2. Adult immunization rates
have fallen short of national
goals, partly because of
misconceptions about the
safety and benefits of
current vaccines.
3. • The danger of these
misconceptions is magnified
during pregnancy, when:
1.Concerned physicians are hesitant
to administer vaccines and
2.Patients are reluctant to accept
them.
4. •The administration of
vaccines during pregnancy
poses a number of concerns
about the risk of transmitting
a virus to a developing fetus.
5. The risk of transmitting
a virus to a developing
fetus is primarily
theoretical
7. Physicians should reassure
their patients that no vaccines
are contraindicated during
breastfeeding.
Immunization duringImmunization during
breastfeeding is safebreastfeeding is safe
8. Routine vaccines that generally
are safe during pregnancy
include:
1.Diphtheria 5.Meningococcal
2.Tetanus 6. rabies
3.Influenza
4.Hepatitis B.
9. Vaccines that are contraindicated
live virus vaccine include:,
1. Measles, Mumps, and Rubella;
2. Varicella
3. (BCG) bacille Calmette-Guérin
4. Yellow vaccine
5. Polio
))because of the theoretic risk ofbecause of the theoretic risk of
fetal transmissionfetal transmission((
10. 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.
13. • typically presents with:
1. Fever, red eyes
2. Coryza (inflammation of mucosal
mem. Lining the nasal cavity)
3. Generally ill appearance, and
4. maculopapular rash start @face to
chest
Measles “Rubeola”
14. Measles
• Risk from disease to pregnant woman:
– Causes significant morbidity and low mortality
– There is no evidence that measles (rubeola) can
cause malformations of the developing embryo
and fetus.
• Risk from disease to fetus or neonate:
– Sign. Increase in abortion rate
– May cause fetal malformation
15. •Mortality occurs in 1-2
per 1,000 cases, often
secondary to pneumonia
or encephalitis.
Measles
16. Rubeola
There is no evidence whatsoever that measles
(rubeola) can cause malformations of the
developing embryo and fetus.
Measles can, however, trigger miscarriages
(spontaneous abortions) and premature
delivery in pregnant women
17. • Mumps results from infection with
the paramyxovirus and can lead to
parotitis, meningoencephalitis, and
orchitis.
• Neurologic complications, such as
deafness, can also occur as a result of
mumps infection.
Mumps
18. Mumps
-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
20. Rubella
Crosses the placenta barrier and cause
congenital rubella syndrome.
It can cause 20% spontaneous abortion
in the 1st
trimester.
21. Congenital Rubella syndrome
Can result in defects such as:
*malformations of the heart (especially PDA), eyes or brain
*deafness
*spleen, liver or bone marrow problems (some of which may
disappear shortly after birth)
*mental retardation
*small head size (microcephaly)
* Eye defects - cataracts
*low birth weight
*hepatomegaly
22. •Measles, mumps, and
rubella vaccine should
not be given to pregnant
women, because of
potential adverse effects
on the fetus. But should be
vaccinated post partum.
24. • RNA Enterovirus with three different
strains that cause disease.
• Exposure may result in asymptomatic
infection as well as nonparalytic and
paralytic disease.
• Asymptomatic patients can transmit
the disease to susceptible persons.
Polio
25. • 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).
Polio
26. • 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.
• IPV is inactivated by formaldehyde, and
its use has eliminated vaccine-associated
polio infection.
Polio
27. • 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.
Polio
28. • 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.
Polio
30. • Yellow fever is a viral hemorrhagic
fever syndrome spread by mosquitoes
in parts of South America and Africa.
• The yellow fever vaccine is a live,
attenuated virus grown in chick
embryos.
YELLOW FEVER
31. •It is indicated for use in
laboratory workers involved
with the virus and in persons
planning to travel to endemic
areas.
YELLOW FEVER
32. • No specific evidence is available to
demonstrate the safety of yellow fever
immunization during pregnancy.
