Rekan2,
menyambung diskusi soal imunisasi Tetanus saat hamil, ini ada artikel
dari www.cdc.gov (wah, bukan 'mania' CDC nih, tapi karena belakangan
surfing ke sana dan ketemu yg. menarik2...).
Pengalaman pribadi sih, dulu waktu hamil tidak diberi suntikan TT, tapi
sepulang dari RS sesudah kena campak dulu itu, DSOG saya menyarankan
untuk vaksin Rubella, karena dari cek darah, belum ada antibodi tsb.
Cuma saya harus tidak boleh hamil sampai 3 bulan sesudahnya. Jadi beliau
menyarankan divaksin saat menstruasi, supaya bener2 yakin sedang tidak
hamil.
Semoga artikel ini berguna.
Semoga juga belum 40 KB...:-)
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\\\
( o> Salam,
/U ) Rien.
----oo---
Vaccination of Pregnant Women
"Risk from vaccination during pregnancy is largely theoretical. The
benefit of vaccination among pregnant women usually outweighs the
potential risk when a) the risk for disease exposure is high, b)
infection would pose a special risk to the mother or fetus, and c)
the vaccine is unlikely to cause harm." ACIP General
Recommendations on Immunization, p. 20
Generally, live-virus vaccines are contraindicated for pregnant
women because of the theoretical risk of transmission of the
vaccine virus to the fetus. If a live-virus vaccine is
inadvertently given to a pregnant woman, or if a woman becomes
pregnant within 3 months after vaccination, she should be counseled
about the potential effects on the fetus. But it is not ordinarily
an indication to terminate the pregnancy.
Whether live or inactivated vaccines are used, vaccination of
pregnant women should be considered on the basis of risks vs.
benefits - i.e., the risk of the vaccination vs. the benefits of
protection in a particular circumstance. The following table may be
used as a general guide.
-------------------------------------
Passive Immunization during Pregnancy
"There is no known risk to the fetus from passive immunization of
pregnant women with immune globulin preparations." ACIP General
Recommendations on Immunization, p. 21
In the following table, relevant passages from ACIP
recommendations are reprinted for each vaccine.
Material in quotation marks is taken verbatim from
ACIP (emphasis in bold type added); material not in
quotation marks is paraphrased.
----------------------------------------------------
Guidelines for Vaccinating Pregnant Women
Abstracted from recommendations of the
Advisory Committee on Immunization Practices (ACIP)
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
to [hepatitis A virus]." (1)
HEPATITIS B • "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). The vaccine contains
noninfectious HBsAg particles and should
cause no risk to the fetus. [Hepatitis B
virus] infection affecting a pregnant woman
may result in severe disease for the mother
and chronic infection for the newborn.
Therefore, neither pregnancy nor lactation
should be considered a contraindication to
vaccination of women."(2)
• "Hepatitis B vaccine is recommended for
women at risk for hepatitis B infection . .
." (3)
INFLUENZA • "On the basis of . . . data that suggest
that influenza infection may cause increased
morbidity in women during the second and
third trimesters of pregnancy, the [ACIP]
recommends that women who will be beyond the
first trimester of pregnancy (>14 weeks'
gestation) during the influenza season be
vaccinated." (4)
• "Pregnant women who have medical
conditions that increase their risk for
complications from influenza should be
vaccinated before the influenza
season--regardless of the state of
pregnancy." (4)
• "Studies of influenza immunization of more
than 2,000 pregnant women have demonstrated
no adverse fetal effects associated with
influenza vaccine; however, more data are
needed." (4)
MEASLES • "MMR and its component vaccines should not
be administered to women known to be
pregnant. Because a risk to the fetus from
administration of these live virus vaccines
cannot be excluded for theoretical reasons,
women should be counseled to avoid becoming
pregnant for 30 days after vaccination with
measles or mumps containing vaccines and for
3 months after administration of MMR or
other rubella-containing vaccines." (5)
• "If a pregnant woman is vaccinated or if
she becomes pregnant within 3 months after
vaccination, she should be counseled about
the theoretical basis of concern for the
fetus, but MMR vaccination during pregnancy
should not ordinarily be a reason to
consider termination of pregnancy." (5)
MUMPS • "MMR and its component vaccines should not
be administered to women known to be
pregnant. Because a risk to the fetus from
administration of these live virus vaccines
cannot be excluded for theoretical reasons,
women should be counseled to avoid becoming
pregnant for 30 days after vaccination with
measles or mumps containing vaccines and for
3 months after administration of MMR or
other rubella-containing vaccines." (5)
• "If a pregnant woman is vaccinated or if
she becomes pregnant within 3 months after
vaccination, she should be counseled about
the theoretical basis of concern for the
fetus, but MMR vaccination during pregnancy
should not ordinarily be a reason to
consider termination of pregnancy." (5)
PNEUMOCOCCAL • "The safety of pneumococcal polysaccharide
vaccine during the first trimester of
pregnancy has not been evaluated, although
no adverse consequences have been reported
among newborns whose mothers were
inadvertently vaccinated during pregnancy."
