Full length article| Volume 265, P1-6, October 2021

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Vaccination in pregnancy – The when, what and how?


      Immunization is a fundamental component of preventive healthcare. This gain special significance in pregnancy. Maternal antigen-specific IgG, is actively transported across the placenta during pregnancy. This significantly, contributes to infant immunity in the first few months of life. Vaccination during pregnancy has the potential to indirectly protect the most vulnerable infants during the first few months of life, when vaccine responses are generally poor and it is difficult to achieve rapid protection through immunization. This is especially relevant when there is prior exposure to infection in woman or vaccine administration. A vaccine given during pregnancy in these women would result in a booster response and a relatively high level of IgG protecting their children in initial few months of life. Passive antibody transfer from mother to fetus can protect fetuses from infection until their own immunization schedule is initiated.
      Lack of administration of appropriate vaccination to women during pregnancy lead to an increase in maternal and fetal morbidity and mortality from preventable infections like influenza, pertussis. Various preventable infections can lead to intensive care unit admission for mothers, preterm birth, and low birth weight babies.
      Recent covid pandemic has brought issue of vaccine use in pregnancy at forefront of all expectant mothers.
      Immunization with inactivated virus, bacterial vaccine and toxoids showed no evidence of adverse fetal effects.
      As a rule, live attenuated vaccines are not recommended in pregnancy.
      This paper gives snapshot of all vaccines, which can be used in pregnancy along with brief details regards various bacterial and viral infections , their common clinical features and effects on pregnancy outcome as well as fetus. This is will provide a useful guide for healthcare providers.


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      1. Jones CE, Calvert A, Le Doare K. Vaccination in pregnancy - Recent developments. Pediatr Infect Dis J 2018.

        • Calvert A.
        • Jones C.E.
        Placental transfer of antibody and its relationship to vaccination in pregnancy.
        Curr Opin Infect Dis. 2017; 30: 268-273
        • Thwaites C.L.
        • Beeching N.J.
        • Newton C.R.
        Maternal and neonatal tetanus.
        Lancet. 2015; 385: 362-370
      2. Tetanus vaccines: WHO position paper, – Recommendations Vaccine 2018 February 2017 36 10.1016/j.vaccine.2017.02.034

      3. ACOG: Committee Opinion. No 282. Immunization During Pregnancy Int J Gynecol Obstet 2003 January 2003 10.1016/s0020-7292(03)00098-5

      4. Clarke KEN, MacNeil A, Hadler S, Scott C, Tiwari TSP, Cherian T. Global epidemiology of diptheria. Updat Myopia A Clin Perspect 2019;25.

        • Sharma N.C.
        • Efstratiou A.
        • Mokrousov I.
        • Mutreja A.
        • Das B.
        • Ramamurthy T.
        Diphtheria. Nat Rev Dis Prim. 2019; 5
        • El Seed A.M.
        • Dafalla A.A.
        • Abboud O.I.
        Fetal immune response following maternal diphtheria during early pregnancy.
        Ann Trop Paediatr. 1981; 1: 217-219
      5. World Health Organization. Diphtheria vaccine: WHO position paper, August 2017 – Recommendations. Vaccine 2018;36.

        • Kilgore P.E.
        • Salim A.M.
        • Zervos M.J.
        • Schmitt H.-J.
        Microbiology, disease, treatment, and prevention.
        Clin Microbiol Rev. 2016; 29: 449-486
      6. McMillan M, Clarke M, Parrella A, Fell DB, Amirthalingam G, Marshall HS. Safety of tetanus, diphtheria, and pertussis vaccination during pregnancy a systematic review. Obstet Gynecol 2017;129.

        • Swamy G.K.
        • Wheeler S.M.
        Neonatal pertussis, cocooning and maternal immunization.
        Expert Rev Vaccines. 2014; 13: 1107-1114
        • Bosis S.
        • Mayer A.
        • Esposito S.
        Meningococcal disease in childhood: Epidemiology, clinical features and prevention.
        J Prev Med Hyg. 2015; 56
      7. Abu Raya B, Sadarangani M. Meningococcal vaccination in pregnancy. Hum Vaccines Immunother 2018;14.