• Since theoretic concerns of fetal
infection exist, however, vaccination
is generally not recommended during
pregnancy.
YELLOW FEVER
33. •When travel cannot be
postponed and mosquito
exposure is likely, yellow
fever vaccination may be
considered.
YELLOW FEVER
36. • Fever, malaise, myalgia, and upper
respiratory tract symptoms or
infections characterize influenza
infection.
• Most severe complications are the
result of pneumonia secondary to
influenza infection.
Influenza
37. •The influenza vaccine is a
killed virus preparation
with an annually adjusted
antigenic makeup.
Influenza
39. •The vaccine should be
administered to all pregnant
women who will be in the
second or third trimester of
pregnancy during the influenza
season
Influenza
40. • Women in their second or third
trimesters have higher morbidity, from
influenza infection.
• 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.
Influenza
42. • Rabies is a viral infection transmitted
most commonly by the saliva of
infected animals.
• Nonspecific prodromal symptoms
progress to encephalitis marked by
confusion, hallucinations.
RABIES
43. • Dysregulation of the autonomic nervous
system and involvement of the brainstem
and cranial nerves lead to the classic
"foaming at the mouth" appearance.
• Three forms of inactivated rabies
vaccines are available, all considered
equally safe and efficacious
RABIES
44. • Passive immunization is achieved through
administration of human rabies immune
globulin (HRIG).
• Indications for pre-exposure
immunization depend on the likelihood of
exposure.
• It may be considered in animal workers
and travelers to enzootic areas who
anticipate animal exposure.
RABIES
45. •With any animal bites or
wild animals, the animal
should be euthanized, and
the brain tested for infection.
RABIES
46. •Bites from normally acting
dogs, cats warrant a 10-day
observation period, with
prophylaxis and euthanization
of the animal deferred.
RABIES
47. • In patients who have not been immunized
previously, 20 IU per kg of HRIG is given at
the wound site for high-risk bites or if testing
is positive.
• Patients with previous vaccinations do not
need HRIG but do require revaccination on a
modified schedule.
• There have been no identified associations
between rabies vaccination and fetal
abnormalities
RABIES
51. • The risk of developing chronic illness
associated with complications
(cirrhosis, hepatocellular carcinoma,
and a chronic carrier state)
has been a key factor in the
recommendation for
universal vaccination of all children
Hepatitis B
52. Risk factors for a pregnant woman include:
1. Having multiple sexual partners,
2. Using or abusing intravenous drugs,
3. Having occupational exposure, and
4. Being a household contact of acutely
infected persons or persons with a
chronic carrier state.
Hepatitis B
53. • The hepatitis B vaccine contains viral
surface antigen produced by
recombinant DNA technology.
• It is administered in the fetus at three
doses, at birth and at one and six
months of age, and has minimal to no
side effects.
Hepatitis B
54. • Because it contains noninfectious
hepatitis B surface antigen
particles and it cause no risk to
the fetus, neither pregnancy nor
lactation is a contraindication to
vaccination.
Hepatitis B
56. • Most cases of typhoid fever in
developed countries occur in
travelers who recently have
returned from high-risk areas, such
as South America, India, and
western Africa
TYPHOID
57. • Transmission of Salmonella
typhi is significantly
increased with travel during
local epidemics and
ingestion of food from street
vendors.
TYPHOID
58. Primary prevention consists of:
1. Hand washing,
2. Drinking only safe water,
3. Peeling all fruits and vegetables,
and
4. Eating well-cooked foods.
TYPHOID
59. • The two types of typhoid vaccination in
use today are a live attenuated oral
vaccine and a parenteral polysaccharide
vaccine.
• Both forms require that immunization be
completed at least two weeks before
exposure.
TYPHOID
60. • Its use is contraindicated in:
1. Infants,
2. Immunocompromised persons, and
3. Those with abnormal gastrointestinal
function, as well as
4. Pregnant women.
TYPHOID
61. •Neither form of typhoid
vaccine is officially
recommended during
pregnancy.
