Immunization during pregnancy

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Immunization during pregnancy is the administration of a vaccine to a pregnant individual. [1] This may be done either to protect the individual from disease or to induce an antibody response, such that the antibodies cross the placenta and provide passive immunity to the infant after birth. In many countries, including the US, [2] Canada, [3] UK, [4] Australia [5] [6] and New Zealand, [7] vaccination against influenza, COVID-19 and whooping cough is routinely offered during pregnancy.

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Other vaccines may be offered during pregnancy where travel-related or occupational exposure to disease-causing organisms warrant this. However, certain vaccines are contra-indicated in pregnancy. These include vaccines that include live attenuated organisms, such as the MMR and BCG vaccines, since there is a potential risk that these could infect the fetus.

Tetanus and whooping cough vaccination in pregnancy

Newborns are at increased risk of infection, particularly before they receive their first infant vaccinations. For this reason, certain vaccinations are offered during pregnancy in order to induce an antibody response, resulting in the passage of antibody across the placenta and into the fetus: this confers passive immunity on the newborn. As early as 1879, it was noted that infants born following smallpox vaccination in pregnancy were themselves protected against smallpox. [8] However, the original smallpox vaccination was never widely used during pregnancy because, as a live vaccine, its use is contraindicated.[ citation needed ]

Tetanus is a bacterial infection caused by Clostridium tetani. Newborns can be infected via their unhealed umbilical stump, particularly when the umbilical cord is cut with a non-sterile instrument, and suffer a generalised infection. The tetanus toxoid vaccine was first licensed for use in 1938 and, during the 1960s, it was noted that tetanus vaccination in pregnancy could prevent neonatal tetanus. [9] Subsequent trials showed that vaccination of pregnant women reduces infant deaths from tetanus by 94%. [10] [11] In 1988, the World Health Assembly passed a resolution to use maternal vaccination to eliminate neonatal tetanus by the year 2000. Although neonatal tetanus has not yet been eliminated, by 2017 there were an estimated 31,000 annual infant deaths from tetanus, down from 787,000 in 1987. [12]

Whooping cough, or pertussis, is a contagious respiratory disease caused by the bacteria Bordetella pertussis. It is fatal in an estimated 0.5% of infants in the USA. [13] The first vaccine against whooping cough was developed in the 1930s, and in the 1940s a study found that vaccination in pregnancy protected infants against developing whooping cough. [14]

The tetanus and whooping cough vaccinations are generally administered in combination during pregnancy, for example as the DTaP vaccine (which also protects against diphtheria) or the 4-in-1 vaccine (which also protects against diphtheria and polio).[ citation needed ]

Influenza vaccination in pregnancy

Influenza is a respiratory infection caused by influenza viruses. Pregnant women are disproportionately affected by influenza: in the 1918 pandemic, mortality rates as high as 27% were reported in this population and in the 1957 pandemic, nearly 20% of deaths in pregnancy were attributed to influenza. In the 2009 pandemic, even with medical advances, pregnant women accounted for a disproportionately high percentage of deaths. [15]

The influenza vaccine was first used in the US military from 1938, and then in the civilian population from the 1940s. Given the increased risk of influenza during pregnancy, public health bodies in the USA recommended that pregnant women should be prioritised for influenza vaccination from the 1960s, [16] with the CDC endorsing the recommendation from 1997. [17] However, it was not until 2005 that a randomised clinical trial formally demonstrated the efficacy of influenza vaccination in pregnancy. [18]

Following the 2009 pandemic, both Australia and the UK added influenza vaccination to the recommended schedule for pregnant women. [19]

COVID-19 vaccination in pregnancy

COVID-19 is a respiratory infection caused by the SARS-CoV2 virus. Before COVID-19 vaccines were available, pregnant women who caught the disease were at increased risk of needing intensive care, invasive ventilation or ECMO, but not at increased risk of death. [20] Infection significantly increased the risk of preterm birth, stillbirth and pre-eclampsia. [21]

COVID-19 vaccination during pregnancy is safe and associated with improved levels of risk for stillbirth, premature birth and admission of the newborn to intensive care. Vaccination can prevent COVID-19 infection during pregnancy although these immunity benefits are not passed on to the child. [22]

mRNA COVID-19 vaccines were first rolled out in December 2020. At this time, in recognition of the risks posed by COVID-19 disease in pregnancy, the US and Israel offered the vaccines to all pregnant women shortly afterwards, and the first safety and effectiveness data therefore came from these vaccines and these nations. [23]

