Immunizations

IMMUNIZATIONS DURING PREGNANCY

 Immediate

goal of immunization is prevention of disease in the individual and eradication of the disease itself

2 Types of Immunization  Active

immunization Involves administration of all or part of a microorganism to elicit an immunologic response  Passive immunization Administration of preformed antibody to a

Live Attenuated Virus Vaccine  Meales

•Indication during pregnancy -contraindicated •Dosing schedule - Single dose (MMR)

 Mumps

•Indication during pregnancy - contraindicated •Dosing schedule - Single dose (MMR)

 Rubella

•Indication during pregnancy - contraindicated •Dosing schedule - Single dose (MMR)

 Varicella

•Indication during pregnancy - contraindicated, but no adverse outcome reported in pregnancy •Dosing schedule - 2 doses needed with 2nd dose given 4-8 wk after 1st dose

Inactivated Virus Vaccine  Influenza

•Indication during pregnancy - All women, regardless of trimester, who will be pregnant during the influenza season •Dosing schedule - 1 dose IM every year

 Rabies

•Indication during pregnancy - Indications for prophylaxis not altered by pregnancy •Dosing schedule - To be consulted for indications, dosage and route of administration

 Hepatiti

B •Indication during pregnancy - Preexposure & postexposure for women at risk of infection •Dosing schedule - 3 doses series IM at 0, 1, & 6 month

 Hepatitis

A •Indication during pregnancy - Preexposure & postexposure if at risk (international travel) •Dosing schedule - 2 doses schedule 6 months apart

Inactivated Bacterial Vaccines  Pneumococcus

•Indication during pregnancy - Indications not altered by pregnancy •Dosing schedule - 1 dose only; consider repeat dose in 6 yrs for high-risk women

 Meningococcus

•Indication during pregnancy - Indications not altered by pregnancy •Dosing schedule - 1 dose

 Typhoid

•Indication during pregnancy - Not recommended routinely •Dosing schedule - Primary: 2 injections > 4 wks apart - Booster: 1 dose, schedule not yet determined

Toxoids

 Tetanus-diphtheria

•Indication during pregnancy -lack of primary series or no booster within past 10 year •Dosing schedule - Primary: 2 doses at 1-2 mo interval w/ 3rd dose 612 mo after the 2nd - Booster: Single dose IM every 10 year after

Specific Immune Globulins  Hepatitis

B •Indication during pregnancy - Postexposure prophylaxis •Dosing schedule - Give along w/ hepatitis vaccine, then vaccine alone at 1 & 6 months

 Rabies

•Indication during pregnancy - Postexposure prophylaxis •Dosing schedule - Half dose at injury site, half dose in deltoid

 Tetanus

•Indication during pregnancy - Postexposure prophylaxis

•Dosing schedule - 1 dose IM

 Varicella

•Indication during pregnancy - Considered for exposed pregnant women to protect against maternal not congenital infection •Dosing schedule - 1 dose IM w/in 9 hrs of exposure

Standard Immune Globulins  Hepatitis

A •Indication during pregnancy - Postexposure prophylaxis •Dosing schedule - 0.02 ml/kg IM for 1 dose of immune globulin

 Measles

•Indication during pregnancy - Postexposure prophylaxis •Dosing schedule - .25 ml/kg for 1 dose