TYPHOID
63. • Cholera is an acute diarrheal disease
endemic to Africa, Asia, and Latin
America.
• It is caused by a toxin from Vibrio
cholera bacteria, which live in, and are
transmitted by, the fecal-oral route from
contaminated water sources.
CHOLERA
64. • Two improved oral vaccines are available :
1. a killed, whole cell recombinant vaccine and
2. a live, attenuated strain.
• Both are more effective, better tolerated, and
longer lasting than the parenteral vaccine.
CHOLERA
These may be considered for use inThese may be considered for use in
populations at immediate risk of a cholerapopulations at immediate risk of a cholera
epidemic or for travelers to areas of highepidemic or for travelers to areas of high
endemicity.endemicity.
65. • No specific information exists on the
safety of parenteral cholera
vaccination during pregnancy.
• Because cholera during pregnancy is
a serious illness, exposure should be
minimized during pregnancy
whenever possible.
CHOLERA
67. • Streptococcus pneumoniae
is a gram-positive diplococci
that is a major cause of
1.Pneumonia,
2.Meningitis, and
3.Bacteremia.
Pneumococcal
68. • Risk factors for pneumococcal
infection in pregnant women
include
1. Diabetes,
2. Cardiovascular disease,
3. Immunodeficiency,
4. Asthma.
Pneumococcal
69. • The current vaccine includes
purified capsular polysaccharide
• women at high risk should be
given this vaccination before, but
not during, pregnancy.
Pneumococcal
70. • 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.
Pneumococcal
74. Adverse effects:
-characterized by limb
atrophy and scarring of
the skin of the extremity,
known as congenital
varicella syndrome.
-Other manifestations include
central nervous system
and eye abnormalities.
-increase mortality in
neonates.
75. • The varicella-zoster virus causes
chickenpox and rarely cause
serious complications, (as
encephalitis and severe
pneumonia).
• Up to 15 % of infected persons
have herpes zoster later in life.
Varicella
76. • Women who are vaccinated should avoid
becoming pregnant for one month
following each injection.
• The presence of pregnant household
members does not constitute a
contraindication to vaccination of others
within the house.
Varicella
77. Varicella immunoglobulin indicated:
• If a susceptible pregnant woman is exposed to varicella,
however, administration of varicella-zoster immune
globulin should be strongly considered
• Indicated also for newborns of mothers who developed
varicella within 4 days prior to delivery or 2 days
following delivery.
• Approx. 90-95% of adults are immune
• Not indicated for prevention of congenital varicella
79. •Diphtheria is an infection
of the nasal, pharyngeal,
laryngeal, or other mucous
membranes that can cause
neuritis, myocarditis,
thrombocytopenia, and
ascending paralysis.
82. • 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.
83. •Previously vaccinated pregnant
women who have not received
a Td vaccination within the
past 10 years should receive a
booster dose.
Who needs the Tetanus and
Diphtheria vaccine?
84. •Pregnant women who are
not immunized or only
partially immunized
should complete the
primary series.
Tetanus and Diphtheria
88. •It is acquired via the fecal-
oral route by person-
to-person contact or
ingestion of contaminated
food or water.
Hepatitis A
89. • Safety during pregnancy has not
been determined.
• Because hepatitis A vaccine is
produced from inactivated virus,
the risk to the developing fetus is
expected to be low.
Hepatitis A
90. • Administration of immune
globulin is strongly recommended;
which is considered safe
during pregnancy and is more than
85 % effective in preventing acute
hepatitis
Hepatitis A
92. • In the USA, meningococcal disease is
the leading cause of bacterial
meningitis in children ages two
through 18 years.
• Meningococcal vaccine contains the
purified polysaccharide of four
serogroups of Neisseria meningitidis.
Meningococcal
93. • Routine vaccination is recommended for
high-risk groups, including
1. Military recruits,
2. Patients with terminal complement
component deficiencies
3. Persons with anatomic or functional
asplenia.
