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VACCINES

The Effectiveness of Immunizations

"Since coming into widespread use, immunizations have saved billions of lives around the world. They have enhanced the quality of life, eliminated a huge burden of suffering and disability, and contributed to the length of life. " As an example the chart below shows the impact of immunization against rubella.

Reported rubella cases, United States, 1966-1997*



Rubella vaccine reduced rubella cases by 99.64% ,and congenital rubella syndrome (CRS) deaths by 99.99%.
 
Source: U.S. Department of Health & Human Services http://www.hhs.gov/nvpo/concepts/intro6.htm
 

SEE ALSO:


Hepatitis A (Havrix ®)
Inactivated virus  vaccine.

Each 1-mL adult dose of vaccine consists of 1440 EL.U. of viral antigen.

Indicated for active immunization against disease caused by hepatitis A virus (HAV) for persons ≥12 months of age.

  • Primary immunization for adults consists of a single 1-mL dose by intramuscular injection and a 1-mL booster dose administered anytime between 6 and 12 months later in order to ensure the highest antibody titers.

(Single-Dose Vials and Prefilled Syringes)

The vaccine is considered safe for use during pregnancy [1, 2]. Compatible with breast feeding [3]


Hepatitis B (Recombivax HB ® )
Inactivated (recombinant) noninfectious vaccine.
Each 1 mL dose contains 10 mcg of hepatitis B surface antigen.

Indicated for vaccination against infection caused by all known subtypes of hepatitis B virus.

  • Adults 19 years of age and older: 1-mL dose by intramuscular injection into the deltoid muscle, at initial visit, then one month and six months after the first dose, for a total of three doses

(1 mL single-dose vials, or single-dose prefilled syringe with one-inch 23 gauge needle is provided separately)

Pregnancy and lactation are not contraindications to vaccine [4].The American College of Obstetricians and Gynecologists recommends the use of hepatitis B vaccine for pregnant women at risk of acquiring the disease [2]. Compatible with breast feeding '[3,5].


Influenza (Fluzone®)
Inactivated virus vaccine.

Indicated for active immunization against influenza disease caused by influenza virus types A and B

  • Adults 0.5 mL dose by intramuscular injection into the deltoid muscle

(0.5 mL syringe without needle, 0.5 mL Vial ; 5 mL vial. 5 mL vial contains the preservative thimerosal)

 The vaccine is recommended by the American College of Obstetricians and Gynecologists " ...in the second and third trimester during the flu season, and  women at high risk for pulmonary complications regardless of the trimester." [2] Pregnancy and lactation are not contraindications [5,6,7].

 


Pneumococcal (Pneumovax®)
Killed bacteria vaccine.

indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine.

  • Administer a single 0.5 mL dose subcutaneously or intramuscularly (preferably in the deltoid muscle or lateral mid-thigh),

(Single dose and 5 dose vials)

The American College of Obstetricians and Gynecologists does not consider the indications for the vaccine to be altered by pregnancy. The vaccine is recommended for women with asplenia, metabolic, renal, cardiopulmonoary diseases, smokers and immunosuppressed patients [2,8]. Compatible with breast feeding [3].


Rubella (MERUVAX®II)
Live attenuated virus vaccine used to prevent infection by the rubella virus.

The dose for any age is 0.5 mL of reconstituted vaccine administered subcutaneously, preferably into the outer aspect of the upper arm. A 25 gauge, 5/8" needle is recommended.


(Single-dose vials of lyophilized vaccine with vials of diluent)

Indicated for vaccination against rubella in persons 12 months of age or older. The American College of Obstetricians and Gynecologists (ACOG) [2] recommends that vaccination of women susceptible to rubella infection should be part of postpartum care.


Tdap (Adacel® )[9, 10]
Sterile liquid suspension of tetanus and diphtheria toxoids and acellular pertussis components

Indicated for active booster immunization for the prevention of tetanus, diphtheria and pertussis as a single dose in persons 11 through 64 years of age.

Single injection of one dose (0.5 mL) administered intramuscularly.

Adacel vaccine should not be combined through reconstitution or mixed with any other vaccine.

CDC's Advisory Committee on Immunization Practices recommends" that pregnant women who were not vaccinated previously with Tdap:

1) Receive Tdap in the immediate postpartum period before discharge from hospital or birthing center
2) May receive Tdap at an interval as short as 2 years since the most recent Td vaccine,
3) Receive Td during pregnancy for tetanus and diphtheria protection when indicated OR
4) defer the Td vaccine indicated during pregnancy to substitute Tdap vaccine in the immediate postpartum period if the woman is likely to have sufficient protection against tetanus and diphtheria "

Health-care providers may choose to administer Tdap instead of Td during pregnancy to add protection against pertussis in persons at increased risk for pertussis such as  adolescents aged 11--18 years, health-care personnel, and women employed in institutions in which a pertussis outbreak is occurring or living in a community in which a pertussis outbreak is occurring. Vaccinating with tetanus toxoid--containing vaccines during the second or third trimester is preferred.

The pregnant woman should be informed of the lack of data confirming the safety and immunogenicity of Tdap in pregnant women, the unknown potential for early protection of the infant against pertussis by transplacental maternal antibodies, and the possible adverse effect of maternal antibodies on the ability of the infant to mount an adequate immune response to antigens in pediatric DTaP or conjugate vaccines containing tetanus toxoid or diphtheria toxoid.


Health-care providers are encouraged to report vaccination of pregnant women with Tdap, regardless of trimester, to the appropriate manufacturer's registry. For ADACEL,® vaccination should be reported to sanofi pasteur, telephone 1-800-822-2463 and for BOOSTRIX,® vaccination should be reported to GlaxoSmithKline Biologicals, telephone 1-888-825-5249 [10]


(0.5mL prefilled syringes)

 


 

References:

1. Duff B, Duff P.Hepatitis A vaccine: ready for prime time.Obstet Gynecol. 1998;91(3):468-71.  MEDLINE
2. ACOG Committee Opinion. Immunization during pregnancy.Obstet Gynecol. 2003;101:207-12.MEDLINE

3. Centers for Disease Control & Prevention. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 43 (No. RR-1): 20-21, 1994.
4. Centers for Disease Control & Prevention. Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 40 (No. RR-13): 4, 1991.
5.Breastfeeding and Maternal Medication. Recommendations for Drugs in the Eleventh WHO Model list of Essential Drugs. pp 23-24 World Health Organization, 2002. 20 Avenue Appia ,1211 Geneva ,Switzerland
6. Centers for Disease Control & Prevention. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 47 (No. RR-6): 6, 1998.
7. Fiore AE. et al. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007.MMWR Recomm Rep. 2007 Jul 13;56(RR-6):1-54. PMID: 17625497
8. Centers for Disease Control & Prevention. Prevention of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 46 (No. RR-8): 6, 1997.
9.. Adacel prescribing information. Sanofi Pasteur Inc. January 2009 http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=17656
10. Murphy TV, et. al., Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC).Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008 May 30;57(RR-4):1-51. PMID: 18509304

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