Other Vaccines

We list here the literature pertinent to those common vaccines that do not fall into our other categories. In most cases the literature supports their use during pregnancy when indicated.

An exception may be the BCG vaccine for prevention of tuberculosis. This vaccine is not available for general use in the United States, where our practice is located. But it is often required of those who wish to work or live in other countries.

We would like to stress the importance of typhoid vaccine whenever there is risk of exposure to this disease. Typhoid can be especially severe in pregnancy, resulting in bowel perforation as well as miscarriage, fetal death or premature birth. Thus we advocate the use of the vaccine in addition to the usual dietary protective measures.

Pneumococcal

1. Shahid NS, Steinhoff MC, Hoque SS, et al. Serum, breast milk and infant antibody after maternal immunization with pneumococcal vaccine. Lancet 1995;346:1252–1257 Polysaccharide vaccines have been used in pregnancy without adverse events and should be used when benefit outweighs risk.”

2. O'Dempsey TJ, McArdle T, Ceesay SJ, et al. Immunization with a pneumococcal capsular polysaccharide vaccine during pregnancy. Vaccine 1996 Jul;14(10):963-70 The feasibility of preventing invasive pneumococcal infections during the first few months of life by immunization during pregnancy has been investigated. One hundred and fifty Gambian women were immunized with either a 23-valent pneumococcal polysaccharide vaccine or a meningococcal polysaccharide vaccine during the last trimester of pregnancy. Pregnant women showed a good antibody response to five of the six pneumococcal polysaccharides tested (types 1, 3, 5, 6, 14 and 19) but not to type 6 polysaccharide. Mean cord blood/maternal blood IgG antibody ratios varied from 24% (type 1) to 49% (type 3) and differed substantially between individual mother/infant pairs. Pneumococcal antibody levels were higher at birth in infants of women immunized with pneumococcal polysaccharide vaccine than in control infants. However, these antibodies disappeared rapidly during the first few months of life and it is uncertain how much clinical protection against pneumococcal infection maternal immunization would have provided.

Meningococcal

1. McCormick JB, Gusmao H, Nakamura S, et al. Antibody response to serogroup A and C meningococcal polysaccharide vaccines in infants born of mothers vaccinated during pregnancy. J Clin Invest 1980;65:1141–1144. The polyvalent meningococcal meningitis vaccine (quadravalent A, C, Y, W135, or A & C) may be administered during pregnancy if the woman is entering an area where the disease is epidemic or during an outbreak. The safety of these vaccines during pregnancy has not been conclusively demonstrated, although a small study published by McCormick et al. In 1980 showed no birth defects in infants whose mothers were vaccinated during an epidemic in Brazil. Results from this study also showed that these children were not immunotolerant to groups A and C vaccines when administered at 6 months of age.”

2. Letson GW, Little JR, Ottman J, Miller GL. Meningococcal vaccine in pregnancy: an assessment of infant risk. Pediatr Infect Dis J 1998 Mar;17(3):261-3

3. Shahid NS, Steinhoff MC, Roy E, et al Placental and breast transfer of antibodies after maternal immunization with polysaccharide meningococcal vaccine: a randomized, controlled evaluation. Vaccine 2002 May 22;20(17-18):2404-9 We evaluated the strategy of maternal immunization with Neisseria meningitidis (Nm) vaccine in Asian mothers, to assess potential protection of infants, including by breast milk. One hundred and fifty-seven women in the third trimester were randomized to receive a single dose of the polysaccharide Nm (n=75) or a control vaccine (n=82). Group A Nm IgG levels were measured in maternal and infant sera, and specific IgA in breast milk. A 5.6-fold rise of Nm IgG antibody was observed among the Nm vaccinees. At delivery, geometric mean titres (GMTs) of Nm IgG antibody in Nm mothers was 12.5 microg/ml versus 4.97 microg/ml, with a mean infant/maternal antibody ratio of 0.56. Infants of Nm vaccinees had mean IgG levels of 6.9, 2.3, 1.2 and 0.6 microg/ml at 0, 6, 14 and 22 weeks, significantly higher than in control children up to 14 weeks. Anti-Nm IgA levels in milk were 6.8 to 2.0 microg/ml, significantly higher in Nm vaccinees till 6 months. Immunization during pregnancy is safe for both mothers and infants, and provides infants with significantly increased levels of specific IgG for 2-3 months and oral IgA for 6 months.

BCG

1. Bia FJ. Medical considerations for the pregnant traveler. Infect Dis Clin North Am 1992;6:371–388. The bacille Calmette-Guérin vaccine for the prevention of tuberculosis can theoretically cause disseminated disease and thus affects the fetus; skin testing for tuberculosis exposure before and after travel is preferable when the risk is high.”

Typhoid vaccine

Tetanus vaccine

1. Czeizel AE, Rockenbauer M. Tetanus toxoid and congenital abnormalities. Int J Gynaecol Obstet. 1999 Mar;64(3):253-8. OBJECTIVE: To study the human teratogenic potential of tetanus vaccination during pregnancy. METHODS: Pair analysis of cases with congenital abnormalities and matched healthy controls was performed in the large population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1994. RESULTS: Of 35 727 pregnant women who had babies without any defects in the study period (control group), 33 (0.09%) were vaccinated with tetanus. Of 21563 pregnant women who had offspring with congenital abnormalities, 25 (0.12%) had tetanus vaccination. This difference was not significant (P = 0.39). The case-control pair analysis confirmed the safety of tetanus vaccination during pregnancy, particularly in the second and third months of gestation, i.e. during the critical period for congenital abnormalities. CONCLUSION: Tetanus vaccination during pregnancy appears not be teratogenic to the fetus. Thus, there is no contraindication, if the use of tetanus toxoid is necessary during pregnancy.

Pertussis vaccine

1. Van Rie A, Wendelboe AM, Englund JA. Role of maternal pertussis antibodies in infants. Pediatr Infect Dis J. 2005 May;24(5 Suppl):S62-5. Pertussis remains a serious infection in young infants. Most deaths occur in the first 3 months of life, before administration of the first dose of pertussis vaccine. Pertussis antibodies are transferred from mother to infant; but because of the lack of serologic correlates of protection, it is difficult to determine the proportion of infants born with a protective concentration of maternal antibodies. Indirect evidence suggests that maternal antibodies provide short lived protection against fatal pertussis. It is hoped that the protection of young infants could be enhanced by maternal or neonatal vaccination. The possibility of protecting young infants against pertussis by immunizing their mothers during pregnancy was investigated in the 1930s and 1940s; no further studies have been published since. Recent animal and human studies have provided evidence that neonatal immunization with acellular pertussis vaccine can efficiently prime T and B cells and act as a basis for future immune response. The limited data on neonatal and maternal pertussis immunization are promising and call for further research to reduce the vulnerability of young infants to pertussis disease.

2. C H Wirsing von König, S Halperin, M Riffelmann, and N Guiso. Pertussis of adults and infants. Lancet Infect Dis 2002; 2: 744–50 Vaccination of adolescents and adults against pertussis has also been suggested and used as a containment strategy