Pregnancy and tetanus and rabies vaccines

Immunization protects pregnant women from vaccine-preventable diseases, followed by the transfer of acquired antibodies to the newborn. Antibodies passively acquired from the mother can protect the child from diseases in the first months of life. Maternal immunization is an important challenge facing public health practice.

Vaccination and vaccinations during pregnancy lead to the transplacental transfer of antibodies, which can provide protection to the newborn in the first months of life [17].

Widespread implementation of immunization of pregnant women, as an important public health goal for the prevention of neonatal diseases, in the United States and other industrialized countries faces obstacles stemming from theoretical doubts by expectant mothers about the safety of vaccines, relatively low awareness, and practical socioeconomic problems. The most important issue regarding immunization during pregnancy remains the safety of vaccines for the fetus and newborn [1]. The decision to vaccinate a pregnant woman is quite a responsible one. To make this decision, the doctor and the pregnant woman must jointly determine the potential risk of infection with a particular pathogen, as well as the possible consequences of infection for the mother and child. These risks must be weighed against the likely benefits of vaccination [2, 3].

Are live antiviral vaccines contraindicated during pregnancy?

It was believed that pregnancy is a contraindication to vaccination with live viral vaccines due to the theoretical risk of virus penetration through the placenta and intrauterine infection of the fetus. Live virus vaccines include attenuated influenza vaccine (LAIV), MMR (measles, mumps, rubella), and varicella, smallpox, and tuberculosis (BCG) vaccines. Current guidelines suggest that caution should be exercised when administering live viral vaccines during pregnancy. The US Advisory Council on Immunization Practices (ACIP) of the Center for Disease Control (CDC) does not consider vaccination to be an indication for termination of pregnancy [4, 5].

From 1979 to 1980 The CDC closely monitored the effects of RA 27/3 vaccine (live rubella virus vaccine) given to women within three months before or after conception; There are no data on the effect of the vaccine on the development of birth defects or congenital rubella syndrome [6]. Live attenuated polio vaccine was also well tolerated by pregnant women [7, 8].

When live viral vaccines (eg, rubella, chickenpox, OPV) were administered to pregnant women, there was no increase in the incidence of adverse events in the fetus or newborn. Some of these vaccines (eg, OPV, yellow fever) are indicated for pregnant women who are at high risk of exposure to infection.

The only live antiviral vaccine that is toxic to the fetus remains the smallpox vaccine. These vaccines should not be used in women of childbearing age without appropriate toasts confirming the absence of pregnancy, and should not be administered to family members of a pregnant woman.

Pregnancy and tetanus and rabies vaccines

Continuation of the story https://www.babyblog.ru/com/living/555037 and https://www.babyblog.ru/com/living/554235

So, my husband and I went to the gynecologist. The gynecologist said that the fetus was already formed. And, in her opinion, vaccination cannot harm. She called the chief rabiologist (rabies doctor) of the district, she said that there would be no effect on the fetus.

While digging on the Internet, we found the following information:

*Since rabies is almost always fatal, vaccination is vital. In addition, no relationship was found between rabies vaccination and abnormalities in fetal development. Tetanus and diphtheria toxoids are the only immunobiological agents whose administration is routinely indicated for unvaccinated pregnant women . Previously vaccinated pregnant women who have not received tetanus toxoid within the past ten years should receive a booster dose of this drug. Pregnant women who are not vaccinated against tetanus, or who are not fully vaccinated, should complete the initial series of vaccinations. https://www.privivki.ru/spec/pregnant.htm

**Rabies. The vaccine can be used in pregnant women. This vaccine is vital because rabies infection is most often fatal. No negative effects of the vaccine on the fetus have been recorded.

Tetanus/diphtheria. The vaccine can be used in pregnant women. These are the only immunobiological agents whose administration is routinely indicated for unvaccinated pregnant women. It is recommended to vaccinate in the second trimester.

https://www.budumamoi.ru/vak.html

***Vaccinations that are reliably harmless during pregnancy.

Vaccination against rabies. Studies have not found any effect on the course of pregnancy and the condition of the fetus of vaccination against rabies. The need for this vaccination is absolute and is not discussed, because rabies is definitely fatal. Vaccinations against tetanus and diphtheria. The safety of such vaccinations was proven especially carefully , since immunologists considered it necessary not only to allow, but also to show these vaccinations to pregnant women. In the second trimester of pregnancy, revaccination of women who were vaccinated more than 10 years ago and primary vaccination of women who have not previously received vaccinations against tetanus and diphtheria are routinely carried out. https://www.babyeda.ru/pregnancy2.html?id=69

Among my acquaintances, I found one who received these vaccinations for the same indications and at approximately the same time as mine. Everything is ok with the child.

