vaccination during pregnancy or just before
conception.
Routine pregnancy testing
not necessary as long as pregnancy can
reasonably be excluded by history.
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13. Assess the possibility of pregnancy
no symptoms or signs of pregnancy
meets any of the following criteria: pregnancy checklist
1. No intercourse since her last normal menses.
2. using a reliable method of contraception.
3. within the first 7 days after normal menses.
4. within 4 weeks postpartum (for nonlactating
women).
5. within the first 7 days postabortion or miscarriage.
6. fully or nearly fully breastfeeding, amenorrheic, and
less than 6 months postpartum.
Negative predictive value of a checklist: 99 to 100%.
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14. Pregnancy should be avoided
for 28 days following administration of a live vaccine.
When pregnancy occurs within one month of
immunization with the live measles, mumps, rubella
(MMR) vaccine, varicella vaccine, yellow fever vaccine,
or oral polio vaccine:
teratogenesis has not been reported.
termination of pregnancy for exposure to these
vaccines is unwarranted.
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15. II. DURING PREGNANCY
1. Minimizing risks of infection exposure
1. Avoiding travel to high-risk locations
Eg. areas where yellow fever is prevalent
2. Assuring that family members are immunized
according to standard immunization schedules
3. Maintaining good hygienic practices
hand-washing
using clean water
cooking food adequately
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16. 2. Antenatal screening
For
Rubella and varicella
HBsAg during every pregnancy.
In Egypt:
Any pregnant woman who comes in contact with
rubella should be tested for rubella antibodies
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17. A woman found to be HBsAg positive
infant receives
HBIG
hepatitis B vaccine
series no later than 12 hours after birth
completes the recommended hepatitis B vaccine
series on schedule.
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18. 3. Benefits and risks of maternal immunization
Benefits
 Prevent or diminish the severity of infections in
 pregnant women and
 their newborn infants.
{passive protection against vaccine-preventable
infections acquired independently after birth}.
 The prevention of illness during pregnancy:
 improved
 birth outcomes.
maternal, neonatal, and obstetric benefit
 health care system
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19. RISKS
 Inactivated (virus or bacterial) vaccines or
toxoids.
 No risk to the fetus
 Live attenuated (virus or bacterial) vaccines
 theoretical risk to the fetus
 contraindicated during pregnancy.
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20. Lack of autism association with immunizations
Some authors have attributed regressive autism to
childhood vaccine exposure (particularly measles
vaccine and thimerosal
[mercury preservative used in vaccines]).
However, the overwhelming majority of
epidemiologic evidence does not support an
association between immunizations and autism.
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21. Benefits of vaccinating pregnant women usually
outweigh potential risks
When
likelihood of disease exposure is high
infection would pose a risk to the mother or fetus
vaccine is unlikely to cause harm.
The risk-benefit ratio of administering live vaccines
should be weighed individually for such patients
As an example
yellow fever vaccine and the live-attenuated oral
polio vaccine may be warranted for pregnant
women who have a high risk of imminent
exposure.
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22. 4. Timing of immunization during pregnancy
Medically indicated (toxoids, inactivated virus vaccines, and
immune globulin preparations) because of special risks to
the unimmunized pregnant woman, fetus, or newborn.
at any gestational age
even in the first trimester
As an example
Seasonal influenza vaccine should be
administered as soon as it becomes available,
regardless of gestational age.
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23. If prompt administration is not medically indicated
preferable to delay administration of these agents
until the second trimester
1. Possibility of risk to fetal development cannot
be definitively excluded.
2. Avoid false associations in the patient's mind
between immunization and common adverse
first trimester events (eg, miscarriage, birth
defects).
3. Between weeks 28 to 32 of gestation may
optimize the transfer of antibodies to the fetus
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24. 5. Passive immunization during pregnancy
No known risk exists for the fetus from
passive immunization of pregnant women with
immune globulin preparations.
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25. 6. Vacines indicated during pregnancy
INACTIVATED VACCINE
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26. Tetanus
Neonatal tetanus
almost always fatal
completely preventable by ensuring that pregnant
women are protected through vaccination.
