VACCINATIONS IN PREGNANCY

Views:
 
Category: Education
     
 

Presentation Description

vaccinations in pregnancy

Comments

Presentation Transcript

VACCINATIONS IN PREGNANCY: 

VACCINATIONS IN PREGNANCY Dr. SHASHWAT K. JANI M.S. ( GYNEC ) Diploma in Endoscopy Assistant Professor, Sheth V.S. Gen. Hospital. Ahmedabad. e -mail : drshashwatjani@gmail.com 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 1

OBJECTIVE: 

OBJECTIVE To induce a state of immunity in the patient so that confrontation with offending organism can be successful in protecting the host. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 2

PowerPoint Presentation: 

The vaccines are prepared from inactivated, live attenuated , modified or mutant forms of the causative agents. Live vaccines induce prompt but transient production of Abs. while Inactivated vaccines and Toxoids produce a less complete response and several doses are required. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 3

PowerPoint Presentation: 

Adult immunization rates have fallen short of national goals, partly because of misconceptions about the safety and benefits of current vaccines. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 4

PowerPoint Presentation: 

The danger of these misconceptions is magnified during pregnancy, when: Concerned physicians are hesitant to administer vaccines. Patients are reluctant to accept them. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 5

PowerPoint Presentation: 

The administration of vaccines during pregnancy poses a number of concerns about the risk of transmitting a virus to a developing fetus. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 6

PowerPoint Presentation: 

The risk of transmitting a virus to a developing fetus is Primarily Theoretical…!!! 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 7

PowerPoint Presentation: 

Theoretic risks of vaccination must be weighed against the risks of the disease to mother and fetus. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 8

PowerPoint Presentation: 

Physicians should reassure their patients that NO vaccines are contraindicated during breastfeeding. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 9 Immunization during breastfeeding is safe

PowerPoint Presentation: 

Routine vaccines that generally are Safe during pregnancy include: Diphtheria 5.Meningococcal Tetanus 6. Rabies. Influenza Hepatitis B. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 10

PowerPoint Presentation: 

Vaccines that are contraindicated L ive virus vaccine include:, Measles, Mumps, and Rubella ( MMR ) Varicella (BCG) B acille Calmette-Guérin Yellow vaccine Polio. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 11 (Because of the theoretic risk of fetal transmission)

PowerPoint Presentation: 

If a live-virus vaccine is inadvertently given to a pregnant woman, or if a woman becomes pregnant within four weeks after vaccination, she should be counseled about potential effects on the fetus. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 12

Measles, Mumps, Rubella.: 

Measles, Mumps, Rubella . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 13

Measles ( Rubi virus): 

Measles ( Rubi virus) Typically presents with: Fever, red eyes Coryza (inflammation of mucosal mem . Lining the nasal cavity) Generally ill appearance, and maculopapular rash start at face to chest 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 14

Measles: 

Measles Risk from disease to pregnant woman: Causes significant morbidity and low mortality Risk from disease to fetus or neonate: Sign. Increase in abortion rate May cause fetal malformation 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 15

Measles: 

Measles Mortality occurs in 1-2 per 1,000 cases often secondary to pneumonia or encephalitis. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 16

Mumps : 

Mumps Mumps results from infection with the paramyxovirus and can lead to parotitis, meningoencephalitis, and orchitis. Neurologic complications such as deafness, can also occur as a result of mumps infection. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 17

Mumps: 

Mumps - Contraindicated because it’s a live attenuated vaccine, carrying a risk of causing the mump infection - Can cause early miscarriage or birth defects - Most common birth defect is - deafness 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 18

Rubella ( Toga virus ): 

Rubella ( Toga virus ) Crosses the placenta barrier and cause congenital rubella syndrome. It can cause 20% spontaneous abortion in the 1 st trimester. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 19

Congenital Rubella syndrome: 

Congenital Rubella syndrome Can result in defects such as: * Malformations of the heart (especially PDA), eyes or brain * Deafness * Spleen, liver or bone marrow problems (some of which may disappear shortly after birth) * Mental retardation * Small head size (microcephaly) * Eye defects - cataracts * Low birth weight * Hepatomegaly. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 20

PowerPoint Presentation: 

Measles, mumps, and rubella vaccine should not be given to pregnant women, because of potential adverse effects on the fetus. But should be vaccinated post partum. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 21

Polio: 

Polio RNA Enterovirus with three different strains that cause disease. Exposure may result in asymptomatic infection as well as non paralytic and paralytic disease. Asymptomatic patients can transmit the disease to susceptible persons. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 22

