Incorporating vaccine administration as a routine part of prenatal care is key to protecting pregnant women and their offspring from vaccine-preventable diseases. Evidence-based strategies to build a robust vaccination program embedded within an obstetrical practice include: staff education for all individuals who encounter the patient (front desk, medical assistants, lab techs, nurses, midwives, and physicians), patient education in multiple languages, and standing-order sets.2,3,21 When vaccines are not available within your office or clinic, encouraging women to receive needed vaccines at the pharmacy or through their employer is also important, but a less effective strategy.
Vaccines that should be given to every pregnant woman during every pregnancy include influenza during flu season and Tdap.6,22,23 As noted previously, other vaccines may be given if women have high-risk comorbidities or are midway through a vaccine series. HAV, HAB, and the pneumococcal vaccine should be considered for administration during pregnancy based on a patient’s medical history and additional risk factors (Table 3). Obstetrical providers who are knowledgeable about vaccine safety and efficacy and prepared to debunk myths about vaccines in pregnancy will have the highest rates of vaccine uptake (Table 4).1,2
Attention to vaccination continues as we care for women in the postpartum period. All women who are found to be rubella, measles, or VZV non-immune during pregnancy should receive these live-attenuated virus vaccines postpartum without concerns about lactation. Postpartum and lactating women who are age 26 or younger and who have not previously received HPV vaccination should have this series initiated. The vaccine may also be considered for women older than age 26 who are at risk for HPV exposure.19-23 Finally, postpartum and lactating women with risk factors (Table 2) who have not previously been vaccinated should receive HAV, HBV, and pneumococcal vaccines according to ACOG and CDC recommendations. 23
- Finney Rutten LJ, St Sauver JL, Beebe TJ, et al. Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children. Vaccine. 2017;35(45):6122-6128.
- Rutten LJF, St Sauver JL, Beebe TJ, et al. Clinician knowledge, clinician barriers, and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates. Vaccine. 2017;35(1):164-169.
- Martinello RA, Jones L, Topal JE. Correlation between healthcare workers’ knowledge of influenza vaccine and vaccine receipt. Infect Control Hosp Epidemiol. 2003;24(11):845-847.
- Shavell VI, Moniz MH, Gonik B, Beigi RH. Influenza immunization in pregnancy: overcoming patient and health care provider barriers. Am J Obstet Gynecol. 2012;207(3 Suppl):S67-S74.
- Goldfarb I, Panda B, Wylie B, Riley L. Uptake of influenza vaccine in pregnant women during the 2009 H1N1 influenza pandemic. Am J Obstet Gynecol. 2011;204(6 Suppl 1):S112-S115.
- ACOG Committee Opinion No. 732: Influenza Vaccination During Pregnancy. Obstet Gynecol. 2018;131(4):e109-e114.
- Mølgaard-Nielsen D, Fischer TK, Krause TG, Hviid A. Effectiveness of maternal immunization with trivalent inactivated influenza vaccine in pregnant women and their infants. J Intern Med. July 2019.
- Grohskopf LA, Alyanak E, Broder, KR et al . Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR Recomm Rep. 2019;68(3); 1-21.
- Measles & the MMR Vaccine: Recommendations Around Pregnancy, Including the Periconception and Postpartum Periods - UW Medicine Provider Resource. http://providerresource.uwmedicine.org/flexpaper/measles-and-the-mmr-vaccine-recommendations-around-pregnancy-including-the-periconception-and-postpartum-periods. Accessed September 25, 2019.
- Centers for Disease Control and Prevention. Measles: Evidence of Immunity. https://www.cdc.gov/measles/hcp/index.html#immunity.
- McLean HQ, Fiebelkorn AP, Temte JL, et al. Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34.
- Marin M, Güris D, Chaves SS, S et al. Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56(RR-4):1-40.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol. 2007;110(4):941-956.
- Mast EE, Weinbaum CM, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1-33; quiz CE1-CE4.
- Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006;55(RR-7):1-23.
- Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61(40):816-819.
- Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep. 2010;59(34):1102-1106.
- Pneumococcal Vaccination Summary | Who and When to Vaccinate | For Providers | CDC. https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html. Published June 20, 2019. Accessed September 25, 2019.
- HPV Vaccine Recommendations | Human Papillomavirus | CDC. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html. Published June 27, 2019. Accessed September 25, 2019.
- Committee Opinion No. 704 Summary: Human Papillomavirus Vaccination. Obstet Gynecol. 2017;129(6):1155-1156.
- Use of Standing Orders Programs to Increase Adult Vaccination Rates: Recommendations of the Advisory Committee on Immunization Practices. https://www.cdc.gov/mmwr/PDF/rr/rr4901.pdf.
- Committee on Obstetric Practice, Immunization and Emerging Infections Expert Work Group. Committee Opinion No. 718: Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination. Obstet Gynecol. 2017;130(3):e153-e157.
- ACOG Committee Opinion No. 741: Maternal Immunization. Obstet Gynecol. 2018;131(6):e214-e217.