Worldwide, all countries are committed to elimination
=Reduction to zero
(WHO, 2014)
All women of childbearing age, either during
pregnancy or outside of pregnancy, should be
vaccinated against tetanus to protect themselves and
their newborn babies.
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27. Administration of 2 initial doses of tetanus toxoid (TT) 1
month apart
followed by a third dose 6 months later in pregnancy
another dose for each subsequent pregnancy
culminating in 5 total doses.
By the end of June 2017:
96% reduction from the late 1980s.
16 countries still have not eliminated neonatal
disease.
(WHO, 2014)
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28. Tetanus, Diphtheria, and Pertussis (Tdap)
a dose of Tdap=
tetanus toxoid, reduced diphtheria toxoid, and
acellular pertussis vaccine
during each pregnancy
to all pregnant women
irrespective of the patient’s prior history of
receiving
between 27 and 36 w
(CDC, 2017) (Grade 1B).
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29. Timing:
at any time during pregnancy.
between 27 and 36 w
{maximize the maternal antibody response and
passive antibody transfer to the infant}
Women not previously vaccinated with Tdap:
if Tdap is not administered during pregnancy
Tdap should be administered immediately postpartum.
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30. Adverse effects
No
Wound Management:
If a Td booster is indicated for a pregnant woman,
health-care providers should administer Tdap.
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31. In Egypt:
Tetanus toxoid should be administered to prevent
tetanus if the mother has not already been immunized
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36. Influenza
Inactivated influenza vaccine
recommended for pregnant women in many
industrialized countries
{evidence of benefit to the mother and the infant.}
LAV vaccines
pose a theoretical risk to the fetus:
contraindicated in pregnant women.
Inactivated influenza vaccine
recommended for seasonal influenza
{severe course of influenza during pregnancy}
safe
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38. Pre-exposure prophylaxis= Vaccines for Special
Circumstances
Pregnant women with
comorbidities or
exposures that place them at high risk
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39. Hepatitis A
Travel to developing countries
 Exposure to individuals with HAV infection
 Individuals receiving clotting factor concentrates
 Exposure to biologic specimens
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40. Hepatitis B
Pregnant women who are at risk for HBV infection
during pregnancy and should be vaccinated.
having more than one sex partner during the
previous 6 months,
been evaluated or treated for an STD
Recent or current injection drug use
having had an HBsAg-positive sex partner
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41. Pneumococcal vaccine.
Recommended for high-risk women.
women with heart, lung, or sickle cell disease
Diabetes
Women who smoke
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42. Meningococcal (MenB)
may be given in pregnancy or in the postpartum
setting
should any meningococcal disease outbreak
place a woman at risk for infection.
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44. Live attenuated vaccine
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45. III. AFTER PREGNANCY
1. Breastfeeding and vaccination
Inactivated, recombinant, subunit, polysaccharide,
and conjugate vaccines, as well as toxoids
No risk for mothers who are breastfeeding or for
their infants.
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46. The majority of live viruses in vaccines
not to be excreted in human milk.
Varicella vaccine virus
has not been found in human milk.
Rubella vaccine virus
might be excreted in human milk,
the virus usually does not infect the infant.
If infection does occur, it is well tolerated
because the virus is attenuated.
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47. Smallpox vaccination
Breastfeeding is a contraindication
{theoretical risk for contact transmission from
mother to infant}
Yellow fever vaccine
should be avoided in breastfeeding women.
However, when nursing mothers cannot avoid or
postpone travel to areas endemic for yellow fever in
which risk for acquisition is high, these women should
be vaccinated.
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48. 2. Postpartum immunization
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49. Following delivery
postpartum women should receive all recommended
vaccines that could not be or were not administered
during pregnancy
Eg
Measles
mumps, and
rubella;
varicella;
tetanus toxoid, diphtheria, and acellular pertussis
[Tdap]).
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50. CONCLUSION
Vaccines
are an effective way to prevent many infectious
diseases posing maternal and neonatal risks.
Some vaccines
are specifically recommended during pregnancy or
immediately postpartum
have demonstrated efficacy in either maternal or
neonatal illness prevention or both.
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51. ABOUBBAKR ELNASHAR

52. You can get this lecture and 392
lecture from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3. elnashar53@hotmail.com
4.My clinic: Althwara st, Mansura, Egypt
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