Polio: 

Polio The disease continues to be a problem worldwide, but all recent domestic polio cases have been caused by the strains of virus found in the oral polio vaccine (OPV). 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 23

Polio: 

Polio This situation has resulted in a change in the recommendation for use of inactivated polio vaccine (IPV), instead of OPV or a combination of OPV-IPV for all routine vaccinations. IPV is inactivated by formaldehyde, and its use has eliminated vaccine-associated polio infection. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 24

Polio: 

Polio Although no adverse effects have been documented with OPV or IPV in pregnant women or their fetuses, both vaccines should be avoided during pregnancy on a theoretic basis. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 25

Polio: 

Polio The CDC states that IPV may be administered in accordance with the recommended schedules for adults if a pregnant woman is at increased risk for infection and requires immediate protection against polio. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 26

YELLOW FEVER : 

YELLOW FEVER Yellow fever is a viral hemorrhagic fever syndrome spread by mosquitoes in parts of South America and Africa. The yellow fever vaccine is a live, attenuated virus grown in chick embryos. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 27

YELLOW FEVER : 

YELLOW FEVER It is indicated for use in laboratory workers involved with the virus and in persons planning to travel to endemic areas. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 28

YELLOW FEVER : 

YELLOW FEVER No specific evidence is available to demonstrate the safety of yellow fever immunization during pregnancy. Since theoretic concerns of fetal infection exist, however, vaccination is generally not recommended during pregnancy . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 29

YELLOW FEVER : 

YELLOW FEVER When travel cannot be postponed and mosquito exposure is likely, Yellow fever vaccination may be considered. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 30

Inactivated vaccines:: 

Inactivated vaccines: Inactivated Viral Vac . Inactivated bacteria Vac. - Influenza -Cholera - Rabies -Typhoid - Hepatitis B -pneumococcus 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 31

Influenza: 

Influenza Fever, malaise, myalgia, and upper respiratory tract symptoms or infections characterize influenza infection. Most severe complications are the result of pneumonia secondary to influenza infection. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 32

Influenza: 

Influenza The influenza vaccine is a killed virus preparation with an annually adjusted antigenic makeup. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 33

Influenza: 

Influenza It should be administered annually between October and December to high-risk patients. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 34

Influenza: 

Influenza The vaccine should be administered to all pregnant women who will be in the second or third trimester of pregnancy during the influenza season . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 35

Influenza: 

Influenza Women in their second or third trimesters have higher morbidity, from influenza infection. Immunization should be avoided in most patients during the first trimester to avoid a coincidental association with spontaneous abortion, which is common in the first trimester . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 36

RABIES : 

RABIES Rabies is a viral infection transmitted most commonly by the saliva of infected animals. Nonspecific prodromal symptoms progress to encephalitis marked by confusion, hallucinations . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 37

RABIES : 

RABIES Dysregulation of the autonomic nervous system and involvement of the brainstem and cranial nerves lead to the classic "foaming at the mouth" appearance. Three forms of inactivated rabies vaccines are available, all considered equally safe and efficacious. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 38

RABIES : 

RABIES Passive immunization is achieved through administration of human rabies immune globulin (HRIG). It may be considered in animal workers and travelers to enzootic areas who anticipate animal exposure. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 39

RABIES : 

RABIES In patients who have not been immunized previously, 20 IU per kg of HRIG is given at the wound site for high-risk bites or if testing is positive. Patients with previous vaccinations do not need HRIG but do require revaccination on a modified schedule. There have been no identified associations between rabies vaccination and fetal abnormalities 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 40

Hepatitis B: 

Hepatitis B Transmitted through: Contact with infected blood, Sexual activity, and Sharing of intravenous needles. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 41

Hepatitis B: 

Hepatitis B Risk factors for a pregnant woman include: Having multiple sexual partners, Using or abusing intravenous drugs, Having occupational exposure, and Being a household contact of acutely infected persons or persons with a chronic carrier state. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 42

Hepatitis B: 

Hepatitis B Because it contains noninfectious hepatitis B surface antigen particles and it cause no risk to the fetus, neither pregnancy nor lactation is a contraindication to vaccination. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 43

TYPHOID : 

TYPHOID Transmission of Salmonella typhi is significantly increased with travel during epidemics and ingestion of food from street vendors . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 44

TYPHOID : 

TYPHOID The two types of typhoid vaccination in use today are a live attenuated oral vaccine and a parenteral polysaccharide vaccine. Both forms require that immunization be completed at least two weeks before exposure. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 45

TYPHOID : 

TYPHOID Neither form of typhoid vaccine is officially recommended during pregnancy. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 46

CHOLERA : 

CHOLERA Two improved oral vaccines are available : a killed, whole cell recombinant vaccine and a live, attenuated strain . Both are more effective, better tolerated, and longer lasting than the parenteral vaccine. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 47 These may be considered for use in populations at immediate risk of a cholera epidemic or for travelers to areas of high endemicity .

