It is a fact that the rate of routine vaccination among pregnant women is always low when compared to child immunisation. Even in the USA, the Tdap vaccine coverage is 56.6% (Influenza and Tdap Vaccination Coverage Among Pregnant Women — United States, April 2020 | MMWR (CDC.gov)-April 2020. In our clinical training (1979), our professor taught us that the consumption of medicine and even vaccination need to be evaluated carefully to prevent potential risks to unborn children.
Even today, many physicians and community members are sceptical about vaccination during pregnancy, as it might adversely affect the pregnancy outcome.
Many medicines are contraindicated during pregnancy due to possible harmful effects on the baby. However, as far as vaccination is concerned, safety issues are strictly followed throughout the world. And now we have a clear data-backed understanding of what is safe and what is unsafe.
Which vaccines to be given during pregnancy has been beautifully illustrated in Table 1.
(Source: Centers for Disease Control and Prevention document)
Why is maternal immunisation important?
Maternal immunisation has two distinct advantages. First, it protects both mother and foetus from serious infections during the pregnancy period, and second, it protects the newborn from infection immediately after birth by placental transfer of IgG & and IgA antibodies.
Which vaccines are not recommended during pregnancy?
Live attenuated virus vaccines may have potential adverse reactions on pregnancy outcomes; hence they should be avoided.
Examples of currently available live, attenuated vaccines against viral infections include measles, mumps, rubella (MMR), cowpox, yellow fever, influenza (FluMist®) intranasal vaccine), and oral polio vaccine. Live, attenuated bacterial vaccines include tuberculosis, BCG, and oral typhoid vaccine.
How to increase vaccine confidence among pregnant women?
Women frequently underutilize available health services due to their extensive household responsibilities, often neglecting their own well-being. Community awareness about the benefits of vaccination during pregnancy is the key determinant for increasing the uptake of vaccination during pregnancy. The healthcare provider has a major role in successful advocacy about the importance of vaccination. The role of primary care physicians is crucial for positive influence in the minds of pregnant women.
How many doses of Tetanus toxoid vaccine or Tdap / Td should be taken by pregnant women for protection against maternal and neonatal tetanus?
Three vaccinations are generally recommended for pregnant women in India. These vaccines include Tetanus Toxoid (TT), Tdap (Tetanus, Diphtheria, and Pertussis), and the Influenza vaccine.
Tetanus, a lethal bacterial infection, threatens both mother and newborn. Caused by Clostridium tetani, it enters the body through wounds, posing fatal risks if untreated. Neonatal tetanus results from infection of the unhealed umbilical stump. Vaccination remains the sole prevention method, with tetanus toxoid (TT) vaccines safe even during pregnancy. India’s immunization schedule recommends two doses during pregnancy, with a booster dose for subsequent pregnancies within three years. TT vaccination offers maternal and neonatal protection, reducing premature births.
TT1 should be given as early as possible when pregnancy is detected, the TT2 should be given after 4 weeks of TT1. If the mother has taken 2 doses of TT in a previous pregnancy within three years, one booster dose of TT is recommended as India’s national guidelines.
What is the expected duration of protection level of TT during the childbearing age of the women?
The 1st dose has no protection. The 2nd dose protection level is 1-3 years. The 3rd dose (if taken after 6 months of TT2 or during subsequent pregnancy) protects at least for 5 years. The 4th dose (if taken one year after TT3 or during subsequent pregnancy) protects at least for 10 years. 5th dose (if taken one year after TT4 or during subsequent pregnancy) provides lifelong protection.
What vaccines should be recommended during the lactation period?
Except Mpox/Smallpox and yellow fever vaccines, all other vaccines like inactivated (Anthrax, Hep A, HPV, Influenza, JE, IPV, Rabies), live attenuated (Influenza, MMR, Chickenpox, typhoid), recombinant ( Hep B, Meningococcal ), conjugate ( Hib, PCV, meningococcal ), polysaccharide( PCV, Typhoid), toxoid ( DPT) can be safely using during lactation period.
The SDG guidelines highlight the importance of enhancing immunization services for both mothers and children. Although there have been some strides in child immunization rates, pregnant women continue to be largely underserved. What is urgently required are improved communication strategies by community health workers, general physicians, obstetricians, and gynecologists to instill trust in vaccines. This trust-building effort is crucial not only for the well-being of the child and the mother but also for the broader health benefits that immunization offers to society as a whole.