Then I started looking on the Internet for those who had gone through this difficult path. About 8 such friends in misfortune were found. Those with whom I contacted (with the exception of one - she is in the maternity hospital, the second is still pregnant, the third has not yet responded), i.e. 5 remain, they said that the children were not affected by vaccines (from the public: https://puzyaka.ru/forum/showthread.php?t=5711, https://www.forum.samarskie-roditeli.ru/index.php ?showtopic=17278&pid=443500&mode=threaded&start= )

I called a physician friend in Moscow (and she is already an infectious disease specialist), and they explained to me the principle of action of these vaccines. Unlike live vaccines (which are contraindicated for pregnant women (against measles, rubella, polio, which you get sick with)), these vaccines are “dead”, they move in the blood, look for a focus (if they find it, they kill it, if not, then, accordingly, no) and then they come out with urine. Of course, I’m not speaking like a doctor.

Next came textbooks for medical universities on microbiology, where I read that these vaccinations can be given to pregnant women (https://www.booksmed.com/mikrobiologiya/).

I got these vaccines!

But, despite all the above information, I cannot calm down!

I hardly sleep, I’m constantly on edge, my jaw is aching.

Doctors say that this will cause more harm to my baby.

Everything revolves around one topic: pregnancy and these vaccines.

My husband had already calmed down about their impact on pregnancy and stopped supporting me in my worries. And everything stopped being important to me (money, shopping for the baby, weight, appearance, home, studies). How can I pull myself together? I still have two months to go pregnant. How can I survive this?

I hope that all this information will be for informational purposes only and you will never need to apply it in your life. Take care of yourself and your baby from the first days of pregnancy, be careful.

Hepatitis B

Compared with adults, newborns and infants infected with hepatitis B virus have a greater risk of developing severe liver damage and even death or chronic liver damage.

The hepatitis B vaccine includes hepatitis B surface antigen (HbsAg) particles. which are unable to cause infection. CDC believes that its use cannot cause harm to the fetus [10]. In contrast, almost 90% of children born to mothers infected with hepatitis B virus in the last trimester developed chronic hepatitis if they were not vaccinated at the time of birth [11].

Tetanus

Tetanus toxoid administration is indicated for pregnant and lactating women who have not previously received immunization or require a booster injection. No negative effects of the tetanus vaccine on the fetus have been identified [12]. As a precaution, the CDC recommends vaccination after the end of the first trimester of pregnancy [5]. Although Tdap vaccination (acellular DTP vaccine with a reduced content of difluoride toxoid and pertussis component) during pregnancy is not specifically specified, there are also no contraindications to its administration.

Rubella

When infected with the rubella virus in the first 4 weeks. During pregnancy, in approximately 50% of cases, the fetus develops congenital rubella syndrome (CRS). including blindness, heart defects, deafness and other developmental defects [13]. By the third trimester, the risk of developing CRS in the fetus decreases to 10%.

Rubella vaccine is a live antiviral vaccine. It should not be administered to pregnant women due to the theoretical possibility of exposure of the fetus to the live virus. However, there were no cases of CRS development in newborns whose mothers were unscheduledly vaccinated or became pregnant within 3 months. After vaccination All women of childbearing age should be screened for rubella antibodies. Most cases of CRS have been reported in newborns whose mothers were not screened or vaccinated despite medical supervision [14].

Vaccinations during pregnancy

Vaccination (immunization) stimulates the immune system, causing it to produce antibodies, which help the body fight infections and prevent disease.

Some vaccines are safe for pregnant women. Others may be prescribed at least a month before pregnancy or after the birth of the child. Some vaccines are recommended for all pregnant women, while others may only be given in certain circumstances related to health conditions or when there is a risk of infection.

• Vaccines recommended before pregnancy

At the stage of pregnancy planning, the patient must be vaccinated in accordance with the National Preventive Vaccination Calendar.

Vaccinations against measles, rubella, mumps (mumps), and chickenpox

very important for women of reproductive age who have not been vaccinated before. These vaccines can protect against infections that can harm the fetus. However, these vaccinations cannot be given during pregnancy or in the month before you are expected to conceive. Many women of childbearing age in Russia were vaccinated in childhood and are already protected, however, for younger women this problem may be relevant in connection with the “anti-vaccination campaign”.