Rubella vaccination to prevent fetal disease

Rubella, or German measles, is an infection caused by the rubella virus. In childhood, it usually causes a mild disease but infection in pregnancy can result in fetal infection, or congenital rubella syndrome, which causes neonatal deaths, deafness, blindness and intellectual disabilities. The first rubella vaccine was licensed for use in 1969, with its development largely spurred by the heavy burden of congenital rubella experienced in the 1960s. [24]

Because the rubella vaccine is a live attenuated vaccine, there is a theoretical risk that it could cause fetal infection, although this has never been seen to occur. Therefore, rubella vaccination is usually avoided during pregnancy. Rather, vaccination is offered to children to reduce the prevalence of rubella virus in circulation and/or to adolescent girls, to boost their immunity before they are likely to conceive. [25] [26]

Related Research Articles

<span class="mw-page-title-main">Vaccine</span> Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.

<span class="mw-page-title-main">Whooping cough</span> Human disease caused by the bacteria Bordetella pertussis

Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious, vaccine-preventable bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or three months of severe coughing fits. Following a fit of coughing, a high-pitched whoop sound or gasp may occur as the person breathes in. The violent coughing may last for 10 or more weeks, hence the phrase "100-day cough". The cough may be so hard that it causes vomiting, rib fractures, and fatigue. Children less than one year old may have little or no cough and instead have periods where they cannot breathe. The incubation period is usually seven to ten days. Disease may occur in those who have been vaccinated, but symptoms are typically milder.

<span class="mw-page-title-main">Rubella</span> Human viral disease

Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur. Joint pain is common in adults. Complications may include bleeding problems, testicular swelling, encephalitis, and inflammation of nerves. Infection during early pregnancy may result in a miscarriage or a child born with congenital rubella syndrome (CRS). Symptoms of CRS manifest as problems with the eyes such as cataracts, deafness, as well as affecting the heart and brain. Problems are rare after the 20th week of pregnancy.

<span class="mw-page-title-main">Congenital rubella syndrome</span> Medical condition

Congenital rubella syndrome (CRS) occurs when an unborn baby is infected with the rubella virus via maternal-fetal transmission and develops birth defects. The most common congenital defects affect the ophthalmologic, cardiac, auditory, and neurologic systems.

<span class="mw-page-title-main">Immunization</span> Process by which an individuals immune system becomes fortified against an infectious agent

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. The scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Booster dose</span> Additional administration of vaccine

A booster dose is an extra administration of a vaccine after an earlier (primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to protective levels after memory against that antigen has declined through time. For example, tetanus shot boosters are often recommended every 10 years, by which point memory cells specific against tetanus lose their function or undergo apoptosis.

In immunology, passive immunity is the transfer of active humoral immunity of ready-made antibodies. Passive immunity can occur naturally, when maternal antibodies are transferred to the fetus through the placenta, and it can also be induced artificially, when high levels of antibodies specific to a pathogen or toxin are transferred to non-immune persons through blood products that contain antibodies, such as in immunoglobulin therapy or antiserum therapy. Passive immunization is used when there is a high risk of infection and insufficient time for the body to develop its own immune response, or to reduce the symptoms of ongoing or immunosuppressive diseases. Passive immunization can be provided when people cannot synthesize antibodies, and when they have been exposed to a disease that they do not have immunity against.

A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

<span class="mw-page-title-main">Neonatal tetanus</span> Medical condition

Neonatal tetanus is a form of generalised tetanus that occurs in newborns. Infants who have not acquired passive immunity from an immunized mother are at risk. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a non-sterile instrument. Neonatal tetanus mostly occurs in developing countries, particularly those with the least developed health infrastructure. It is rare in developed countries.

<span class="mw-page-title-main">Pertussis vaccine</span> Vaccine protecting against whooping cough

Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effective. The effectiveness of the vaccines appears to decrease by between 2 and 10% per year after vaccination with a more rapid decrease with the acellular vaccines. The vaccine is only available in combination with tetanus and diphtheria vaccines. Pertussis vaccine is estimated to have saved over 500,000 lives in 2002.

<span class="mw-page-title-main">Cocooning (immunization)</span> Vaccination strategy

Cocooning, also known as the Cocoon Strategy, is a vaccination strategy to protect infants and other vulnerable individuals from infectious diseases by vaccinating those in close contact with them. If the people most likely to transmit an infection are immune, their immunity creates a "cocoon" of protection around the newborn.

