Are You Immune?

Since I talked about the flu vaccine and pregnant women in my healthcast [yes, I've expanded into audio, and no, you may not make fun of my DJing abilities], I thought I should elaborate here, and review immunizations in pregnant women.

Immunizations, which are usually given as injections (shots), protect you from disease and reduce the chance that an epidemic can develop. A vaccine prompts your immune system to form antibodies to fight a particular disease in the future. Most vaccines are killed viruses, meaning it's impossible for you to get the disease from the vaccination. Even when the vaccine is live, it's weakened so much that a person with a normal immune system almost never gets sick from it. Of course, pregnancy is a special case.

For all pregnant women, the best time to be immunized is before becoming pregnant!

Some of the common vaccines related to pregnancy are:

[inactivated] Influenza (flu) vaccine: killed virus--Acceptable in pregnancy

Tetanus vaccine: toxoid--Yes

Hepatitis B vaccine: recombinant surface antigen--Yes

[inactivated] Poliovirus vaccine: killed virus--Yes

Measles/Mumps/Rubella (MMR) vaccine: live attenuated virus--No

Varicella-zoster vaccine (VZV): live attenuated virus--No

Who should receive these vaccines?

Influenza vaccine
All pregnant women who will be in their second or third trimester (beyond 14 weeks) during flu season (~October to January) and all women at high risk regardless of trimester.

Tetanus vaccine
All women who have not had a primary series or who have not had a booster within 10 years.

Hepatitis B vaccine
Pregnant women completing an immunization series begun prior to becoming pregnant and nonimmunized women at high risk for hepatitis B.

Poliovirus vaccine
Pregnant women who will be traveling to areas where polio is endemic. (The oral polio vaccine is no longer given because there's a risk the vaccine may cause paralytic poliomyelitis.)

MMR
This vaccine is not administered to pregnant women. If you are found to be rubella nonimmune during pregnancy, make sure you receive MMR within the first 48 hours after delivery (postpartum). In other words, ask for the vaccine, and don't leave the hospital before receiving it.

VZV
This vaccine is not administered during pregnancy. Because maternal infection around the time of delivery is dangerous for the neonate, if you develop chicken pox in the period 5 days before to 2 days after delivery, make sure the baby receives varicella-zoster immune globulin (VZIG).

The CDC has additional immunization information.

*Primack BA, Zimmerman RK. Influenza and Other Vaccinations Important for Women. Female Patient. Oct 2004;29(10):34-40.