When planning a pregnancy, it is better to make sure that you have immunity to these infections. This can be found out from your vaccination record or by taking a blood test for antibodies to these infections. If you are not immunized, you need to be vaccinated against measles, rubella and mumps no later than one month before pregnancy. Exposure to people with measles, rubella or mumps in early pregnancy can lead to miscarriage. Rubella in early pregnancy leads to fetal malformations, such as deafness, blindness, heart and brain defects. Measles can be severe during pregnancy. If you are pregnant, it is advisable to vaccinate your household, especially children, with the measles, rubella and mumps vaccine.

If you are not immunized to rubella and have been in contact with someone who is sick during pregnancy, contact your GP immediately. He will prescribe treatment that can reduce the risk of the disease.

Just like with measles, rubella and mumps, it's best to make sure you're immunized against chickenpox

. The therapist will be able to find out this by the result of a blood test for antibodies to varicella, the causative agent of this disease. If antibodies are not detected, you will be offered a chickenpox vaccine. Planning a pregnancy will have to be postponed for 1 month. Chickenpox during pregnancy, especially in the first trimester, when the formation and formation of fetal organs and systems occurs, increases the risk of developmental defects. During pregnancy, chickenpox can be especially severe and cause complications such as pneumonia.

You can become infected through contact with someone who has chickenpox or herpes zoster. If you are not immunized to chickenpox and have been in contact with someone who has chickenpox during pregnancy, contact your GP immediately. He or she will be able to assess your risk of infection and decide whether you need treatment with herpes zoster virus immune globulin, which can reduce your chance of infection.

Human papillomavirus.

Vaccination against the human papillomavirus is recommended for girls and women from 9 to 26 years of age outside of pregnancy. The HPV vaccine is not recommended for pregnant women, however, there is evidence that the vaccine is safe if a woman has been vaccinated and does not yet know she is pregnant.

• Vaccines recommended for all pregnant women

Flu.

Pregnant women and newborns are at high risk of developing complications from influenza. Seasonal influenza vaccination is recommended for all pregnant women or those preparing for pregnancy. The vaccine does not have a negative effect on the fetus. In addition to protecting a woman from influenza during pregnancy, the vaccine will prevent her infant from getting sick in the first 6 months after birth.

Whooping cough, diphtheria and tetanus.

The whooping cough, diphtheria, and tetanus vaccine is recommended during pregnancy, even if the woman has been vaccinated previously. Vaccination is possible from 27 to 36 weeks of pregnancy. In case of infection with these infections, vaccination can protect the newborn from serious complications.

• Vaccines recommended for some pregnant women

Cases where pregnant women may become infected with certain infections during travel or under other circumstances require additional vaccination.

Hepatitis A.

The hepatitis A virus during pregnancy can cause threatened miscarriage or placental insufficiency. Vaccination is recommended for pregnant women who can become infected with hepatitis A during travel, if hygiene rules are not followed, or during an outbreak of the disease.

Hepatitis B.

A serious infection that can cause chronic inflammation in the liver and be transmitted to the fetus. Three doses of the hepatitis B vaccine are usually given in childhood. However, many adults may not be immunized. The vaccine has no effect on the fetus and its administration is recommended for pregnant women at high risk of contracting hepatitis B or those for whom immunization was started before pregnancy.

Polio.

The causative agent is a virus that leads to paralysis. In many countries around the world, total vaccination has led to the complete elimination of this disease. However, polio outbreaks still occur in some countries. During pregnancy, you should avoid visiting places where polio is present.

Due to the lack of sufficient information about the safety of the vaccine for the fetus, immunization against polio is not recommended during pregnancy. If visiting countries where polio is present is unavoidable, discuss with your GP the need for inactivated polio vaccine.

Pneumococcus.

A bacterium that causes bacterial pneumonia, otitis media and meningitis. Women at high risk of contracting pneumococcus should be immunized with pneumococcal vaccine.

It is better to get vaccinated against pneumococcus before pregnancy. However, the vaccine is safe when administered in the second and third trimester of pregnancy. There is insufficient information about the effect of the vaccine on the fetus in the first trimester.

Yellow fever.

A viral disease spread by mosquitoes. Damages the liver, kidneys, causes bleeding, which can lead to death. The disease is common in tropical regions of South America and Central Africa. Try to avoid visiting areas with active yellow fever during pregnancy.

If travel is unavoidable and there is a risk of exposure to yellow fever, immunization with a live antiviral vaccine during pregnancy is possible. To do this, you need to consult a general practitioner.

