Vaccines Recommended in Special Circumstances During Pregnancy
Vaccination in pregnancy is recommended against certain infections when the risk to the pregnant woman and/or her fetus of acquiring the infection is high. In such cases, vaccines are administered after the first trimester when possible.
Hepatitis B Vaccine
Hepatitis B vaccine is recommended for everyone under the age of 18 and for unvaccinated or incompletely vaccinated women who have risk factors for getting hepatitis B virus (HBV) infection. HBV during pregnancy may lead to severe illness in both mother and fetus and ultimately is likely to cause severe chronic illness in the newborn. All pregnant women should undergo screening for HBV at the first antenatal visit. Women who do not have immunity to HBV and who have a risk factor for acquiring HBV should be vaccinated.
Risk factors for acquiring HBV infection include:
- Close contact with HBV carriers (for example household or sexual contact)
- Being in a special patient risk group (for example those having hemodialysis)
- Infection with another sexually transmitted disease
- Being in prison
- Being an intravenous drug user
- Travel to areas of the world where the infection is endemic
- Screening for this infection allows the newborn infant at risk of HBV to receive birth doses of HBV vaccine and hepatitis B immune globulin (HBIG).
Meningococcal vaccine is recommended for pregnant women who are at increased risk of getting meningococcal disease. The available meningococcal vaccines licensed for use in adults (meningococcal polysaccharide vaccine [MPSV4] and meningococcal conjugate vaccine [MCV4]) protect against 4 types of meningococcal disease: types A, C, Y and W135. Two of these types (C and Y) cause more than two-thirds of all cases in women of child-bearing age in the United States. These vaccines are not recommended routinely for pregnant women but should be given in unvaccinated pregnant women for whom the risk of meningococcal disease is high. These include:
- people living where there is a meningococcus outbreak
- college freshmen, especially those who will live in dormitories
- military recruits
- people traveling to parts of the world where meningococcal disease is common
- microbiologists who could be exposed to meningococcus
- people who have damaged spleens or have had their spleens removed
- people with certain immune deficiencies
- Two published studies of MPS4 vaccine in pregnant women demonstrated it was safe and stimulated the production of antibodies that were transferred to newborn infants. No studies of MCV4 have been performed in pregnant women.
Pneumococcal Polysaccharide Vaccine
Pneumococcal polysaccharide vaccine (PPV23) protects against 23 types of pneumococcal disease. This vaccine is different from the pneumococcal conjugate vaccine (PCV7) recommended for children. PPV23 is recommended for women of child-bearing age who are at increased risk of getting pneumococcal disease, including those who:
have damaged spleens or have had their spleens removed
have certain cardiac, respiratory, metabolic and kidney diseases
have certain immune system deficiencies
take medications that depress the immune system.
In general, this vaccine is best administered before pregnancy occurs, but if a pregnant woman with risk factors has not received it, it should be administered during pregnancy. Studies of PPV23 have shown that it is safe and stimulates the production of antibodies in pregnancy.
Hepatitis A Vaccine
Hepatitis A vaccine is indicated for pregnant women who are at increased risk of acquiring hepatitis A virus (HAV) because HAV infection in pregnancy can be severe and cause spontaneous abortion or premature delivery of the infant. Examples of pregnant women at increased risk of HAV include those who have:
Household or occupational exposure to a person infected with HAV
Traveled to an area where HAV is endemic
Pregnant women exposed to hepatitis A also should receive immunoglobulin (purified antibodies given by injection into the muscle). The safety of hepatitis A vaccine in pregnancy has not been studied; because it is made from an inactivated virus the theoretical risk to the fetus is very small and should be weighed against the risks to mother and fetus of acquiring HAV infection.
Inactivated Poliovirus Vaccine
Inactivated poliovirus vaccine is recommended for pregnant women traveling to areas of the world where polio infection still occurs (for example, certain countries in Africa). Because polio has been eradicated from the developed world, it is not administered routinely during pregnancy. The oral poliovirus vaccine (OPV) that contains live, attenuated poliovirus is not recommended for use in pregnancy.
Rabies vaccine is recommended for pregnant women who have been exposed to rabies because the consequences of inadequately treated rabies exposure far outweigh any theoretical risk from the vaccine. There is no indication that rabies vaccine is associated with fetal abnormality. When the risk that a pregnant woman will be exposed to rabies is high, rabies vaccine can be administered.
Anthrax vaccine has been given inadvertently to pregnant women who subsequently had normal infants, but no studies have been published on the use of this vaccine in pregnancy. The CDC recommends this vaccine only be administered to pregnant women when the risks of acquiring anthrax are far greater than the theoretical risks of the vaccine (for example exposure to aerosolized anthrax).
Japanese Encephalitis Vaccine
Japanese encephalitis vaccine should be administered only to pregnant women who must travel to an area where Japanese encephalitis is endemic and the risks of exposure outweigh the theoretical risk of vaccination.