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Vaccination during pregnancy: rubella, whooping cough, varicella and influenza during pregnancy

Article

10. 09. 2019

To vaccinate or not to vaccinate during pregnancy?

Pregnancy is a very distinct period in a woman's life. Although vaccinating pregnant women is still often considered a taboo topic in our country, it is a very effective method of protecting both mother and fetus from infectious diseases. Some vaccines are specifically indicated in pregnancy to protect a pregnant woman and / or her unborn child. On the other hand, some other vaccines are specifically contraindicated during pregnancy, and should, therefore, be avoided. Some infectious diseases are particularly significant during pregnancy, mainly due to their preventability via vaccination; influenza, whooping cough, chickenpox, and rubella.

Even pre-conception, or during pregnancy planning, the woman should already know about her options for prevention against infectious diseases. She should be supported by her attending physicians i.e. GP and gynecologist. The need for vaccines is determined not only by pregnancy, but also by age, health, and possible travel plans. A woman should know before her pregnancy that she has been properly vaccinated in the past, or she should supplement the necessary vaccines as part of pregnancy planning. 

 

After vaccination, do the antibodies protect the baby as well? 

If the mother's immunity is properly protected, she can provide protection for her fetus via two mechanisms. In the last few weeks of pregnancy, maternal antibodies are actively transported across the placenta to the fetus. These antibodies are developed either after the mother is exposed to a pathogen,  or after she is vaccinated. They protect the child during the first months of their life, at an age when they do not yet have their own antibodies and their vulnerability to infectious diseases is high. The second mechanism protects the fetus by reducing the risk of transmission of infectious diseases from mother to child.

 

Which vaccines should not be administered during pregnancy? 

Live attenuated vaccines should not be administered during pregnancy, and a woman should be careful not to conceive within a month after vaccination. Live vaccines include rubella, measles, mumps, and varicella immunisations. 

 

What vaccines are recommended during pregnancy? 

On the other hand, every pregnant woman should aim to receive flu and whooping cough vaccines. Other inactive vaccines are administered during pregnancy after consideration of the risk of infection for the  individual pregnant woman.

 

Is breastfeeding a reason to delay vaccination? 

After delivery, any vaccinations that could not be administered during pregnancy should be organised. There is no reason why breastfeeding should postpone vaccination. For example, it may be necessary to inoculate a woman against varicella after birth or to supplement missing doses of tick-borne encephalitis or human papillomavirus vaccines.

 

Flu during pregnancy. Vaccination for influenza- recommended during pregnancy. 

In developed countries, influenza is the most common infectious disease that can be prevented by vaccines. Likewise, it is the most common cause of death from a disease that can be prevented by vaccination. Pregnancy significantly increases the risk of influenza complications, such as pneumonia, hospitalisation, and death. Influenza also increases the risk of pregnancy complications including preterm labor. Infants are another group increasingly at risk of influenza complications. Vaccination of pregnant women against influenza is recommended in most developed countries, including the Czech Republic, although in our country it is tragically neglected. Vaccination during pregnancy reduces the risk of complications for the pregnant woman, as well as the risk of complications for her infant, and therefore it is recommended that women should be vaccinated as soon as possible with the influenza vaccine available for the upcoming season, regardless of the stage of pregnancy (or before pregnancy).

 

Whooping cough during pregnancy: vaccination against whooping cough - recommended during pregnancy. 

Another disease against which vaccination of pregnant women is recommended in many countries is whooping cough. The occurrence of this disease is increasing for many different reasons. Infants in the first months of life are the most at-risk age group and the vast majority of pertussis deaths occur under the age of 6 months. In 2014, more than 70 cases of infant whooping cough were reported in the Czech Republic, and in recent years, several infants have died as a result of whooping cough. The current 6-in-1 (hexavaccine) vaccination schedule is insufficient in protecting the youngest patients. The most effective method of preventing infantile pertussis has proven to be vaccinating the mother during the last trimester of pregnancy (preferably in the 27th- 36th week). This recommendation is valid for all pregnancies, regardless of the interval from the last vaccination. A combination vaccine with tetanus, diphtheria and pertussis components (called Tdap) is used.

 

Rubella during pregnancy: vaccination against rubella- not allowed during pregnancy!

Contracting rubella during the first trimester of pregnancy can have catastrophic impacts on the development of the fetus. It can lead to miscarriage, birth defects of the heart, eyes, central nervous system, and they can cause blindness and deafness in the newborn. These disabilities are scientifically called congenital rubella syndrome (CRS). CRS was the main reason for the introduction of rubella vaccination in children. Nowadays, almost all children in the Czech Republic get vaccinated against rubella and therefore the incidence of CRS is low. The vaccination of 12-year-old girls against rubella has been routine since 1982. This means that any women born in 1970 and before should get vaccinated against rubella. However, your birth year isn’t considered as proof of immunity. Every woman, who plans to get pregnant or is pregnant should have documented proof of vaccination (or if rubella was contracted in the past, a proof of antibodies should be documented). 

 

Chickenpox in pregnancy: vaccination against chickenpox- not allowed during pregnancy

Despite being available, the vaccination against chickenpox isn’t part of the national immunisation program in the Czech Republic. Chickenpox is, therefore, one of the most common infectious diseases in childhood, but the risk of serious complications, including death, is very low in childhood. Adults, including pregnant women, have a significantly increased risk of severe chickenpox complications. Chickenpox can cause congenital disorders similar to congenital rubella syndrome in the early stages of pregnancy, although the risk is very small compared to rubella. The most dangerous time to contract chickenpox is within a few days before or after giving birth. In this case, there is a high risk of infecting a newborn with a high risk of death. For this reason, all women of childbearing age should have immunity against chickenpox. This means that every woman should have a documented chickenpox history in the past or be properly vaccinated or have laboratory-proven immunity by testing antibodies in the blood. Pregnant women who do not have a chickenpox immunity certificate should be vaccinated immediately after birth. The vaccine against varicella is contraindicated during pregnancy (must not be given).

 

Other possible vaccinations during pregnancy

Depending on the health condition of the woman as well as other factors, pregnant women may also be vaccinated against other diseases such as hepatitis A and B (jaundice A, B), pneumococci, etc. If in the middle of the vaccine schedule against human papillomaviruses, the schedule should be interrupted during pregnancy.

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