Contents

4 Immunisation of special groups

4.1 Pregnancy and lactation

4.1.1 For women planning pregnancy

Women who are planning pregnancy should know whether they are immune to rubella (see section 18.5.2) and varicella (see section 21.5.3).

MMR

Two doses of MMR vaccine are recommended and funded for women who are susceptible to measles, mumps and/or rubella (see sections 11.5, 13.5 and 18.5). Women who are to receive the rubella vaccine (as MMR) are advised to ensure they are not pregnant at the time of immunisation and for at least four weeks afterwards, although there is no current evidence that rubella vaccine is teratogenic (see section 18.7). If the mother is non-immune, two doses of MMR vaccine, separated by four weeks, should be given after delivery.

Varicella

Varicella vaccine is recommended (but not funded) for adults who are susceptible to varicella. Two doses are given, four to eight weeks apart (see section 21.5 and the manufacturers’ data sheets for administration and dosing information). Women who are to receive the varicella vaccine are advised to ensure they are not pregnant at the time of immunisation and for at least four weeks afterwards.

4.1.2 During pregnancyTop

Inactivated vaccines are considered safe in pregnancy, but because of the theoretical possibility of harm to the fetus, live vaccines should not be administered to a pregnant woman. In some circumstances where there is increased risk of exposure to the microbe, the need for immunisation may outweigh any possible risk to the fetus.

Influenza vaccine

The influenza vaccine is recommended and funded for pregnant women, and may be offered to women at any stage of pregnancy, as soon as the annual influenza vaccine becomes available (see section 10.5). A pregnant woman and her fetus are at increased risk of influenza complications; influenza immunisation is therefore recommended during pregnancy to reduce this risk. Maternal influenza immunisation also offers protection to the neonate through maternal antibody transfer.1 There is no evidence that influenza vaccine prepared from inactivated virus causes harm to the fetus or to the neonate.2

Pertussis vaccine (Tdap)

Pertussis is a severe infection in infants too young to have been immunised. Vaccination with Tdap should be offered in every pregnancy (currently funded between 28 and 38 weeks’ gestation, see section 14.5) to protect the mother and so that antibodies can pass to the fetus; post-partum maternal vaccination will reduce the risk of a mother infecting her baby but does not have the added benefit of providing passive antibodies.

In October 2012 the UK introduced a pertussis vaccination programme for pregnant women in response to a nationwide pertussis outbreak. An observational study of the programme in England estimated vaccine effectiveness at 91 percent (95% CI: 84–95) for preventing pertussis in infants aged under 3 months.3 This high vaccine effectiveness is likely to be a result of protection of infants by both passive antibody transfer and reduced exposure to maternal disease.3

An observational study of the safety of the UK’s maternal pertussis vaccination programme found no evidence of an increased risk of any of the extensive predefined list of adverse events related to pregnancy.4 In particular, there was no evidence of an increased risk of stillbirth.

Close contacts

The confirmation of pregnancy should act as a trigger to update the pertussis vaccination status of all close contacts. This includes making sure siblings have received their routine scheduled vaccines (funded for children aged under 18 years) and offering Tdap to adults, although this is not currently funded.

4.1.3 Lactation and post-partumTop

MMR

MMR vaccine (two doses) is recommended (and funded) after delivery for women who are susceptible to any of the three diseases. Breastfeeding is not a contraindication to MMR vaccine.

Pertussis vaccine (Tdap)

To protect the newborn infant, Tdap is recommended (but not funded) for close contacts of newborns, including women who were not vaccinated during pregnancy. (Note that post-partum Tdap may be locally funded in some regions, so vaccinators are advised to check local guidelines.)

Varicella

Varicella vaccine is recommended (but not funded) for all susceptible adults. Women who are non-immune with healthy babies can receive varicella vaccine after delivery.

Varicella vaccine for the mother is recommended (and funded) after delivery if the baby is immune compromised and the mother is susceptible to varicella (see sections 4.3 and 21.5).