Immunizations+in+Pregnancy

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** IMMUNIZATIONS IN PREGNANCY ** [|**http://www.cdc.gov/vaccines/pubs/preg-guide.htm**]
 * For updated information: **

Generally inactivated vaccines are safe in pregnancy and live attenuated vaccines are avoided except in special circumstances where risk of disease is very high. The risk of live vaccine is primarily theoretical and related to the risk of birth defects from actual infection rather than any reported cases of inadvertent vaccination resulting in fetal birth defects. Women exposed to Varicella or Measles may qualify for IVIG or VariZIG. If exposure reported by patient make every effort to verify validity of exposure, draw STAT titers for immunity if unknown and consult immediately (Kathy Ferris, infection control) to assess whether immune globulin warranted and/or available.
 * __ Strongly recommended for all pregnant women __**** : **
 * Influenza vaccine: ** All pregnant women should be encouraged to receive the annual flu vaccine to protect herself and to pass antibodies to her baby. Numerous studies show **no** increased risk of stillbirth, preterm birth or SGA associated with the vaccine. Several studies support better obstetric outcomes for mothers who are vaccinated.
 * Tdap: ** Recommended in all pregnancies between 27-36 weeks. Repeat in this time frame even if recently received. A boost in maternal antibodies crossing the placenta prior to delivery will help protect the baby from pertussis (whooping cough) in the first 2 months and is more effective than a postpartum vaccination.
 * __ Inactivated versus live attenuated vaccines __**
 * __ Post exposure prophylaxis with immune globulin __**

Do not give nasal version (live attenuated) || Yes. Given regardless of stage of pregnancy || Inactivated || Examples include patients at risk for acquiring HBV –multiple sexual partners, IVDA, household contacts of patients with Hep B. Can be given using accelerated schedule 0,1,4months. || Inactivated. || Pre exposure prophylaxis-Inactivated Hep A vaccine only Post exposure prophylaxis- Inactivated Hep A vaccine and Immune globulin. || Inactivated || Little information about safety in first trimester. Appears safe in second and third trimesters. Ideally should be given preconception. Given to women at risk for invasive pneumococcal Infection- women with functional or anatomic asplenia- sickle cell disease and other hemoglobinopathies. || Inactivated || (don’t use oral form) || Yes, if indicated. Pregnant women should avoid travelling to typhoid endemic area. || Use only the inactive parenteral form ||
 * ** VACCINE ** || ** RECOMMENDATION ** || ** TYPE OF VACCINE ** ||
 * Influenza (injection)
 * Tdap || Yes, given each pregnancy. Ideally given between 28-37wks of pregnancy || Inactivated ||
 * Hepatitis B || Yes, if indicated
 * Hepatitis A || Yes, if indicated
 * Pneumococcal || Yes, if indicated. Pneumococcal polysaccharide vaccine (PPSV23).
 * Yellow Fever || Yes, if indicated. But better to avoid travel to endemic areas. || Live attenuated ||
 * Polio (IPV) || Yes, if indicate. But, better to avoid travel to areas disease is present. || Inactivated ||
 * HPV || No, Under study but likely safe. || Inactivated ||
 * Haemophilus Influenza || Recommended(H. Influenza type B conjugate vaccine) for patients who did not receive childhood Hib series and are at increased risk of invasive Hib disease-pts with chronic conditions: sickle cell disease, leukemia, HIV || Inactivated ||
 * Meningococcal || Yes, if indicated. Either polysaccharide or conjugate. || Both are inactivated ||
 * Varicella or MMR || No. Give before pregnancy and avoid conception for 4wks. Given postpartum if nonimmune during pregnancy || Both are live ||
 * Rabies || Yes, if indicated || Inactivated ||
 * Typhoid injection
 * Cholera, Japanese Encephalitis || Yes, in patients at substantial risk || Inactivated ||