CHOLERA : 

CHOLERA No specific information exists on the safety of parenteral cholera vaccination during pregnancy. Because cholera during pregnancy is a serious illness, exposure should be minimized during pregnancy whenever possible. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 48

Pneumococcal: 

Pneumococcal Risk factors for pneumococcal infection in pregnant women include Diabetes, Cardiovascular disease, Immunodeficiency, Asthma. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 49

Pneumococcal: 

Pneumococcal The current vaccine includes purified capsular polysaccharide. women at high risk should be given this vaccination before, but not during, pregnancy. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 50

Pneumococcal: 

Pneumococcal The safety of the vaccine during pregnancy has not been evaluated, although no adverse outcomes have been reported among newborns whose mothers were inadvertently vaccinated. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 51

ImG vaccines: 

ImG vaccines Specific Immune globulins vaccine: Hepatitis B Rabies Tetanus Varicella 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 52

Varicella ( Chicken Pox ): 

Varicella ( Chicken Pox ) Varicella vaccination is a live attenuated virus and is contraindicated during pregnancy. Women who are vaccinated should avoid becoming pregnant for one month following each injection. The presence of pregnant household members does not constitute a contraindication to vaccination of others within the house. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 53

Adverse effects:: 

Adverse effects: - Characterized by limb atrophy and scarring of the skin of the extremity, known as congenital varicella syndrome. - Other manifestations include central nervous system and eye abnormalities. - Increase mortality in neonates. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 54

Varicella immunoglobulin indicated:: 

Varicella immunoglobulin indicated: If a susceptible pregnant woman is exposed to varicella, however, administration of varicella-zoster immune globulin should be strongly considered Indicated also for newborns of mothers who developed varicella within 4 days prior to delivery or 2 days following delivery. Approx. 90-95% of adults are immune Not indicated for prevention of congenital varicella. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 55

Tetanus and Diphtheria: 

Tetanus and Diphtheria 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 56

PowerPoint Presentation: 

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. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 57

PowerPoint Presentation: 

While no evidence exists to prove that tetanus and diphtheria toxoids are teratogenic , waiting until the second trimester of pregnancy to administer toxoids is a reasonable precaution, minimizing any concern about the theoretic possibility of such reactions. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 58

Who needs the Tetanus and Diphtheria vaccine?: 

Who needs the Tetanus and Diphtheria vaccine? 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 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 59

Tetanus and Diphtheria: 

Tetanus and Diphtheria In INDIA : Where tetanus infection is common in neonates and Antenatal visits are not regular in rural areas… Govt. Of India Guidelines : 1 st dose at 1 st ANC visit & 2 nd after 4-6 weeks. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 60

Other Vaccinations . . .: 

Other Vaccinations . . . 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 61

HPV VACCINE: 

HPV VACCINE Not recommended for use in pregnancy. If patient becomes pregnant - Delay remaining doses till delivery. If vaccinated during pregnancy - No intervention (MTP) needed. Lactating women can receive the HPV vaccine (Gardasil) and still continue breastfeeding as it is a vaccine without live viral DNA. ( FOGSI Recommendations: Pregnancy & Lactation.) 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 62

Hepatitis A: 

Hepatitis A Administration of immune globulin is strongly recommended which is considered safe during pregnancy and is more than 85 % effective in preventing acute hepatitis 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 63

Meningococcal: 

Meningococcal Studies have shown that the meningococcal vaccine is safe and efficacious when given to pregnant women 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 64

BCG VACCINE : 

BCG VACCINE BCG ( B acille Calmette-Guérin ) vaccine is a live vaccine derived from a strain of Mycobacterium bovis . Use of the BCG vaccine is NOT recommended during pregnancy. Pre conceptional immunization of pregnant women to prevent disease in the offspring is preferred to vaccination of pregnant women. 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 65

PowerPoint Presentation: 

25/01/2014 Dr. Shashwat K. Jani. 99099 44160 66

PowerPoint Presentation: 

Thank you 25/01/2014 Dr. Shashwat K. Jani. 99099 44160 67