<span class="mw-page-title-main">Tetanus vaccine</span> Vaccines used to prevent tetanus

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

Pre-conception counseling in the United States allows for optimization of US prenatal care. Pre-conception counseling is a meeting with a health-care professional by a woman before attempting to become pregnant. It generally includes a pre-conception risk assessment for any potential complications of pregnancy.

HIV in pregnancy is the presence of an HIV/AIDS infection in a woman while she is pregnant. There is a risk of HIV transmission from mother to child in three primary situations: pregnancy, childbirth, and while breastfeeding. This topic is important because the risk of viral transmission can be significantly reduced with appropriate medical intervention, and without treatment HIV/AIDS can cause significant illness and death in both the mother and child. This is exemplified by data from The Centers for Disease Control (CDC): In the United States and Puerto Rico between the years of 2014–2017, where prenatal care is generally accessible, there were 10,257 infants in the United States and Puerto Rico who were exposed to a maternal HIV infection in utero who did not become infected and 244 exposed infants who did become infected.

<span class="mw-page-title-main">Non-specific effect of vaccines</span> Unintended side effects of vaccines which may be beneficial or bad

Non-specific effects of vaccines are effects which go beyond the specific protective effects against the targeted diseases. Non-specific effects can be strongly beneficial by increasing protection against non-targeted infections. This has been shown with two live attenuated vaccines, BCG vaccine and measles vaccine, through multiple randomized controlled trials. Theoretically, non-specific effects of vaccines may be detrimental, increasing overall mortality despite providing protection against the target diseases. Although observational studies suggest that diphtheria-tetanus-pertussis vaccine (DTP) may be highly detrimental, these studies are at high risk of bias and have failed to replicate when conducted by independent groups.

<span class="mw-page-title-main">Neonatal infection</span> Human disease

Neonatal infections are infections of the neonate (newborn) acquired during prenatal development or within the first four weeks of life. Neonatal infections may be contracted by mother to child transmission, in the birth canal during childbirth, or after birth. Neonatal infections may present soon after delivery, or take several weeks to show symptoms. Some neonatal infections such as HIV, hepatitis B, and malaria do not become apparent until much later. Signs and symptoms of infection may include respiratory distress, temperature instability, irritability, poor feeding, failure to thrive, persistent crying and skin rashes.

<span class="mw-page-title-main">COVID-19 in pregnancy</span> Overview about the effects of COVID-19 infection on pregnancy

COVID-19 infection in pregnancy is associated with several pregnancy complications. However, pregnancy does not appear to increase the susceptibility of becoming infected by COVID-19. Recommendations for the prevention of COVID-19 include the same measures as non-pregnant people.

