VACCINATION IN PREGNANCY 25092023.pptx

Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉

1. Vaccination in pregnancy 14 TH SAFOG CONFERENCE, The lalit , MUMBAI, 23/09/2023.

2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital President, MOGS (2022-2023) Joint Treasurer, FOGSI (2021-2025) Organising Secretary, AICOG Mumbai 2025 Treasurer, AFG (2023-2024) Member Oncology Committee, SAFOG (2021-2023) Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses Editor-in-Chief, FEMAS , JGOG & TOA Journal 67 publications in International and National Journals with 172 C itations National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-202 2 ) Chair & Convener, FOGSI Cell Violence Against Doctors (2015 - 16) Member, Oncology Committee AOFOG (2013-2015) Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16) Member, Managing Committee IAGE (2013-17), (2018-20) , (2022-2023) Editorial Board, European Journal of Gynaec. Oncology (Italy) Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH (2018-19) DR. NIRANJAN CHAVAN MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP, DIPLOMA IN ENDOSCOPY (USA)

3. OVERVIEW HISTORY INTRODUCTION GENERAL PRINCIPLES OF IMMUNISATION TIME OF VACCINE ADMINISTRATION VACCINES IN PREGNANCY PRE-CONCEPTIONAL IMMUNISATION ROUTINE PRE-NATAL IMMUNISATION SPECIAL VACCINES COVID-19 VACCINE IN PREGNANCY

4. introduction Maternal immunization protects both the mother and fetus from the morbidity of certain infections. It can also provide the infant passive protection against vaccine-preventable infections acquired independently after birth. Vaccination during pregnancy is warranted when the risk of exposure is high, the infection poses risks to the mother and/or fetus, and the vaccine is unlikely to cause harm. 

5. GENERAL PRINCIPLES FOR IMMUNISATION IN PREGNANCY Pregnancy should be ruled out prior to immunization in women of childbearing age. Immunization history: a part of 1 st ANC visit. Live viral vaccines are contraindicated. The risk is largely theoretical. Pregnant women who have inadvertently received live vaccines should not undergo termination for teratogenic risk. Non-pregnant women should delay pregnancy for at least 4 weeks. Postpartum patients should receive all recommended vaccines that could not be or were not administered during pregnancy.

6. Providers should administer appropriate non-live vaccines to pregnant patients with medical or exposure indications that put them at risk for vaccine-preventable infections. I mmunizations that are routinely recommended for all pregnant patients: Tetanus, reduced Diphtheria toxoid, acellular Pertussis (Tdap) vaccine, and Influenza vaccine. P ostpartum patients should receive all recommended vaccines that could not be or were not administered during pregnancy.

7. TIME OF VACCINE ADMINISTRATION The ideal timing of vaccination is in the early third trimester to achieve maximum maternal antibody levels and maximum antibody transfer before delivery. M aternal IgG levels reach their peak about four weeks after immunization. T he influenza vaccine is given for maternal and infant protection and should therefore be provided seasonally to all pregnant patients regardless of gestational age.

8. VACCINES IN PREGNANCY

9. COVID -19 Vaccine

10. PRE-CONCEPTIONAL IMMUNISATION   Individuals should be vaccinated against preventable diseases in their environment before conception according to the recommended adult immunization schedule.  Measles-related morbidity appears to be greater in pregnant than in nonpregnant patients, and measles, mumps, and rubella infections are associated with adverse pregnancy outcomes.  Women should delay pregnancy for at least 4 weeks after receiving the live MMR vaccine. MMR vaccine should be given in 2 doses 4 weeks apart.

11. Consequences of measles, mumps, and rubella in pregnancy in an unvaccinated woman Measles - increased rate of spontaneous abortion , preterm labor, LBW Mumps - if affected in the first trimester, increased risk of IUFD Rubella - Congenital rubella syndrome

12. RUBELLA The typical rash of rubella is an erythematous maculopapular eruption , mildly pruritic , and evolves into pinpoint papules . The rash characteristically begins on the face and spreads to the trunk and extremities within hours. A pproximately 20 percent of those infected will develop discrete rose spots on the soft palate ( Forchheimer spots). Serum should be obtained within 7 to 10 days after the onset of the rash and repeated two to three weeks later. Rubella virus may be isolated from nasal, blood, throat, urine, or cerebrospinal fluid specimens.

13. Reverse transcription-nested PCR assay detects rubella virus in chorionic villous samples (CVS) and amniotic fluid samples of affected pregnancies.  Women should be offered pregnancy termination prior to 16 weeks gestation. After 20 weeks gestation, parents should be counseled about the potential for delayed consequences of rubella infection.   CVS sampling done at 10 to 12 weeks gestation would allow for earlier detection than other samples, such as fetal blood obtained at 18 to 20 weeks gestation.

14. Congenital rubella syndrome  Risk of congenital defects after maternal infection is essentially limited to maternal infection in the first 16 weeks of pregnancy .

15. measles The exanthem of measles arises approximately two to four days after the onset of fever; it consists of an erythematous, maculopapular, blanching rash, which classically begins on the face and spreads cephalocaudally. Congenital measles (defined by the appearance of measles rash within 10 days of birth) and postnatally acquired measles (defined as the appearance of measles rash within 14 to 30 days of birth) are associated with a spectrum of illnesses like  diarrhea , pneumonia, and encephalitis. 

16. varicella Mother acquires varicella infection during the early gestational period (weeks 8 to 20), the fetus is at risk for developing congenital varicella syndrome    Nonpregnant women who do not have evidence of immunity to varicella should be offered the standard dosing of vaccine (i.e ., 2 doses four to eight weeks apart).