        • Adriani K.S.
        • Brouwer M.C.
        • van der Ende A.
        • van de Beek D.
        Bacterial meningitis in pregnancy: Report of six cases and review of the literature.
        Clin Microbiol Infect. 2012; 18: 345-351
        • Weiser J.N.
        • Ferreira D.M.
        • Paton J.C.
        Streptococcus pneumoniae: Transmission, colonization and invasion.
        Nat Rev Microbiol. 2018; 16: 355-367
        • Service U
        D of H& H.
        Vaccines and Preventable Disease, Centers Dis Control Prev2019
        • Chaithongwongwatthana S.
        • Yamasmit W.
        • Limpongsanurak S.
        • Lumbiganon P.
        • Tolosa J.E.
        Pneumococcal vaccination during pregnancy for preventing infant infection.
        Cochrane Database Syst Rev. 2015;
        • Lekshmi N.
        • Joseph I.
        • Ramamurthy T.
        • Thomas S.
        Changing facades of vibrio cholerae: An enigma in the epidemiology of cholera.
        Indian J Med Res. 2018; 147: 133
      8. I. C, M. B, J. T, N. S, E. S. Pregnancy and cholera; pregnancy outcomes from specialized cholera treatment unit for pregnant women in Leogane, Haiti Trop Med Int Heal 16 2011

      9. World Health Organization. WHO Fact Sheet: Cholera. World Heal Organ - Fact Sheets 2019.

        • Marchello C.S.
        • Birkhold M.
        • Crump J.A.
        Complications and mortality of typhoid fever: A global systematic review and meta-analysis.
        J Infect. 2020; 81: 902-910
        • Carles G.
        • Montoya Y.
        • Seve B.
        • Rakotofananina T.
        • Largeaud M.
        • Mignot V.
        Typhoid fever and pregnancy.
        J Gynecol Obstet Biol La Reprod. 2002; 31
      10. Jackson BR, Iqbal S, Mahon B, Centers for Disease Control and Prevention (CDC). Updated recommendations for the use of typhoid vaccine--Advisory Committee on Immunization Practices, United States, 2015. MMWR Morb Mortal Wkly Rep 2015;64.

      11. WHO. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. 2020.

        • Joshi S.S.
        • Coffin C.S.
        Hepatitis B and Pregnancy: Virologic and Immunologic Characteristics.
        Hepatol Commun. 2020; 4: 157-171
        • Mast E.E.
        • Weinbaum C.M.
        • Fiore A.E.
        • Alter M.J.
        • Bell B.P.
        • Finelli L.
        • et al.
        A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults.
        MMWR Recomm Rep. 2006; 55
        • Chaudhry S.A.
        • Koren G.
        Hepatitis A infection during pregnancy.
        Can Fam Physician. 2015;
        • Groom H.C.
        • Smith N.
        • Irving S.A.
        • Koppolu P.
        • Vazquez- Benitez G.
        • Kharbanda E.O.
        • et al.
        Uptake and safety of hepatitis A vaccination during pregnancy: A Vaccine Safety Datalink study.
        Vaccine. 2019; 37: 6648-6655
      12. Merckx M, Liesbeth WVW, Arbyn M, Meys J, Weyers S, Temmerman M, et al. Transmission of carcinogenic human papillomavirus types from mother to child: A meta-analysis of published studies. Eur J Cancer Prev 2013.

        • Bruni L.
        The frequency of HPV infection worldwide. HPV.
        World. 2020;
        • Wang A.
        • Liu C.
        • Wang Y.
        • Yin A.
        • Wu J.
        • Zhang C.
        • et al.
        Pregnancy Outcomes After Human Papillomavirus Vaccination in Periconceptional Period or During Pregnancy: A Systematic Review and Meta-analysis.
        Hum Vaccines Immunother. 2020; 16: 581-589
        • Yizengaw E.
        • Getahun T.
        • Mulu W.
        • Ashagrie M.
        • Abdela I.
        • Geta M.
        Incidence of human rabies virus exposure in northwestern Amhara, Ethiopia.
        BMC Infect Dis. 2018; 18
        • Aguèmon C.T.
        • Tarantola A.
        • Zoumènou E.
        • Goyet S.
        • Assouto P.
        • Ly S.
        • et al.
        Rabies transmission risks during peripartum - Two cases and a review of the literature.
        Vaccine. 2016; 34: 1752-1757
        • Nigg A.J.
        • Walker P.L.
        Overview, prevention, and treatment of rabies.
        Pharmacotherapy. 2009; 29: 1182-1195
        • Arora M.
        • Lakshmi R.
        Maternal vaccines—safety in pregnancy.
        Best Pract Res Clin Obstet Gynaecol. 2021;
        • Krammer F.
        • Smith G.J.D.
        • Fouchier R.A.M.
        • Peiris M.
        • Kedzierska K.
        • Doherty P.C.
        • et al.
        Nat Rev Dis Prim. 2018; 4
        • ACOG Committee Opinion No
        732: Influenza Vaccination During Pregnancy.
        Obstet Gynecol. 2018; 131
        • Lam E.
        • Rosen J.B.
        • Zucker J.R.
        An update on outbreaks, vaccine efficacy, and genomic diversity.
        Clin Microbiol Rev. 2020; 33
        • Ornoy A.
        • Tenenbaum A.
        Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses.
        Reprod Toxicol. 2006; 21: 446-457
        • Rasmussen S.A.
        • Jamieson D.J.
        What obstetric health care providers need to know about measles and pregnancy.
        Obstet Gynecol. 2015; 126: 163-170
        • Ragusa R.
        • Platania A.
        • Cuccia M.
        • Zappalà G.
        • Giorgianni G.
        • D’Agati P.
        • et al.
        Measles and Pregnancy: Immunity and Immunization - What Can Be Learned from Observing Complications during an Epidemic Year.
        J Pregnancy. 2020; 2020: 1-8
        • Patel M.K.
        • Antoni Sébastien
        • Danovaro-Holliday M.C.
        • Desai S.
        • Gacic-Dobo M.
        • Nedelec Y.
        • et al.
        The epidemiology of rubella, 2007–18: an ecological analysis of surveillance data.
        Lancet Glob Heal. 2020; 8: e1399-e1407
        • Best J.M.
        Semin Fetal Neonatal Med. 2007; 12: 182-192
        • McLean H.Q.
        • Fiebelkorn A.P.
        • Temte J.L.
        • Wallace G.S.
        Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Reports. 2013;
      13. Kerr Y, Mailhot M, Williams AJ, Swezy V, Quick L, Tangermann RH, et al. Lessons Learned and Legacy of the Stop Transmission of Polio Program. J Infect Dis 2017;216.

