Pregnancy Immunization Recommendations
Whether your office provides immunizations or you refer out for them, vaccines play an important role in keeping a pregnant woman and her baby healthy before, during, and after pregnancy.
Before becoming pregnant, a woman should be up-to-date on routine adult immunizations. The Centers for Disease Control and Prevention’s Immunizations and Pregnancy Vaccines Chart outlines recommendations that can be used to help assess the immunizations your patient needs. You may want to check if your patient has a yellow immunization record of her immunization history.
Of particular importance are:
- Tdap (tetanus, diphtheria, pertussis) – this is important for preventing pertussis (whooping cough). It should be given in place of Td vaccine, when tetanus protection is indicated
- MMR (measles, mumps, rubella)
- influenza – especially important if your patient might be pregnant during flu season, but recommended for all adults
- hepatitis B, if indiciated
Live vaccines (including MMR and varicella) should be given a month or more before pregnancy. Inactivated vaccines can be given before or during pregnancy, as needed.
HPV vaccine is recommended for females from 11 through 26 years of age. More research is needed about HPV vaccine and pregnancy. For now, pregnant women should wait until their pregnancy is over before getting the vaccine. If a woman finds out she is pregnant after she has started getting the vaccine series, she should wait until her pregnancy is over before finishing the three-dose series.
Flu vaccine is recommended for everyone annually. It is safe and, and very important, for a pregnant woman to receive the inactivated flu vaccine. A pregnant woman who gets the flu is at risk for serious complications and hospitalization. In California, the influenza vaccine given to pregnant women is preservative-free.
Pregnant women should not be vaccinated with live, attenuated influenza vaccine (LAIV), the influenza nasal spray vaccine.
Learn more about pregnancy and influenza vaccine recommendations.
Novel H1N1 Influenza Infection
Several illnesses among pregnant women have been reported.
It is anticipated that the pandemic H1N1 virus will again circulate during the 2010-2011 influenza season. This year’s 2010-2011 seasonal flu vaccine contains protection against the 3 strains anticipated to be circulating in the Northern hemisphere, including the pandemic H1N1 influenza A strain. Pregnant women should make sure that they receive the seasonal flu vaccine.
Pertussis (whooping cough)
Because of the pertussis epidemic in California, if a pregnant woman has not yet received the pertussis booster vaccine (Tdap), she should talk to her health care provider about the best time to get immunized. Young infants are the most vulnerable to the severe complications of whooping cough and may even die from the disease. Mothers and other close contacts are often the source of whooping cough in young infants. Make sure that all potential contacts with the newborn are protected against pertussis at least two weeks prior to close contact with the infant.
Many vaccine-preventable diseases, rarely seen in the United States, are still common in other parts of the world. Information about travel vaccines can be found at CDC’s traveler’s health website.
Some immunizations should be given in the hospital before discharge to protect your patient from diseases that can be dangerous if spread to her newborn or to future babies. It is safe for a woman to receive vaccines right after giving birth, even while she is breastfeeding.
Pertussis (whooping cough) and Influenza
Babies can get very sick from pertussis (whooping cough) and influenza, but are too young to be immunized.
A woman who has not received the new vaccine for the prevention of tetanus, diphtheria, and pertussis (Tdap) should be vaccinated right after delivery. Vaccinating a new mother against pertussis (whooping cough) also reduces the risk to her infant. Learn more about the new Tdap recommendations on preventing tetanus, diphtheria, and pertussis among your pregnant and postpartum patients and their infants.
In order to further protect your patient’s newborn, Tdap and influenza vaccine are needed for:
- anyone who lives with,
- or takes care of her baby.
MMR and Varicella
A woman who is not immune to measles, mumps, or rubella should be vaccinated with MMR before leaving the hospital. Your patient should also receive varicella vaccine before discharge if she does not have evidence of immunity.
If the first-ever dose of MMR or varicella vaccine is given after delivery, then the 2nd doses should be given 4-8 weeks later.
California Vaccines for Children (VFC) Program
The California Vaccines for Children (VFC) program helps families by providing free vaccines to doctors who serve eligible children through age 18 years. That way, children can get the routine immunizations they need at little or no out-of-pocket cost to the family.
California Thimerosal (Mercury) Law
The new Mercury-Free Act took effect on July 1, 2006. The Act prohibits administering vaccines containing more than trace thimerosal preservative to pregnant women or to children under age three.