References

  1. ↑ Vesikari T, Maertens K, Finn A (2021). "6. Maternal immunization". In Vesikari T, Damme PV (eds.). Pediatric Vaccines and Vaccinations: A European Textbook (Second ed.). Switzerland: Springer. pp. 49–53. ISBN   978-3-030-77172-0.
  2. ↑ "Vaccines During and After Pregnancy". 26 January 2022.
  3. ↑ "Vaccination and pregnancy: During pregnancy". 22 September 2021.
  4. ↑ "Vaccinations in pregnancy". 9 December 2020.
  5. ↑ Immunisation for pregnancy Australian Government. Department of Health and Aged Care. Retrieved 10 December 2022
  6. ↑ Pregnancy, breastfeeding and COVID-19 vaccines Australian Government. Department of Health and Aged Care. Retrieved 10 December 2022
  7. ↑ "Immunisation during pregnancy".
  8. ↑ de Martino M (2016). "Dismantling the Taboo against Vaccines in Pregnancy". International Journal of Molecular Sciences. 17 (6): 894. doi: 10.3390/ijms17060894 . PMC   4926428 . PMID   27338346.
  9. ↑ Schofield FD, Tucker VM, Westbook GR (1961). "Neonatal tetanus in New Guinea. Effect of active immunization in pregnancy". British Medical Journal. 2 (5255): 785–789. doi:10.1136/bmj.2.5255.785. PMC   1969799 . PMID   13748431.
  10. ↑ Blencowe H, Lawn J, Vandelaer J, Roper M, Cousens S (2010). "Tetanus toxoid immunization to reduce mortality from neonatal tetanus". International Journal of Epidemiology. 39 (Suppl 1): i102–i109. doi:10.1093/ije/dyq027. PMC   2845866 . PMID   20348112.
  11. ↑ Demicheli V, Barale A, Rivetti A (2015). "Vaccines for women for preventing neonatal tetanus". The Cochrane Database of Systematic Reviews. 2015 (7): CD002959. doi:10.1002/14651858.CD002959.pub4. PMC   7138051 . PMID   26144877.
  12. ↑ "Maternal and Neonatal Tetanus Elimination (MNTE)".
  13. ↑ "Complications of Whooping Cough (Pertussis) | CDC". April 2021.
  14. ↑ Cohen P, Scandron S (1943). "The placental transmission of protective antibodies against whooping cough: by inoculation of the pregnant mother". JAMA. 121 (9): 656–662. doi:10.1001/jama.1943.02840090026008.
  15. ↑ Pazos M, Sperling R, Moran T, Kraus T (2012). "The influence of pregnancy on systemic immunity". Immunologic Research. 54 (1–3): 254–61. doi:10.1007/s12026-012-8303-9. PMC   7091327 . PMID   22447351.
  16. ↑ Burney L (1960). "Influenza immunization: Statement". Public Health Reports. 75 (10): 944. doi:10.2307/4590965. JSTOR   4590965. PMC   1929542 . PMID   19316369.
  17. ↑ "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR. 46: 1–25. 1997.
  18. ↑ Zaman K, Roy E, Arifeen S, Rahman M, Raqib R, Wilson E, Omer S, Shahid N, Brieman R, Steinhoff M (2008). "Effectiveness of Maternal Influenza Immunization in Mothers and Infants". New England Journal of Medicine. 359 (15): 1555–1564. doi: 10.1056/NEJMoa0708630 . PMID   18799552. S2CID   205089531.
  19. ↑ Mackin DW, Walker SP (October 2021). "The historical aspects of vaccination in pregnancy". Best Practice & Research Clinical Obstetrics & Gynaecology. 76: 13–22. doi:10.1016/j.bpobgyn.2020.09.005. PMC   7550856 . PMID   33168428.
  20. ↑ "Update to living systematic review on covid-19 in pregnancy". BMJ (Clinical Research Ed.). 377: o1205. 2022-05-30. doi: 10.1136/bmj.o1205 . ISSN   1756-1833. PMID   35636775. S2CID   249157852.
  21. ↑ Marchand G, Patil A, Masoud A, Ware K, King A, Ruther S, Brazil G, Calteux N, Ulibarri H, Parise J, Arroyo A, Coriel C, Cook C, Ruuska A, Nourlden AZ, Sainz K (2022). "Systematic review and meta-analysis of COVID-19 maternal and neonatal clinical features and pregnancy outcomes up to June 3, 2021". AJOG Global Reports. 2 (1): 100049. doi:10.1016/j.xagr.2021.100049. PMC   8720679 . PMID   35005663.
  22. ↑ Rahmati M, Yon DK, Lee SW, Butler L, Koyanagi A, et al. (March 2023). "Effects of COVID-19 vaccination during pregnancy on SARS-CoV-2 infection and maternal and neonatal outcomes: A systematic review and meta-analysis". Rev Med Virol (Systematic review). 33 (3): e2434. doi:10.1002/rmv.2434. PMID   36896895. S2CID   257429897.
  23. ↑ Male V (2022). "SARS-CoV-2 infection and COVID-19 vaccination in pregnancy". Nature Reviews Immunology. 22 (5): 277–282. doi:10.1038/s41577-022-00703-6. PMC   8931577 . PMID   35304596.
  24. ↑ • Cooper LZ (1985). "The history and medical consequences of rubella". Reviews of Infectious Diseases. 7 (Suppl 1): S2-10. doi:10.1093/clinids/7.supplement_1.s2. PMID   3890105.
  25. ↑ Miller CL, Miller E, Waight PA (1987). "Rubella susceptibility and the continuing risk of infection in pregnancy". BMJ (Clin Res Ed). 294 (6582): 1277–1278. doi:10.1136/bmj.294.6582.1277. PMC   1246439 . PMID   3109615.
  26. ↑ Walker D, Carter H, Jones IG (1986). "Measles, mumps, and rubella: the need for a change in immunisation policy". BMJ (Clin Res Ed). 292 (6534): 1501–1502. doi:10.1136/bmj.292.6534.1501. PMC   1340503 . PMID   3087495.
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