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Technically Speaking
September 2013
Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Vaccinations and Pregnancy
Published September 2013
Twenty-five years ago, vaccines generally were not recommended for pregnant women. My, how things have changed! Although certain vaccines should not be given during pregnancy, two vaccines are specifically recommended during this time, and a few additional vaccines are recommended for pregnant women when indicated because of certain risk conditions.
So how do you keep these variations straight? This column provides an overview of the immunization recommendations for pregnant women and gives links to helpful resources, including a new handout, “Vaccinations for Pregnant Women,” created collaboratively by the American College of Obstetricians and Gynecologists (ACOG) and the Immunization Action Coalition (IAC). This great handout was designed to share with pregnant women to remind them about the vaccines they need.
Vaccines recommended during pregnancy
Two vaccines — inactivated influenza vaccine and Tdap (tetanus-diphtheria-acellular pertussis) — are specifically recommended for pregnant women.
Influenza vaccine has been recommended for almost a decade for all women who are pregnant or will be pregnant during influenza season. The use of this vaccine is critical because influenza is more likely to cause serious illness and complications in pregnant women than in non-pregnant women. As an important side benefit, influenza vaccine administered to the mother also will help protect the newborn infant from influenza. Only injectable inactivated influenza vaccine (i.e., not live nasal spray vaccine) is recommended for use during pregnancy.
Tdap vaccine is recommended for pregnant women during each pregnancy, regardless of the woman’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, the optimal timing for Tdap administration is between 27 and 36 weeks’ gestation. However, Tdap may be administered at any time during the pregnancy. Women with no history of Tdap vaccination and to whom the vaccine was not administered during pregnancy should receive Tdap immediately postpartum.
Vaccines that should be administered during pregnancy when indicated
Several inactivated vaccines fall into a middle ground. Although they are not recommended for all pregnant women, they should be given if the woman has a particular risk condition — health, occupational, or other — indicating a need for a particular vaccine. These vaccines include hepatitis A, hepatitis B, meningococcal, and pneumococcal (PCV13 and PPSV23), all of which are safe to administer during pregnancy.
Vaccines that should not be administered during pregnancy
The vaccines that should not be given to pregnant women include
Live vaccines — MMR (measles-mumps-rubella), MMRV (measles-mumps-rubella-varicella), Var (varicella), and LAIV (nasal spray, live attenuated influenza vaccine) — are contraindicated in pregnancy because of theoretical concerns for the fetus. However, there have been no documented cases of injury to any infant when these vaccines were inadvertently administered during pregnancy.
Human papillomavirus (HPV) vaccine — this inactivated vaccine is not recommended during pregnancy.
Healthcare professionals should try to ensure all women of childbearing age are up to date with their recommended vaccines before they try to conceive.
General resources about vaccination during pregnancy
Vaccinations for Pregnant Women (ACOG/IAC patient handout)
Immunization Resources for Obstetrician-Gynecologists: A Comprehensive Toolkit (ACOG)
Guidelines for Vaccinating Pregnant Women (CDC web page)
Summary of Recommendations for Adult Immunization (IAC 4-page summary for healthcare professionals)
Cocooning Protects Babies—Everyone in a baby’s life needs to get vaccinated against whooping cough and flu! (IAC parent handout)
Spanish version
Resources about influenza and Tdap vaccination during pregnancy
ACIP recommendations for the use of Tdap in pregnancy, MMWR, Feb. 22, 2013
Information on pregnant women and influenza, including a flyer for patients (CDC)
ACOG Committee Opinion: Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination (ACOG)
Expecting? Protect Your Baby from Whooping Cough. (California VFC Program, patient handout)
Spanish version
2013 ISSUES >> view all
Handouts for Parents, Teens, and Adults Help Providers Explain the Value of Vaccines
At Your Fingertips: Official Vaccine Recommendations and Product Information
Ask the Experts: Providing Answers to Your Timely and Challenging Influenza Vaccination Questions
Vaccinations and Pregnancy
Temperature Monitoring – The "Vital Sign" for Vaccine Storage
JULY 2013
The End of Hepatitis B Transmission Begins At Birth
APRIL 2013
Recommendations for Use of Meningococcal Vaccines in High-Risk Infants and Children
MARCH 2013
What to Do if the Wrong Dose of a Vaccine Is Administered
CDC's 2013 Immunization Schedules and IAC's Easy-To-Use Summaries
Expanded Tdap Recommendations: Administer Tdap to Pregnant Women during Each Pregnancy
This page was reviewed on October 15, 2013
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.