Chicken pox

Infection of a pregnant woman can lead to the development of congenital chickenpox syndrome in the fetus, characterized by limb atrophy, strictures, microcephaly, cortical atrophy, and chorioretinitis. cataracts and other defects [15]. Compared to the first trimester, the risk of developing congenital varicella syndrome is slightly higher in the period from 13 to 20 weeks. pregnancy [16]. The effect of the vaccine on the fetus has not been proven. The risk of developing congenital varicella syndrome after infection with wild type virus is 0.4-2.0%; When using an attenuated vaccine, the risk of developing congenital varicella syndrome should theoretically be lower or completely absent [16].

What is rabies

Rabies is an acute zoonotic (general name for diseases that are transmitted from animals to humans) infectious process that affects the central nervous system and, if not treated promptly, is fatal.

The virus is found in the saliva of animals:

• Fox;
• Rodents;
• Dogs;
• Cats;
• Kabanov;
• Bats.

If infected saliva gets on damaged human skin, this leads to the development of rabies. The disease is transmitted by using objects contaminated with saliva through the mucous membrane.

But rabies has a very long incubation period, which is the amount of time from the moment of infection to the onset of symptoms. And during this period it can occur without symptoms. An infected animal becomes dangerous at the last stage of the disease, almost not long before its death.

Until this time, the animal is not infectious, since the causative agent of the disease is not yet excreted in saliva. And precisely because of this, if the animal is alive and well within ten days from the moment of the bite, then it cannot infect.

When infected, symptoms appear after 1-3 months, and the duration of the incubation period depends on the dose of infected saliva.

The pathology is manifested by paralysis, nervous excitement, and a feeling of fear.

Hepatitis A

The safety of hepatitis A vaccination during pregnancy has not been studied; however, since the hepatitis A vaccine is based on inactivated hepatitis A virus, the possibility of infection is theoretically very small. The risk associated with vaccination must be weighed against the possible risk of developing hepatitis A in a pregnant woman, especially if the risk of exposure to infection is high [18 ].

Literature:

1. Munoz FM, Englund JA, Infect. Dis. Clin. North Amor. 2001: 15(1): 253-271.
2. Silvers MJ. Steploe MM. Prim. Care Clin. Off. Pracl. 2001:28: 1-9.
3. AnmncanCollegeotObntotnciansandGynecoiogisls, Committee on Obstetric Practice. Immunization during pregnancy. ACOG Com Opin. 2003; 282.
4. Centers for Disease Control arxl Prevention. General recommendations on immunization, recommendations of tl»e Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) MMWR Morb. Mortal. Wkly Rep. 2002; 51 (RR02): 1-36.
5. Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women. 2004. Available at: https://www.in.gov/iHdh/programs/immunization/lmmunzationSchedGuldelines%20for%20Vaccinating%20Pregnant%20Women.pdf. Accessed January 25.2008.
6. American Academy of Pediatrics: Poliowus infections. In Pickering LK (ed): 2000 Red Book Report of the Committee on Infectious Diseases, ed 25. Elk Grove Village. IL. American Academy of Pediatrics. 2000. pp. 465 470.
7. DaSilva MM, Prom KA. Johnson FA. et at. JAMA 1958:1681 -1685-
8. Linder N. Hands!ler R. Fruman O. et al Pedi.itr Infect. Ois J. 1994; 13:959-962
9. Naleway AL. Smith WJ, Mullooly JP. Epidemiol Rev. 2006; 28: 47-53.
10. Centers for Disease Control and Prevention Connecticut. 1994-1995 and United States. 1979-1994. MMWR Morb Mortal. Wkly Rep. 1996: 45: 584 -587.
11. Estaban R. Vaccine 1995; 13(suppl 1): S35 - S36.
12. Silveira CM. Caceres VM, Dutra MG. Lopes-Camelo J. CastMla EE Bulletin WHO. 1995:73.605-608
13. AmencanColk*geofKtetriciansandGynecologists. ACOG N(ws Release November 29, 2002.
14. HacktoyBKJ Nurse Midwifery 1999.44:106-117. 15- Centers for Disease Control and Prevention. MMWR Morb. Modal. Wkly Rep. 1996: 45 (RR* 11): 1-25.
15. Pastuszak AL. Levy M. Schick In el al N. Engl. J Med 1994; 330: 901 905
16. Englund. J. et al. Path 2007: 137: S16 - S19 18 COC. MMWR 2006: 55 (No. RR-7): 15
17. CDC. MMWR 2006; 55 (No. RR-7): 15.

Table 1. ACIP recommendations regarding immunization during pregnancy or lactation