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Vaccination in pregnancy

all vaccines recommended in pregnancy

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Vaccination in pregnancy

  2. 2. WHAT IS VACCINE????????  A vaccine is a substance that is introduced into the body to prevent Infection or a certain pathogen  The vaccines are prepared from inactivated, live attenuated , modified or mutant forms of the causative agents. 3 Dr.ShashwatK.Jani.9909944160
  3. 3. OBJECTIVE Dr.ShashwatK.Jani.9909944160 4  To induce a state of immunity in the patient so that confrontation with offending organism can be successful in protecting the host.
  4. 4. Achievements: The biggest achievement of the immunization program is the eradication of small pox. India is free of Poliomyelitis caused by Wild Polio Virus (WPV) on 27 march 2014. India declared free of maternal and neonatal TT in June 2015 Besides, vaccination has contributed significantly to the decline in the cases and deaths due to the Vaccine Preventable Diseases (VPDs).
  5. 5. Adult immunization rates have fallen short of national goals, partly because of misconceptions about the safety and benefits of current vaccines.
  6. 6.  The danger of these misconceptions is magnified during pregnancy, when: 1. Concerned physicians are hesitant to administer vaccines and 2. Patients are reluctant to accept them.
  7. 7. The administration of vaccines during pregnancy poses a number of concerns about the risk of transmitting a virus to a developing fetus.
  8. 8.  The risk of transmitting a virus to a developing fetus is primarily Theoretical
  9. 9. Theoretic risks of vaccination must be weighed against the risks of the disease to mother and fetus.
  10. 10. MAJOR CONTENT OF VACCINES 1. Toxoids 2. Inactivated vaccines. 3. Attenuated vaccines 4. Subunit vaccines 5. Hyper immune globulins.
  11. 11.  Routine vaccines that generally are safe during pregnancy include- 1. Tetanus 2. Influenza 3. Hepatitis B 4. Meningococcal 5. Rabies
  12. 12. SPECIAL CONSIDERATIONS 1. Pneumococcal vaccine 2. Typhoid 3. Cholera 4. Hepatitis A 5. Yellow fever 6. Japanese encephalitis 7. Polio
  13. 13.  Vaccines that are contraindicated live attenuated vaccine include: 1. Measles, Mumps, and Rubella; 2. Varicella 3. (BCG) bacille Calmette-Guérin 4. Oral Polio
  14. 14. If a live-virus vaccine is inadvertently given to a pregnant woman, or if a woman becomes pregnant within four weeks after vaccination, she should be counseled about potential effects on the fetus.
  15. 15. INFLUENZA
  16. 16. INFLUENZA The influenza vaccine is a killed virus preparation with an annually adjusted antigenic makeup.
  17. 17. INFLUENZA It should be administered annually between October and December to high-risk patients.
  18. 18. INFLUENZA The vaccine should be administered to all pregnant women who will be in the second or third trimester of pregnancy during the influenza season
  19. 19. INFLUENZA Women in their second or third trimesters have higher morbidity, from influenza infection. Immunization should be avoided in most patients during the first trimester to avoid a coincidental association with spontaneous abortion, which is common in the first trimester.
  20. 20. INFLUENZA VACCINE  Trivalent inactivated influenza vaccine (TIV),live attenuated influenza vaccine (LAIV),recombinant quadrivalent vaccines are available in India.  TIV is annual, single IM dose of 0.5 ml.also known as flu shot(H1N1,H3N2,influenza B)  LAIV is administered by the intranasal route is approved for use in adults upto 50 years of age. Evidence recommends people at high risk for influenza related complication.  Recombinant quadrivalent vaccine is given, intradermal 0.5 ml single dose.saftey in pregnancy is under trial. 08/20/17VSGH
  21. 21. RABIES
  22. 22. Three forms of inactivated rabies vaccines are available, all considered equally safe and efficacious
  23. 23. RABIES Passive immunization is achieved through administration of human rabies immune globulin (HRIG).  20 IU per kg of HRIG is given at the wound site. There have been no identified associations between rabies vaccination and fetal abnormalities
  24. 24. ACTIVE IMMUNISATION Cell-culture vaccine is used for post- exposure prophylaxis in pregnancy. A five-dose i.m. regimen is recommended for post-exposure vaccination It is administered on days 0, 3, 7, 14 and 28 into the deltoid muscle.
  25. 25. PRE-EXPOSURE PROPHYLAXIS  Indications for pre-exposure immunization depend on the likelihood of exposure.  It may be considered in animal workers and travelers to enzootic areas who anticipate animal exposure.  3 intramuscular 0.1ml dose of cell-culture-based vaccine given on days 0, 7 and 21 or 28
  26. 26. TETANUS