        • Bandyopadhyay A.S.
        • Garon J.
        • Seib K.
        • Orenstein W.A.
        Polio vaccination: Past, present and future.
        Future Microbiol. 2015; 10: 791-808
        • Harjulehto-Mervaala T.
        • Aro T.
        • Hiilesmaa V.K.
        • Hovi T.
        • Saxen H.
        • Saxen L.
        Oral polio vaccination during pregnancy: Lack of impact on fetal development and perinatal outcome.
        Clin Infect Dis. 1994; 18: 414-420
        • Gershon A.A.
        • Breuer J.
        • Cohen J.I.
        • Cohrs R.J.
        • Gershon M.D.
        • Gilden D.
        • et al.
        Varicella zoster virus infection.
        Nat Rev Dis Prim. 2015; 1
        • Wilson E.
        • Goss M.A.
        • Marin M.
        • Shields K.E.
        • Seward J.F.
        • Rasmussen S.A.
        • et al.
        Varicella vaccine exposure during pregnancy: Data from 10 years of the pregnancy registry.
        J. Infect. Dis. 2008; 197: S178-S184
        • Hall C.
        • Khodr Z.G.
        • Chang R.N.
        • Bukowinski A.T.
        • Gumbs G.R.
        • Conlin A.M.S.
        Safety of yellow fever vaccination in pregnancy: Findings from a cohort of active duty US military women.
        J Travel Med. 2021; 27
      14. Cetron MS, Marfin AA, Julian KG, Gubler DJ, Sharp DJ, Barwick RS, et al. Yellow fever vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR Recomm Rep 2002.

        • Wastnedge E.A.N.
        • Reynolds R.M.
        • van Boeckel S.R.
        • Stock S.J.
        • Denison F.C.
        • Maybin J.A.
        • et al.
        Pregnancy and COVID-19.
        Physiol Rev. 2021; 101: 303-318
        • Craig A.
        • Hughes B.
        • Swamy G.
        COVID-19 vaccines in pregnancy.
        Am J Obstet Gynecol MFM. 2020;
        • Jacob S.T.
        • Crozier I.
        • Fischer W.A.
        • Hewlett A.
        • Kraft C.S.
        • Vega M.-A.
        • et al.
        Ebola virus disease.
        Nat Rev Dis Prim. 2020; 6
      15. Legardy-Williams JK, Carter RJ, Goldstein ST, Jarrett OD, Szefer E, Fombah AE, et al. Pregnancy outcomes among women receiving RVSVΔ-Zebov-GP Ebola vaccine during the Sierra Leone trial to introduce a vaccine against Ebola. Emerg Infect Dis 2020;26.

        • Laris-González A.
        • Bernal-Serrano D.
        • Jarde A.
        • Kampmann B.
        Safety of administering live vaccines during pregnancy: A systematic review and meta-analysis of pregnancy outcomes.
        Vaccines. 2020; 8: 124
        • McGregor J.A.
        • French J.I.
        • Christian J.
        • Perhach M.
        • Jones J.
        Reducing risks of fetal injury and stillbirths caused by infection/inflammation using healthy behaviors.
        BMC Pregnancy Childbirth. 2015; 15