(6)
POLIO • "Although no adverse effects of OPV or IPV
have been documented among pregnant women or
their fetuses, vaccination of pregnant women
should be avoided. However, if a pregnant
woman requires immediate protection against
poliomyelitis, she may be administered OPV
or IPV in accordance with the recommended
schedules for adults." (7)
RUBELLA • "MMR and its component vaccines should not
be administered to women known to be
pregnant. Because a risk to the fetus from
administration of these live virus vaccines
cannot be excluded for theoretical reasons,
women should be counseled to avoid becoming
pregnant for 30 days after vaccination with
measles or mumps containing vaccines and for
3 months after administration of MMR or
other rubella-containing vaccines." (5)
• "If a pregnant woman is vaccinated or if
she becomes pregnant within 3 months after
vaccination, she should be counseled about
the theoretical basis of concern for the
fetus, but MMR vaccination during pregnancy
should not ordinarily be a reason to
consider termination of pregnancy." (5)
• "Rubella-susceptible women who are not
vaccinated because they state they are or
may be pregnant should be counseled about
the potential risk for CRS and the
importance of being vaccinated as soon as
they are no longer pregnant." (5)
• A registry of susceptible women vaccinated
with rubella vaccine between 3 months before
and 3 months after conception - the "Vaccine
in Pregnancy (VIP) Registry" - was kept
between 1971 and 1989. No evidence of CRS
occurred in the offspring of the 226 women
who received the current RA 27/3 rubella
vaccine and continued their pregnancy to
term. (5)
TETANUS & DIPHTHERIA • "Combined tetanus and diphtheria toxoids
are . . . routinely indicated for
susceptible pregnant women. Previously
vaccinated pregnant women who have not
received a Td vaccination within the last 10
years should receive a booster dose." (8)
• "Pregnant women who are unimmunized or
only partially immunized against tetanus
should complete the primary series." (8)
• "Although no evidence exists that tetanus
and diphtheria toxoids are teratogenic,
waiting until the second trimester of
pregnancy to administer Td is a reasonable
precaution for minimizing any concern about
the theoretical possibility of such
reactions." (9)
VARICELLA • "The effects of the varicella virus
vaccine on the fetus are unknown; therefore,
pregnant women should not be vaccinated.
Nonpregnant women who are vaccinated should
avoid becoming pregnant for 1 month
following each injection. For susceptible
persons, having a pregnant household member
is not a contraindication to vaccination."
(10)
• "If a pregnant woman is vaccinated or
becomes pregnant within 1 month of
vaccination, she should be counseled about
potential effects on the fetus." (10)
• "Because the virulence of the attenuated
virus used in the vaccine is less than that
of the wild-type virus, the risk to the
fetus, if any, should be even lower." (10)
• "In most circumstances, the decision to
terminate a pregnancy should not be based on
whether vaccine was administered during
pregnancy." (10)
• "VZIG [Varicella Zoster Immune Globulin]
should be strongly considered for
susceptible, pregnant women who have been
exposed." (10)
• The manufacturer & CDC have established a
VARIVAX® Pregnancy Registry to monitor
outcomes of women who got the vaccine 3
months before or any time during pregnancy.
Call 1-800-986-8999.
BCG • "Although no harmful effects to the fetus
have been associated with BCG vaccine, its
use is not recommended during pregnancy."
(11)
CHOLERA • "No specific information exists on the
safety of cholera vaccine during pregnancy.