  27. 27. Tetanus toxoid is routinely recommended for susceptible pregnant women.
  28. 28. While no evidence exists to prove that tetanus toxoid is teratogenic, waiting until the second trimester of pregnancy to administer toxoids is a reasonable precaution, minimizing any concern about the theoretic possibility of such reactions.
  29. 29. WHO NEEDS THE TETANUS VACCINE? Previously vaccinated pregnant women who have not received a Td vaccination within the past 3 years should receive a booster dose.
  30. 30. WHO NEEDS THE TETANUS AND DIPHTHERIA VACCINE?  According to CDC guidelines : 1ST dose between 16 -20 weeks & 2nd dose after 4 – 6 weeks . Previously vaccinated pregnant women who have not received a Td vaccination within the past 3 years should receive a booster dose. 33 Dr.ShashwatK.Jani.9909944160
  31. 31. In INDIA : Where tetanus infection is common in neonates and Antenatal visits are not regular in rural areas… Govt. Of India Guidelines : 1st dose at 1st ANC visit & 2nd after 4-6 weeks. 34 Dr.ShashwatK.Jani.9909944160
  32. 32. HEPATITIS B
  33. 33. HEPATITIS B Risk factors for a pregnant woman include: 1. Having multiple sexual partners, 2. Abusing intravenous drugs, 3. Having occupational exposure 4. Being a household contact of acutely infected persons or persons with a chronic carrier state.
  34. 34. HEPATITIS B Because it contains noninfectious hepatitis B surface antigen particles and it cause no risk to the fetus, neither pregnancy nor lactation is a contraindication to vaccination.
  35. 35.  20mcg is administered at 0, 1 and 6 months as an intramuscular injection in the deltoid  Antibody titres rise 20 to 30% after the first dose, 75 to 80% after 2nd dose and 90 to 95% after 3rd dose.
  36. 36. HEPATITIS A  A formaldehyde inactivated vaccine prepared from HAV grown in Diploid cells.  1ml im at 0,6 months  A vaccination is effective for 10 years  Advised mainly in persons entering endemic areas with HAV Infection.
  37. 37. COMBINED VACCINATION FOR HEPATITIS A AND B INFECTIONS. Now a combined vaccine is available for prevention of Hepatitis A and B Available as TWINRIX ( GSK ) 0.5ml im in 3 doses of 0,1,6months.
  39. 39. MENINGOCOCCAL  Vaccination may benefit travelers to areas in which N. meningitidis is endemic or epidemic  3 types of vaccines-(polysachharide/protein/conjugate based)  Only polysachharide vaccine safe in pregnancy  85% efficacy  0.5ml,im,single dose.  Offers protection for 3 years
  40. 40. PNEUMOCOCCAL VACCINE  A polyvalent polysaccharide containing capsular antigen with 23 Sero types  Gives 80 -90 % protection  Used in Dysfunctional spleen Sickle cell diseases, Chronic diseases of Liver, lungs, heart, Renal failure. HIV infection  0.5ml im single dose.
  41. 41. TYPHOID  3types of vaccines are available- 1)Vi polysaccharide vaccine-im 2)Ty21a-oral 3)Inactivated vaccine  Only inactivated vaccine can be given in pregnancy  0.5ml,subcutaneous,6weeks apart  ACOG recommends vaccine only when- 1)Travelling to endemic area 2)Close contact
  42. 42. YELLOW FEVER  Inactivated vaccine  0.5ml,im,single dose.  Offers life long immunity.  99% efficacy.  ACOG recommends vaccine only in people travelling to endemic areas.
  43. 43. JAPANESE ENCEPHALITIS  A vero cell derived inactivated vaccine of SA14- 14-2 strain- 0.5ml,im,2 doses 4weeks apart 75%efficacy Offers protection for 1 year  A vero cell derived vaccine of beijing strain- 0.5ml,im,3 doses 4 weeks apart 95% efficacy.offers protection for 3 years
  44. 44. CHOLERA  Killed bacterial vaccine  0.5ml,im,2 doses,4weeks apart  ACOG recommends vaccine to be given in only in outbreaks.  Risk to foetus is unknown  Maternal vaccine increases IgA titres in breastmilk
  45. 45. POLIO • Inactivated vaccine(salk) • 0.5ml,im • 3 doses at 0,4,6 months • Recommended only in outbreaks
  46. 46. IMMUNOGLOBULINS Recommended for post-exposure prophlyaxis in - oHepatitis A oHepatitis B oVaricella zooster oTetanus oMeasles oRabies
  47. 47.  Hepatitis A- -within 14 days -0.02ml/kg body weight,single dose -90% efficacy  Hepatitis B- -Within 12hours of exposure -0.05ml/kg body weight,repeat after 1 month -For newborn-0.5 ml -92% efficacy
  48. 48.  Varicella zooster Ig- -within 72hours -5ml,im,single dose  Measles- -Within 4 hours 0.25ml/kg body weight,im
  49. 49. The benefits of immunization to the pregnant woman and her neonate usually outweigh the theoretic risks of adverse effects.
  50. 50. Preconceptional immunization of pregnant women to prevent disease in the offspring is preferred to vaccination of pregnant women.
  51. 51. Whether live or inactivated vaccines are used, vaccination of pregnant women should be considered on the basis of the risk of the vaccination vs. the benefits of protection in a particular circumstance.