Vaccination in Pregnancy antenatal ppt.pptx

Vaccinations in Antenatal period
Obstetrics

1. Vaccination in Pregnancy By Dr. Lipsy Goyal Moderator –Dr Kavita M Bhatti

2. VACCINE IMMUNOBIOLOGICAL SUBSTANCE DESIGNED TO PRODUCE SPECIFIC PROTECTION AGAINST A GIVEN DISEASE.

3. TYPES Live attenuated Inactivated vaccine Toxoid Measles Mumps Rubella Yellow fever Varicella Small pox( vaccinia ) Influenza Rabies Hepatitis B Hepatitis A Pnemococcus Meningiococcus Typhoid Tetanus- diptheria - acellular pertussis ( Tdap )

4. IMMUNISATION DURING PREGNANCY Consider safe if otherwise indicated Contraindicated during pregnancy or safety not established Special recommendation pertains Tdap Influenza Hepatitis B Meningococcal Rabies Measles Mumps Rubella varicella Hepatitis A Pneumococcal Polio(IPV) Typhoid Yellow fever

5. dT Diphtheria is an infection of the nasal, pharyngeal, laryngeal, or other mucous membranes that can cause neuritis, myocarditis , thrombocytopenia, and ascending paralysis. Tetanus infection can cause production of a neurotoxin, leading to tetanic muscle contractions.

6. Who needs the Tetanus and Diphtheria vaccine?

7. According to CDC guidelines : 1 st dose between 16 -20 weeks 2 nd dose after 4 – 6 weeks . Previously vaccinated pregnant women who have not received a Td vaccination within the past 10 years should receive a booster dose. O.5 ml Intramuscular in upper arm

8. T-dap Tetanus – diptheria-acellular pertussis . Provide TRIPLE PROTECTION. “T” refers to standard dose of tetanus antigen. d and p refers to pediatric vaccine. One of the most cost effective stratergies in protecting newborn /young infants from pertussis Transplacental transfer of antibodies from mother to fetus . Antibodies provide protection in first few months of life.

9. OPTIMAL TIME to administer Tdap ?

10. ACOG , RCOG , IAP recommend single dose at 27-36weeks gestation At any time of pregnancy To maximise maternal body response and passive antibody transfer and levels in newborn

11. Newborn receives the highest possible protection against pertussis at birth along with tetanus and diptheria .

12. Young infants entirely dependent on passive immunization from maternal antibodies until the infant vaccine series is initiated at age 2 months Demonstrated by Healy and coworkers (2013), maternal antipertussis antibodies are relatively short-lived, and Tdap administration before pregnancy—or even in the first half of the current pregnancy—is not likely to provide a high level of newborn antibody protection. To maximize passive antibody transfer to the fetus, a dose of Tdap is ideally given .

13. Tdap can be considered instead of second dose of tetanus. If unknown tetanus vaccine status: administer 3 vaccinations containing tetanus and reduced diphtheria toxoids at 0, 4 weeks and 6 to 12 months; Tdap should replace one dose of Td, preferably given between 27 – 36 weeks gestation

14. Women not previously vaccinated with Tdap : if Tdap is not administered during pregnancy Tdap should be administered immediately postpartum.

15. Adverse effects mild to moderate pain Injection site induration Swelling , redness Wound Management: If a Td booster is indicated for a pregnant woman, health-care providers should administer Tdap .

16. INFLUENZA Inactivated influenza vaccine recommended for pregnant women in many industrialized countries {evidence of benefit to the mother and the infant.} LAV vaccines pose a theoretical risk to the fetus: contraindicated in pregnant women. Inactivated influenza vaccine recommended for all women who are or will become pregnant (in any trimester) during influenza season (CDC and ACOG) In the United States, usually early October through late March

17. Recommendations by ACOG Inactivated influenza vaccines can be given safely during any trimester. Maternal influenza immunization is an essential component of prenatal care for women and their newborns CDC and ACOG recommend post-exposure antiviral chemoprophylaxis (75 mg of oseltamivir once daily for 10 days) be considered for : pregnant women women who are up to 2 weeks postpartum (including pregnancy loss) close contact with someone infected with influenza. If oseltamivir is unavailable, zanamiver can be substituted, two inhalations once daily for 10 days.

18. Hepatitis B Pregnant women who are at risk for HBV infection during pregnancy and should be vaccinated. having more than one partner 6 months prior to pregnancy. evaluated or treated for an STD . Recent or current injection drug use. having had an HBsAg -positive sex partner.

19. If a woman acquires the virus during pregnancy, her fetus has a high likelihood of being chronically infected and for developing severe liver disease. Immunizing pregnant women against hepatitis B has been shown to be safe but has not been recommended for at-risk women until recently.

20. Dose schedule 3 doses series IM At 0,1 and 6 months Used with hepatitis B immune globulin for some exposure Exposed newborn needs birth-dose vaccination and immune globulin as soon as possible All infant should receive birth dose of vaccine

21. Meningococcal ( MenB ) Could be given in pregnancy or postpartum. Any meningococcal disease outbreak place a woman at risk for infection. Quadrivalent conjugate vaccine IM , single dose Asplenia , 2 doses

22. TYPHOID VACCINE Vi POLYSACCHARIDE ANTIGEN Not recommended routinely except for close , continued exposure or travel to endemic areas I.M. injection Primary :2 inj 4weeks apart Booster:1 dose , schedule not yet determined BRAND NAME-TYPBAR VACCINE

23. Hepatitis A Travel to developing countries Exposure to individuals with HAV infection Individuals receiving clotting factor concentrates Should be used with hep A immune globulin 2 doses I/M , 6 months apart Immunoglobulin-0.02ml/kg I/M in one dose. Infants born to women in incubation period or acutely ill state should receive dose of 0.5ml Ig as soon as possible

24. PNEUMOCOCCAL VACCINE Polysaccharide vaccine Brand- pneumovax 23 vaccine Contains 23 strains bacterial capsule Given before splenectomy , renal , metabolic , cardiac disease, immunosuppresion Safety in 1 st trimester not evaluated. 1 dose , repeat dose in 6 years in high risk women

25. Vaccines contraindicated in pregnancy MMR( measles , mumps , rubella) CONTRAINDICATED Vaccine susceptible women postpartum Breastfeeding is not contraindicated Congenital rubella syndrome never described after vaccination

26. VARICELLA Contraindicated but no adverse effects reported in pregnancy Teratogenicity is theoretical Vaccination of susceptible women considered postpartum Available as varilrix • S.C. Injection

27. HUMAN PAPILLOMA VIRUS VACCINE • RECOMBINANT VACCINE • QUADRIVALENT(TYPES 6,11,16,18)-GARDASIL • BIVALENT(16 & 18)-CERVARIX • I.M. INJECTION • REGIMEN-0,1MONTHS,6MONTHS NOT RECOMMENDED No teratogenicity observed

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