Which vaccines contraindicated in pregnancy

Epub Apr Vaccinations given during pregnancy, A descriptive study external icon. Am J Prev Med. Epub Dec Safety of influenza A H1N1 live attenuated monovalent vaccine in pregnant women.

Inactivated influenza vaccine during pregnancy and risks for adverse obstetric events external icon. Obstet Gynecol. Identifying pregnancy episodes, outcomes, and mother-infant pairs in the Vaccine Safety Datalink external icon. Predictors of seasonal influenza vaccination during pregnancy external icon.

Safety of meningococcal polysaccharide-protein conjugate vaccine in pregnancy: A review of the Vaccine Adverse Event Reporting System external icon.

Am J Obstet Gynecol. Epub Feb Trivalent inactivated Influenza vaccine and spontaneous abortion. Safety of seasonal influenza and influenza A H1N1 monovalent vaccines in pregnancy external icon.

Expert Rev Vaccines. Assessing the safety of influenza immunization during pregnancy: The Vaccine Safety Datalink external icon. Epub Jul 9. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women external icon. Adverse events following administration to pregnant women of influenza A H1N1 monovalent vaccine reported to the Vaccine Adverse Event Reporting System. Adverse events in pregnant women following administration of trivalent inactivated influenza vaccine and live attenuated influenza vaccine in the Vaccine Adverse Event Reporting System, Epub Oct Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants external icon.

Arch Pediatr Adolesc Med. Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants external icon. Am J Perinatol. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Vaccine Safety. Section Navigation. Facebook Twitter LinkedIn Syndicate.

Minus Related Pages. Frequently Asked Questions. Are vaccines safe during pregnancy? Which vaccines should I get if I am pregnant?

Which vaccines should I not get if I am pregnant? Can a vaccine harm my developing baby? Are vaccines safe if I am breastfeeding? 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. MMWR ; 60 No. Top of Page. Women susceptible to rubella and varicella should be vaccinated immediately after delivery.

A woman found to be HBsAg positive should be monitored carefully to ensure that the infant receives HBIG and begins the hepatitis B vaccine series no later than 12 hours after birth and that the infant completes the recommended hepatitis B vaccine series on schedule.

Although live viruses in vaccines can replicate in vaccine recipients i. Varicella vaccine virus has not been found in human milk. Although 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. Inactivated, recombinant, subunit, polysaccharide, and conjugate vaccines, as well as toxoids, pose no risk for mothers who are breastfeeding or for their infants.

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. Formulating policy to guide vaccination of women during pregnancy and breastfeeding is challenging because the evidence-base to guide decisions is extremely limited.

Regulation traditionally required that each product be classified under one of five pregnancy categories A, B, C, D, or X, as described below , on the basis of risk of reproductive and developmental adverse effects or, for certain categories, on the basis of such risk weighted against potential benefits.

Pregnancy Category A. Adequate and well controlled studies in women fail to demonstrate a risk to the fetus in the first trimester and there is no evidence of a risk in later trimester , and the possibility of fetal harm appears remote.

Recent world events have brought to light the threat of terrorists who may deliberately release smallpox, and have prompted an evaluation of vaccination policies and emergency preparedness. The U. Detailed information about the smallpox vaccination program is available online at www. Vaccinia vaccine should not be administered to pregnant women for routine non-emergency indications. Smallpox infection among pregnant women has been reported to result in a more severe infection than among nonpregnant women.

Therefore, the risks to the mother and fetus from experiencing clinical smallpox substantially outweigh any potential risks regarding vaccination.

While the vaccinia vaccine has not been shown to be teratogenic or to cause congenital malformations, the virus has been reported to cause fetal infection on rare occasion, with subsequent risk of skin lesions, preterm delivery, stillbirth, or infant death. Women should therefore actively avoid becoming pregnant for at least four weeks after vaccination and until the scab has completely healed and fallen off. Vaccination should also be avoided for household or close contacts of women who are pregnant.

A pregnancy test may be considered for women who might be pregnant with the caveat that very early pregnancies will not be detected. The safety of breast milk after maternal vaccination has not been studied, so women who are pumping or breastfeeding should not receive the vaccine. Household contacts of breastfeeding infants theoretically can be immunized; however, it is reasonable to defer pre-event vaccination of household contacts of infants younger than one year since data suggest higher risks of adverse effects in this age group.

As with any vaccination, these risks need to be weighed against the potential benefits, given the individual circumstance of each patient. Patients with close-proximity contact with a smallpox patient should be vaccinated regardless of their pregnancy status or that of their household contacts.

Because infection during pregnancy has been reported to cause a more aggressive course of disease than in the non-pregnant state, the risks of vaccination would be outweighed by the risks of disease in these situations. Vaccinia Immune Globulin VIG is also available from the CDC by Investigational New Drug Protocol for the treatment of adverse reactions to the vaccine, such as progressive vaccinia, eczema vaccinatum, and severe generalized vaccinia.

Rabies is a viral infection transmitted most commonly by the saliva of infected animals. Nonspecific prodromal symptoms progress to encephalitis marked by confusion, hallucinations, and bizarre thoughts that are interspersed by shortening periods of lucid thought. Three forms of inactivated rabies vaccines are available in the United States, all considered equally safe and efficacious.

Passive immunization is achieved through administration of human rabies immune globulin HRIG. Indications for pre-exposure rabies immunization depend on the likelihood of exposure. For the U. With any animal bites occurring out of this country, as well as with bites from a domestic bat, woodchuck, skunk, raccoon, or fox, and with abnormally acting pets or wild animals, the animal should be euthanized, and the brain tested for infection.