4. High school or college students
Meningococcal
94. • Vaccination also may benefit travelers to
areas in which N. meningitidis is endemic
or epidemic, such as Africa.
• Studies have shown that the
meningococcal vaccine is safe and
efficacious when given to pregnant
women
Meningococcal
95. • Vaccinations typically not
administered on a routine basis by
family physicians and other
vaccines of interest include:
anthrax, smallpox, rabies, yellow
fever, BCG, typhoid, and cholera.
97. • Anthrax is caused by the spore-
forming bacterium Bacillus
anthracis, occurring in humans in
three forms:
1. Cutaneous,
2. Inhalational, and
3. Gastrointestinal.
ANTHRAX
98. • The potential use of anthrax in
acts of bioterrorism has long been
a concern because of its:
1. Stability,
2. High mortality, and
3. High potential for respiratory
transmission.
ANTHRAX
99. •The anthrax vaccine is
prepared from a bacteria-free
culture containing the three
major toxin components
produced by the bacteria
ANTHRAX
100. The recommended immunization
schedule consists of:
1. Three injections given at two-
week intervals, followed by
another
2. Three doses at six-month
intervals.
ANTHRAX
101. • No studies have addressed the safety
of the anthrax vaccine during
pregnancy.
• As with other non -live- virus
vaccines, anthrax vaccine does not
carry theoretic risks of fetal infection.
ANTHRAX
102. • Vaccination should be
considered on a case-by-case
basis and administered only
when the potential benefits
outweigh the potential risks to
the mother and fetus.
ANTHRAX
105. • Prodromal symptoms include a high
fever and oral lesions that ulcerate,
followed by a macular rash.
• The rash becomes raised, then
umbilicated and pustular, particularly
when on the face and extremities.
SMALLPOX
106. • Recent world events have
brought to light the threat of
terrorists who may release
smallpox, and have prompted
an evaluation of vaccination
policies
SMALLPOX
109. • The vaccine has not been shown to be
teratogenic or to cause congenital
malformations, but the virus has been
reported to cause fetal infection on
rare occasion, with subsequent risk of
skin lesions, preterm delivery,
stillbirth, or infant death.
SMALLPOX
110. • Women should therefore
actively avoid becoming
pregnant for at least four weeks
after vaccination and until the
scab has completely healed and
fallen off.
SMALLPOX
111. • Vaccination should also be avoided
for household or close contacts of
women who are pregnant.
• Inadvertent vaccination during
pregnancy, however, should not be
considered a reason to terminate the
pregnancy
SMALLPOX
112. • The safety of breast milk after
maternal vaccination has not been
studied, so women who are
breastfeeding should not receive the
vaccine.
• Household contacts of breastfeeding
infants theoretically can be
immunized.
SMALLPOX
116. • It is likely that the BCG vaccine
has been given to thousands of
pregnant women in other
countries.
• While no harmful fetal side effects
have been identified to date.
BCG VACCINE
117. •Use of the BCG
vaccine is not
recommended during
pregnancy.
BCG VACCINE
119. •The benefits of
immunization to the
pregnant woman and her
neonate usually outweigh
the theoretic risks of
adverse effects.
120. •The theoretic risks of the
vaccination of pregnant
women with killed virus
vaccines have not been
identified.
121. •Vaccination of women
during the postpartum
period, especially for
rubella and varicella,
should be encouraged.
122. •Women susceptible to
rubella should be
vaccinated with measles–
mumps–rubella on
postpartum discharge from
the hospital.
123. •Generally, live-virus vaccines
are contraindicated for
pregnant women because of
the theoretical risk of
transmission of the vaccine
virus to the fetus.
124. • Whether live or inactivated
vaccines are used, vaccination of
pregnant women should be
considered on the basis of
the risk of the vaccination vs.
the benefits of protection in a
particular circumstance.
