After the global pandemic of the new crown this year, pregnant mothers are generally very worried about being infected with the new crown virus, which will threaten the health of their babies.
In fact, it is not just the new coronavirus. This group of pregnant women is a high-risk group for infectious diseases. After being infected with certain infectious diseases, it may cause maternal death, congenital malformations of the fetus, spontaneous abortion, premature birth, low birth weight, etc., which seriously endanger the health of maternal and infants.
Respond to the threat of infectious diseases, vaccines are the most effective weapon.
However, in my country's clinical work, immunization of pregnant women often becomes an easy to ignore content. Even many clinicians cannot give clear suggestions on which vaccine is safe during pregnancy and how to get vaccinated.
The author checked the technical guide for vaccination of World Health Organization (WHO), the technical guide for vaccination of in pregnancy released by the American Society of Obstetricians and Gynecologists (ACOG) (2018 edition), and the technical guide for vaccination of influenza vaccine (2018-2019) released by the Chinese Center for Disease Control and Prevention, and sorted out the vaccination suggestions for several major vaccines for reference by pregnant mothers.
commonly used vaccines in my country are mainly divided into three categories:
live attenuated vaccines: chickenpox, measles , rubella, typhoid, mumps , yellow fever, etc.
toxin : tetanus .
inactivated vaccine : hepatitis A, hepatitis B, influenza , rabies , meningitis, etc.
live attenuated vaccine cannot be injected during pregnancy, while toxins and inactivated vaccines can be injected during pregnancy. Inactivated viruses cannot pass through the placental barrier and will not cause fetal malformations.
The first category: Vaccine that can be vaccinated during pregnancy
1.1 Inactivated influenza vaccine
A large number of domestic and foreign studies have confirmed that after pregnant women have influenza, the risk of severe illness, death and adverse pregnancy outcome is very high.
At the same time, studies have confirmed that there is sufficient evidence for the safety of pregnant women getting influenza vaccine at any stage of pregnancy. At the same time, vaccination is clear in preventing influenza and protecting babies under 6 months of age through fetal transmission antibodies.
Therefore, the "WHO Flu Vaccine Position Document (2012 Edition)" lists pregnant women as the first priority vaccination population .
American Society of Obstetricians and Gynecologists (ACOG) guidelines recommend that inactivated influenza vaccine can be given at any stage of pregnancy . If conditions permit, it should be vaccinated during each flu season.
In 2018, after careful evaluation by the National Center for Disease Control and Prevention, the "Guidelines" recommended:
(1) Women who are preparing to get pregnant during the flu season or pregnant women with can receive the flu vaccine .
(2) Pregnant women can receive at any stage of pregnancy.
Note: Although the influenza vaccines approved for marketing in my country are all inactivated vaccines (cleavage vaccines and subunit vaccines), due to the lack of safety evaluation data for pregnant women to receive influenza vaccines in China, some influenza vaccine product manuals still list pregnant women as contraindications.
1.2 Diphtheria and Tetanus Vaccine
Diphtheria and Tetanus Vaccine is prepared from pertussis vaccine, refined diphtheria and tetanus toxins in an appropriate proportion, to prevent three diseases: pertussis, diphtheria and tetanus.
Whooping cough: can withstand it for adults, but for children, it may cause brain damage and may be fatal at any time.
Dipopause: Laryngeal infection caused by bacteria can cause dyspnea and affect the heart.
Tetanus: is also called "tummy acuity". It has muscle pain and tightness, and the patient will have a cavity tightly closed and cannot eat, which may even lead to death. The incidence of tetanus in newborns in my country is relatively high and the mortality rate is also very high, which is a major factor threatening the life of newborns.
diphtheria and tetanus vaccine can be vaccinated at 27 to 36 weeks of pregnancy. It is best to be vaccinated as soon as possible within this time range to enhance the immune response of pregnant women and maximize the amount of antibodies passively obtained by the newborn.