Bites from normally acting dogs, cats, and ferrets in the United States warrant a day observation period, with prophylaxis and euthanization of the animal deferred. Postexposure rabies vaccination may be started pending the results of these tests, depending on local rabies incidence rates.

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. Considering the potential maternal and fetal consequences of untreated rabies exposure, similar guidelines should be used for postexposure prophylaxis in pregnant and nonpregnant patients.

If a substantial risk of exposure to rabies remains after risk-factor modification, pre-exposure prophylaxis may be indicated during pregnancy. Japanese encephalitis JE is the leading cause of viral encephalitis in Asian countries, with one quarter of cases having a fatal outcome, and residual neuropsychiatric sequelae occurring in up to one half of survivors.

Transmission peaks in late summer but varies regionally and may be year-round in tropical areas. Travelers to rural parts of Asia have a highly variable risk of acquiring JE infection, estimated at approximately one in 5, per month.

In the case of short-term travel to urban areas, however, risks of acquiring JE infection are less than one per million. JE vaccination is recommended only for travelers with a significant risk of exposure. In general, those spending at least a month in endemic areas during the transmission season and those planning to participate in outdoor activities exposing them to unavoidable mosquito bites should be vaccinated.

The most widely used JE vaccine the Biken vaccine is an inactivated virus vaccine that produces a percent rate of seroconversion after three doses. No specific data are available regarding JE vaccine safety in pregnancy.

Since JE infection during the first and second trimesters has been associated with intrauterine infection and miscarriage, the vaccine is not recommended during this time. In deciding whether to vaccinate a pregnant woman, the theoretic risks of vaccination must be weighed against the maternal and fetal risks associated with JE infection, given the likelihood of exposure. Vaccination should be considered before conception in a woman who will be traveling to high-risk areas while pregnant, in conjunction with optimized mosquito-bite precautions.

Yellow fever is a viral hemorrhagic fever syndrome spread by mosquitoes in parts of South America and Africa; it has urban and rural forms. The yellow fever vaccine is a live, attenuated virus grown in chick embryos. It is indicated for use in laboratory workers involved with the virus and in persons planning to travel to endemic areas. It is contraindicated in persons with anaphylactic reactions to eggs and immunocompromised persons, as well as infants under nine months of age, because of an age-related risk of encephalitis.

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. A physician's waiver will often suffice for international travel requirements. Mosquito exposure must be minimized as much as possible.

When travel cannot be postponed and mosquito exposure is likely, however, yellow fever vaccination may be considered. Mycobacterium tuberculosis causes more than 8 million new cases of tuberculosis TB annually, the majority of them in developing countries.

The number of cases reported in the United States has increased since the mids, as has the incidence of multi—drug-resistant TB. Despite this trend, the incidence of disease in the United States is low enough that routine immunization is not recommended. The efficacy of the vaccine in protecting children from active disease has been shown to be about 80 percent, but the efficacy in adolescents and adults is significantly less and highly variable across studies.

Physicians who are considering the use of BCG vaccine in their patients are encouraged to consult the TB control programs in their area. 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, data from BCG immunization research have not been studied extensively in pregnant women. Use of the BCG vaccine is not recommended during pregnancy. 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, or intermediate-risk areas, such as Mexico, Haiti, north Africa, and Iran.

Transmission of Salmonella typhi is significantly increased with travel during local epidemics and ingestion of food from street vendors. Primary prevention consists of hand washing, drinking only safe water, peeling all fruits and vegetables, and eating well-cooked foods. 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. The oral vaccine is given on alternate days in four doses, with reported efficacy rates varying greatly 50 to 95 percent. Its use is contraindicated in infants, immunocompromised persons, and those with abnormal gastrointestinal function, as well as pregnant women. The purified capsular polysaccharide Vi vaccine is given as a single injection.

It has similar efficacy rates, but its use is not contraindicated in the immunocompromised population. Neither form of typhoid vaccine is officially recommended during pregnancy. The oral form is contraindicated in pregnancy because it is a live virus, presenting theoretic risks of transmission to the fetus.

This contraindication does not exist with the parenteral form; however, studies demonstrating the latter's efficacy and safety during pregnancy have not been performed. Potential benefits and risks of immunization should be considered on an individual basis.

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.

No cholera vaccines are currently licensed for use in the United States. Both are more effective, better tolerated, and longer lasting than the parenteral vaccine. These may be considered for use in populations at immediate risk of a cholera epidemic or for travelers to areas of high endemicity. Parenteral cholera vaccination is no longer recommended by the World Health Organization. Officially, cholera vaccination requirements no longer exist for any country. Should proof of vaccination be requested, a physician's statement of medical contraindication usually suffices.

No specific information exists on the safety of parenteral cholera vaccination during pregnancy. Preliminary data indicate safety of the killed vaccine in pregnancy and breastfeeding, but the live vaccine should be avoided due to theoretical safety concerns. Plague, a disease caused by Yersinia pestis , is naturally hosted by rodents and their fleas.

The plague vaccine is no longer commercially available in the United States. It was previously recommended only for use in travelers to endemic areas who had a high risk of exposure to wild rodents and fleas.

Its efficacy was not well studied. All persons with definite exposure should receive a seven-day course of appropriate antibiotics often tetracyclines, doxycycline, or trimetho-prim-sulfamethoxazole [Bactrim, Septra].

The effects of plague vaccine on the developing fetus are not known. Pregnant women should avoid high-risk situations and use insecticides and other protective measures. Prophylactic antibiotics that are safe during pregnancy may be considered in women with a substantial risk of infection.

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