17. Congenital varicella syndrome

18. ROUTINE PRENATAL IMMUNIZATIONS

19. TOG 6 TH CONCLAVE BY FOGSI

20. ROUTINE PRENATAL IMMUNIZATIONS Two doses of tetanus toxoid injection at least 28 days apart are to be given to all pregnant mothers commencing from the second trimester. If the subsequent pregnancy occurs within 5 years only one booster is given. Tetanus diphtheria acellular pertussis (T-dap) vaccination can be considered instead of the second dose of tetanus toxoid to offer protection against diphtheria and pertussis in addition to tetanus. Tetanus and diphtheria vaccination can be an alternative if T-dap is not available.

21. If a case of neonatal tetanus is identified, the mother should be given tetanus toxoid as early as possible and the baby to be treated as per national guidelines. The mother should receive a second dose of toxoid 4 weeks after the first and a third dose 6 months after the second. All  patients who are pregnant during the influenza season should receive the  inactivated influenza vaccine   as soon as it becomes available and before the onset of influenza activity in the community, regardless of their stage of pregnancy .

22. VACCINES CONTRAINDICATED IN PREGNANCY

23. TOG 6 TH CONCLAVE BY FOGSI

24. SPECIAL VACCINES

25. TOG 6 TH CONCLAVE BY FOGSI

26. HEPATITIS A Hepatitis A is an RNA virus, and the vaccines are formalin-inactivated The vaccine is indicated in special circumstances when the benefits outweigh the risks- Chronic liver disease Hemophilia Intravenous drug abuse Working with primates and Travel to endemic regions.

27. HEPATITIS b Hepatitis B is a DNA virus and is an inactivated subunit vaccine. Three doses are highly effective in disease prevention. The vaccine is recommended for pregnant women who are at high risk during pregnancy such as Women with multiple sex partners during the previous 6 months, Those who inject drugs/partner injects drugs, Regular blood transfusion , Liver disease and chronic kidney disease, Women traveling to high-risk countries and, Risk of contact with body fluids like doctors, nurses, and lab staff

28. Pneumococcal vaccine Thirteen-valent pneumococcal conjugate vaccine and 23-valent polysaccharide vaccines are recommended for mothers who have risk factors. The vaccine can be given during breastfeeding. The risk factors recommended for vaccine usage are Diabetes mellitus, Congenital or acquired immunodeficiencies, Anatomic or functional asplenia, Chronic liver disease, Smoking, alcoholism, cirrhosis of the liver, and chronic renal failure.

29. Yellow fever Yellow fever is caused by an RNA flavivirus and is spread by mosquitoes, and the vaccine is live attenuated. The disease is endemic in South America and sub-Saharan Africa. CDC recommends vaccination during pregnancy if there is a risk of exposure. Non-pregnant women of reproductive age group are advised to avoid conception for 4 weeks post-vaccination. In countries where the Yellow fever vaccine is an entry requirement but the disease is not endemic, pregnancy constitutes medical grounds for exemption from the vaccination requirement.

30. rabies The  rabies vaccine , an inactivated vaccine, can be given as pre-exposure prophylaxis during pregnancy if the risk of exposure is substantial.

31. Human papilloma virus HPV vaccines are not recommended for use in pregnant women. If a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose series should be delayed until completion of pregnancy. A pregnancy test is not needed before vaccination. If a vaccine dose has been administered during pregnancy, no intervention is needed .

32. Bcg vaccine BCG vaccination should not be given during pregnancy as it is a live vaccine and can harm the fetus.

33. COVID -19 VACCINE The Ministry of Health and Family Welfare, Government of India , approved the vaccination of pregnant women against COVID-19 on 2nd July 2021. Vaccination is highly effective in reducing the severity of COVID-19 infection, hospitalization, and death. Protective antibodies are found in umbilical cord blood and breast milk which shows protection to the neonate.

34. Vaccines available in India are: Covishield- produced by Serum Institute of India (SII) in collaboration with Astra-Zeneca. This is an adenovirus-based viral vector vaccine. Covaxin - produced by Bharat Biotech Ltd. This is an indigenous vaccine and is an inactivated (killed) whole virus vaccine. Sputnik V- produced by Gamaleya Research Institute. This is an adenovirus-based viral vector vaccine. ZYCOV-D – produced by Zydus Cadila Healthcare. It is a DNA plasmid-based vaccine.

35. All vaccines at present recommend 2 doses . They are to be administered intramuscularly preferably on deltoid muscle. The vaccinated person is to be observed for 30 minutes for any immediate adverse effects. The interval between two doses is generally 4 to 8 weeks .

36. Figo statement on COVID-19 vaccination and breastfeeding

37. ICMR is currently doing a project on “ Severity of COVID disease and pregnancy outcome among women with COVID infection with or without COVID vaccination – A multicentric case-control study” The study will be conducted in Govt. Medical colleges from 6 zones of the country, namely JIPMER (South Zone ), Lokamanya Tilak Municipal Medical College in Mumbai (West Zone), AIIMS Bhubaneswar (East Zone), AIIMS Bhopal (Central Zone), Maulana Azad Medical College (North Zone), and Tripura Medical College (North-East Zone). I am contributing to this research project as I am the Principal Investigator of the West Zone .

38. TOG 2019 REFERENCES Bhatt B, Jindal H, Malik JS, et al. Vaccination for pregnant women: Need to address. Hum Vaccin Immunother . 2014; 10(12):3627-8. Swamy GK, Heine RP. Vaccinations for Pregnant Women. Obstet Gynecol. 2015 Jan; 125(1): 212–226. WHO recommendation on tetanus toxoid vaccination for pregnant women. 2018. https://extranet.who.int/rhl/topics/ preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-tetanus-toxoid vaccination-pregnant-women B, Jindal H, Malik JS, et al. Vaccination for pregnant women: Need to address. pregnant-women

39. THANK YOU!