The second category: In special circumstances, vaccination can be considered during pregnancy
2.1 After being scratched and bitten by animals, you can get rabies vaccine
If pregnant mothers are scratched or bitten by cats or dogs, they will definitely be very entangled. Should they get rabies vaccine? Will vaccination affect the fetus?
In the "Rabies Vaccine Standalone Document", the World Health Organization pointed out that "since rabies is a fatal disease, there are no contraindications for post-exposure prevention after high-risk exposure. The same is true for post-exposure prevention in infancy or pregnancy and for immunological impairments (including children with HIV/AIDS)." The passage of
translates to: pregnant women, babies and other special groups are not contraindicated for rabies vaccines, and they can be given.
At the same time, the rabies vaccines currently used in my country are refined VERO cell rabies vaccine and refined gopher kidney cell rabies vaccine, both of which are inactivated vaccines .
In terms of ingredient , no one will affect embryonic development.
In terms of type , inactivated vaccines can be used during pregnancy, and studies at home and abroad have shown that pregnant women who receive qualified rabies vaccine have pregnancy complications and baby birth defects similar to pregnant women who have not been vaccinated, and do not increase the risk of miscarriage, premature birth or teratogenicity.
From the risk , whether animals bite or scratch pregnant mothers have received rabies vaccine immunization is unclear, which makes the risk of infectious diseases exposed to a higher risk. The mortality rate of rabies is very high, almost 100%. Once infected, it is difficult for both mother and son to escape.
Therefore, in rabies endemic areas, pregnant mothers should be given rabies vaccine if they are bitten by dogs or other animals; or in non-endemic areas, they should be bitten by mad dogs or animals suspected of mad dogs. For severe bites, rabies immunoglobulin or anti-rabies serum should be injected immediately, and then rabies vaccine should be injected according to the immune procedure.
2.2 Risk factors should be evaluated for hepatitis A and hepatitis B vaccines
exposure risk : If there are high-risk factors that cause severe adverse outcomes due to hepatitis A virus infection, such as chronic liver disease, coagulation factor dysfunction, intravenous or non-venous drug use, frequent exposure to non-human primates at work, etc., and have not been vaccinated with hepatitis A vaccine before pregnancy.
HP exposure risk : Family members or sexual partners are positive for hepatitis B surface antigen, have been dating more than one sexual partner within 6 months, have been found to have sexually transmitted infection, have a current or recent history of intravenous drug use, patients with chronic liver disease, HIV-infected people or travel to endemic areas.
Anyone who wants to avoid infection with hepatitis A and hepatitis B virus during pregnancy can be vaccinated during pregnancy or postpartum stage.
2.3 To get pneumonia vaccine, you need to weigh the pros and cons.
There are two types of pneumococcal vaccines on the market: the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and the 13-valent pneumococcal vaccine (PCV13).
Unless it is a high-risk group for pneumococcal disease, pregnant women should be vaccinated with pneumonia vaccine with caution. After consulting with the doctor, weigh the pros and cons and think that the benefits of immunization of are better than , may be risky of .
2.4 For meningococcal vaccine, you should look at the indications
tetravalent meningococcal vaccine. The indications for vaccination are: HIV infection, lack of complement components, functional assangia or anatomical spleen deficiency; history of contact during meningococcal disease outbreak, going to endemic prevalence areas, high incidence areas, or engaging in microbiological research and often exposed to Neisseria meningitis.
If pregnant mothers meet the above vaccination indications, they should consult the doctor and weigh the pros and cons when they think that the benefits of immunization are greater than possible risks, get vaccinated.
The third category: vaccines that are prohibited during pregnancy
Live attenuated vaccines are prohibited during pregnancy women.
includes: measles-mumps-rubella vaccine, chickenpox vaccine, BCG vaccine, live attenuated viral vaccine for Japanese encephalitis and meningitis, oral polio vaccine, etc.
