Because there are theoretical risks to your unborn baby from vaccination, it's crucial to carefully review the risks and benefits of each immunization. Ideally, all pregnant women should be up to date on their routine immunizations. In general, pregnant women should be advised to avoid live vaccines and to avoid becoming pregnant within three months of having received one; however, no harm to the unborn baby has been reported from the accidental administration of these vaccines during pregnancy. Current information on vaccine safety during pregnancy is subject to change and can be verified at the Centers for Disease Control and Prevention Website.
Diphtheria-Tetanus The combination diphtheria-tetanus immunization should be given if the pregnant traveler has not been immunized within 10 years. Although no evidence exists that tetanus and diphtheria toxoids are teratogenic, waiting until the second trimester of pregnancy to administer is a reasonable precaution for minimizing any concern about the theoretical possibility of such reactions.
Measles, Mumps and Rubella The measles vaccine, as well as the measles, mumps and rubella (MMR) vaccines in combination, are live virus vaccines and are contraindicated in pregnancy. However, in cases in which the rubella vaccine was accidentally administered no complications have been reported. Because of the increased incidence of measles in children in developing countries, and because of the disease's communicability and its potential for causing serious consequences in adults, it is advisable to recommend that nonimmune women delay traveling until after giving birth, when immunization can be given safely. If a pregnant woman has a documented exposure to measles, immune globulin should be given within a six-day period to prevent illness.
Poliomyelitis Although no adverse effects of IPV have been documented among pregnant women or their fetuses, vaccination of pregnant women should be avoided on theoretical grounds. However, if a pregnant woman is at increased risk for infection and requires immediate protection against polio, IPV can be administered in accordance with the recommended schedules for adults. Paralytic disease can occur with greater frequency when infection develops during pregnancy. Damage to the unborn baby has also been reported, with up to 50 percent mortality in neonatal infection.
Hepatitis B The hepatitis B vaccine may be administered during pregnancy. On the basis of limited experience, there is no apparent risk of adverse effects to developing fetuses when hepatitis B vaccine is administered to pregnant women (CDC, unpublished data). Influenza Because of the increased risk for influenza-related complications, women who will be beyond the first trimester of pregnancy (greater than 14 weeks' gestation) during the flu season should be vaccinated. Pregnant women who have medical conditions that increase their risk for complications from influenza should be vaccinated before the flu season -- regardless of the stage of pregnancy.
Travel-Related Immunization during Pregnancy Yellow Fever The yellow fever vaccine should not be given to a pregnant woman unless travel to an endemic or epidemic area is unavoidable. In these instances, the vaccine can be administered. Although concerns exist, no congenital abnormalities have been reported after administration of this vaccine to pregnant women. If traveling to or transiting regions within a country where the disease is not a current threat but where policy requires a yellow fever vaccination certificate, pregnant travelers should be advised to carry a physician's waiver, along with documentation (of the waiver) on the immunization record. In general, pregnant women should be advised to postpone until after delivery (when vaccine can be administered without concern of fetal toxicity) travel to areas where yellow fever is a risk. However, a nursing mother should also delay travel because the neonate cannot be immunized due to the risk of vaccine-associated encephalitis.
Hepatitis A The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated hepatitis A virus, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination should be weighed against the risk for hepatitis A in women who may be at high risk for exposure.
Typhoid The safety of the oral Ty21a typhoid vaccine in pregnancy is not known. It is not absolutely contraindicated during pregnancy, according to the Advisory Committee on Immunization Practices (ACIP). Nonetheless, the Vi capsular polysaccharide vaccine (ViCPS) injectable preparation is the vaccine of choice during pregnancy because it is inactivated and requires only one injection. With either of these, the vaccine efficacy (about 70 percent) needs to be weighed against the risk of disease.
Meningococcal Meningitis The polyvalent meningococcal meningitis vaccine can be administered during pregnancy if the woman is entering an area where the disease is epidemic. Studies of vaccination during pregnancy have not documented adverse effects among either pregnant women or neonates. Based on data from studies involving the use of meningococcal vaccines and other polysaccharide vaccines administered during pregnancy, altering meningococcal vaccination recommendations during pregnancy is unnecessary.
Rabies Because of the potential consequences of inadequately treated rabies exposure, and because there is no indication that fetal abnormalities have been associated with rabies vaccination, pregnancy is not considered a contraindication to postexposure treatment.
Japanese Encephalitis No information is available on the safety of Japanese encephalitis vaccine during pregnancy. It should not be routinely administered during pregnancy, except when a woman must stay in a high-risk area. If not mandatory, travel to such areas should be delayed.
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