Its use should be individualized to reflect
actual need." (12)
JAPANESE • "No specific information is available on
ENCEPHALITIS the safety of JE vaccine in pregnancy.
Vaccination poses an unknown but theoretical
risk to the developing fetus, and the
vaccine should not be routinely administered
during pregnancy." (13)
• "Pregnant women who must travel to an area
where risk of JE is high should be
vaccinated when the theoretical risks of
immunization are outweighed by the risk of
infection to the mother and developing
fetus." (13)
MENINGOCOCCAL • Studies have shown the vaccine to be both
safe and efficacious when given to pregnant
women. While high antibody levels were found
in umbilical cord blood following
vaccination during pregnancy, antibody
levels in the infants decreased during the
first few months after birth. Subsequent
response to meningococcal vaccination was
not affected.
• "Based on data from studies involving use
of meningococcal vaccines administered
during pregnancy, altering meningococcal
vaccination recommendations during pregnancy
is unnecessary." (14)
PLAGUE • "The effects of plague vaccine on the
developing fetus. . . are unknown. Pregnant
women who cannot avoid high-risk situations
should be advised of risk-reduction
practices and should be vaccinated only if
the potential benefits of vaccination
outweigh potential risks to the fetus." (15)
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 prophylaxis." (16)
• "If there is substantial risk of exposure
to rabies, preexposure prophylaxis may also
be indicated during pregnancy." (16)
TYPHOID • "No data have been reported on the use of
any of the three typhoid vaccines among
pregnant women." (17)
VACCINIA • "Vaccinia should not be administered to
pregnant women." (18)
• "On rare occasions, almost always after
primary vaccination, vaccinia virus has been
reported to cause fetal infection. . . .
Vaccinia vaccine is not known to cause
congenital malformations." (18)
YELLOW FEVER • "Although specific information is not
available concerning adverse effects of
yellow fever vaccine on the developing
fetus, pregnant women theoretically should
not be vaccinated, and travel to areas where
yellow fever is present should be postponed
until after delivery." (19)
• "If international travel requirements
constitute the only reason to vaccinate a
pregnant woman, rather than an increased
risk of infection, efforts should be made to
obtain a waiver letter from the traveler's
physician." (19)
• "Pregnant women who must travel to areas
where the risk of yellow fever is high
should be vaccinated. Under these
circumstances, for both mother and fetus,
the small theoretical risk from vaccination
is far outweighed by the risk of yellow
fever infection." (19)
--------------------------------------------------
Prenatal Screening for Vaccine-Preventable Diseases
The ACIP currently recommends prenatal screening for rubella and
hepatitis B:
"Prenatal serologic screening . . . is indicated for all pregnant
women who lack acceptable evidence of rubella immunity. Upon
completion or termination of their pregnancies, women who do not
have serologic evidence of rubella immunity or documentation of
rubella vaccination should be vaccinated with MMR before discharge
from the hospital, birthing center, or abortion clinic." ACIP,
Measles, Mumps, and Rubella -- Vaccine Use and Strategies for
Elimination of Measles, Rubella, and Congenital Rubella Syndrome
and Control of Mumps, p. 18.
"All pregnant women should be routinely tested for HBsAg during an
early prenatal visit in each pregnancy. . . . HBsAg-positive
mothers identified during screening may have HBV-related acute or
chronic liver disease and should be evaluated by their
physicians." ACIP, Protection Against Viral Hepatitis, p. 14.
--------------------------------------------------
Vaccinating Women who are Breastfeeding
"Neither killed nor live vaccines affect the safety of
breast-feeding for mothers or infants. Breast-feeding does not
adversely affect immunization and is not a contraindication for
any vaccine." ACIP, General Recommendations on Immunization, p.
20.
The following applies to varicella vaccine, which was licensed
after the ACIP General Recommendations were published: "Whether
attenuated vaccine VZV is excreted in human milk and, if so,
whether the infant could be infected are not known. Most live
vaccines have not been demonstrated to be secreted in breast milk.
Attenuated rubella vaccine virus has been detected in breast milk
but has produced only asymptomatic infection in the nursing
infant. Therefore, varicella vaccine may be considered for a
nursing mother." ACIP, Prevention of Varicella, pp. 19-20.
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