CDC Guidelines for Vaccinating Pregnant Women

Vaccinations are an integral part during pregnancy. It becomes important for a physician to know which vaccines are advisable and which are not. Risk to a developing fetus from vaccination of the mother during pregnancy is theoretical. No evidence exists of risk to the fetus from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines administered to a pregnant woman pose a theoretical risk to the fetus; therefore, live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.

In 2014 CDC issued General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the basic Guidelines for Vaccinating Pregnant Women. The basic recommedations of the guidelines are as follows:-

Hepatitis A

• [Hepatitis A] is an inactivated vaccine, and similar to hepatitis B vaccines, is recommended if another high risk condition or other indication is present.

Hepatitis B

• Pregnancy is not a contraindication to vaccination. Limited data suggest that developing fetuses are not at risk for adverse events when hepatitis B vaccine is administered to pregnant women. Available vaccines contain noninfectious HBsAg and should cause no risk of infection to the fetus.


• Pregnant women who are identified as being at risk for HBV infection during pregnancy (e.g., having more than one sex partner during the previous 6 months, been evaluated or treated for an STD, recent or current injection drug use, or having had an HBsAg-positive sex partner) should be vaccinated.

Human Papillomavirus (HPV)

• HPV vaccines are not recommended for use in pregnant women. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination. If a vaccine dose has been administered during pregnancy, no intervention is needed.

Influenza (Inactivated)

• Women in the second and third trimesters of pregnancy are at increased risk for hospitalization from influenza. Because vaccinating against influenza before the season begins is critical, and because predicting exactly when the season will begin is impossible, routine influenza vaccination is recommended for all women who are or will be pregnant (in any trimester) during influenza season,

Influenza (LAIV)

• Do not administer LAIV to . . . pregnant women.

Measles, Mumps, Rubella (MMR)

• Measles-mumps-rubella (MMR) vaccine and its component vaccines should not be administered to women known to be pregnant. Because a risk to the fetus from administration of these live virus vaccines cannot be excluded for theoretical reasons, women should be counseled to avoid becoming pregnant for 28 days after vaccination with measles or mumps vaccines or MMR or other rubella-containing vaccines.


• Because of the importance of protecting women of childbearing age against rubella and varicella, reasonable practices in any vaccination program include asking women if they are pregnant or might become pregnant in the next 4 weeks; not vaccinating women who state that they are or plan to become pregnant; explaining the theoretical risk for the fetus of MMR, varicella, or MMRV vaccine were administered to a woman who is pregnant; and counseling women who are vaccinated not to become pregnant during the 4 weeks after MMR, varicella, or MMRV vaccination. . . . Routine pregnancy testing of women of childbearing age before administering a live-virus vaccine is not recommended. If a pregnant woman is inadvertently vaccinated or becomes pregnant within 4 weeks after MMR or varicella vaccination, she should be counseled about the theoretical basis of concern for the fetus; however, MMR or varicella vaccination during pregnancy should not be considered a reason to terminate pregnancy.

Meningococcal (MenACWY or MPSV4)

• Pregnancy should not preclude vaccination with MenACWY or MPSV4, if indicated.

Meningococcal (MenB)

• Pregnancy should not preclude vaccination with serogroup B meningococcal (MenB) vaccines, if indicated. There is not very much information about the potential risks of this vaccine for a pregnant woman or breastfeeding mother. It should be used during pregnancy only if clearly needed.

Pneumococcal Conjugate (PCV13)

• ACIP has not published pregnancy recommendations for PCV13 at this time. (Use of PCV13 is limited among women of childbearing age.)

Pneumococcal Polysaccharide (PPSV23)

• The safety of pneumococcal polysaccharide vaccine during the first trimester of pregnancy has not been evaluated, although no adverse consequences have been reported among newborns whose mothers were inadvertently vaccinated during pregnancy.

Polio (IPV)

• Although no adverse effects of IPV have been documented among pregnant women or their fetuses, vaccination of pregnant women should be avoided on theoretical grounds.However, if a pregnant woman is at increased risk for infection and requires immediate protection against polio, IPV can be administered in accordance with the recommended schedules for adults.

Tetanus, Diphtheria, and Pertussis (Tdap); & Tetanus and Diphtheria (Td)

• Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient's prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks of gestation although Tdap may be given at any time during pregnancy.


• For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum.


• Available data from studies do not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine.


• Wound Management: If a Td booster is indicated for a pregnant woman, health-care providers should administer Tdap.


• Unknown or Incomplete Tetanus Vaccination: To ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids. The recommended schedule is 0, 4 weeks and 6 6 through 12 months. Tdap should replace 1 dose of Td, preferably between 27 and 36 weeks gestation . .

Varicella

• Because the effects of the varicella virus on the fetus are unknown, pregnant women should not be vaccinated. Nonpregnant women who are vaccinated should avoid becoming pregnant for 1 month after each injection. For persons without evidence of immunity, having a pregnant household member is not a contraindication for vaccination.


• Wild-type varicella poses a low risk to the fetus. Because the virulence of the attenuated virus used in the vaccine is less that that of the wild-type virus, the risk to the fetus, if any, should be even lower.


• Because of the importance of protecting women of childbearing age against rubella and varicella, reasonable practices in any vaccination program include asking women if they are pregnant or might become pregnant in the next 4 weeks; not vaccinating women who state that they are or plan to become pregnant; explaining the theoretical risk for the fetus of MMR, varicella, or MMRV vaccine were administered to a woman who is pregnant; and counseling women who are vaccinated not to become pregnant during the 4 weeks after MMR, varicella, or MMRV vaccination. . . . Routine pregnancy testing of women of childbearing age before administering a live-virus vaccine is not recommended. If a pregnant woman is inadvertently vaccinated or becomes pregnant within 4 weeks after MMR or varicella vaccination, she should be counseled about the theoretical basis of concern for the fetus; however, MMR or varicella vaccination during pregnancy should not be considered a reason to terminate pregnancy.

Zoster

• Zoster vaccine (Zostavax®) should not be administered to pregnant women. Additionally, Zostavax is not licensed for the age groups that include women of traditional childbearing ages.