Postnatal - Vaccination

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Introduction

Community immunity
Community immunity
Australian Public Health Activities (2007-08)

Although the use of most vaccines during pregnancy is not usually recommended on precautionary grounds, there is no convincing evidence that pregnancy should be an absolute contraindication to the use of any vaccine, particularly inactivated vaccines. The only exception is vaccinia virus (smallpox vaccination), which has been shown to cause fetal malformation. For Australian information see the Australian Immunisation Handbook (June2015)[1]


AIH 10th edition 3.3.2 - Women planning pregnancy "The need for vaccination, particularly for hepatitis B, measles, mumps, rubella and varicella, should be assessed as part of any pre-conception health check. Where previous vaccination history or infection is uncertain, relevant serological testing can be undertaken to ascertain immunity to hepatitis B, measles, mumps and rubella."


Tinycc Vaccination page - http://tiny.cc/Vaccination


Links: Viral Infection | Infectious Diseases School Exclusion


Viral Links: viral infection | TORCH | cytomegalovirus | hepatitis | HIV | parvovirus | polio | rubella virus | chickenpox | Lymphocytic Choriomeningitis Virus | Zika virus | human papillomavirus | rotavirus | vaccination | environment
Historic Embryology - Viral 
1941 Rubella Cataracts | 1944 Rubella Defects

neonatal diagnosis

Some Recent Findings

  • (No) Association between seasonal influenza vaccination with pre- and postnatal outcomes[2] "Influenza vaccination during pregnancy is known to prevent severe influenza illness but its effects on other outcomes and the extent to which its safety is affected by timing of vaccination, maternal race/ethnicity and the type of vaccine is less clear. Therefore, we examined this in a large retrospective cohort. METHODS: We analyzed medical and vaccination records from the Kaiser Permanente Southern California (KPSC) records and from the Kaiser Immunization Tracking System (2008-2016). The study included women who were pregnant with singletons during the influenza season. Odds ratios (OR) and their 95% confidence intervals (CI) were used to quantify the associations between immunization status during pregnancy and prenatal and postnatal outcomes after adjusting for confounders. CONCLUSIONS: This study found no evidence of adverse maternal and infant outcomes associated with seasonal influenza vaccine during pregnancy. On the contrary, vaccinated women were less likely to have adverse outcomes than unvaccinated women. The lack of increased adverse outcomes associated with influenza vaccination suggests that the benefits of vaccination during pregnancy to the woman and her child far outweigh any risk, if there is one, from the vaccination."
  • The impact of timing of maternal influenza immunization on infant antibody levels at birth[3] "Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available."
  • Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012): A Record Linkage Cohort Study[4] "Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations. METHODS: We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000-2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission. ...Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk."
  • Infections in Pregnancy and the Role of Vaccines[5] "Pregnant women are at risk for infection and may have significant morbidity or mortality. Influenza, pertussis, zika, and cytomegalovirus produce mild or asymptomatic illness in the mother, but have profound implications for her fetus. Maternal immunization can prevent or mitigate infections in pregnant women and their infants. The Advisory Committee of Immunization Practices (USA) recommends 2 vaccines during pregnancy: inactivated influenza, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis during pregnancy. The benefits of MMR, varicella, and other vaccines are reviewed. Novel vaccine studies for use during pregnancy for prevention of illness are explored."
  • Human papillomavirus infection and intrauterine growth restriction: a data-linkage study[6] "Using unbiased population data, to examine whether having a positive Pap smear, and thus a high probability of Human Papilloma Virus (HPV) infection, is a significant risk factor for intrauterine growth restriction (IUGR) in a subsequent pregnancy. Two independent population-based databases, namely the South Australian Perinatal Statistics Collection and the South Australian Cervical Screening Database, were deidentified and linked by the SANT Datalinkage Service. Analyses were performed on cases where Pap smear screening data was available for up to 2 years prior to a singleton live birth. ...Those having a positive Pap smear were more likely to have a baby with IUGR than those with negative smear results. For SGA, 5.8% babies were from mothers with positive Pap smears compared to 4.0% with negative smears indicating a 40% higher risk of having an SGA baby (95%CI 20-70%) among women with positive Pap smears. For VLBW, 7.6% mothers had positive Pap smears compared with 4.0% with negative smears (p < .001), which reflects a 90% increased risk (95%CI 40-150%). These associations reduced to 20% (95%CI 1-40%) and 50% (95%CI 10-100%) for SGA and VLBW, respectively, after adjusting for all other significant covariates including maternal age, ethnicity, marital status, occupation, smoking, pregnancy history, and maternal health during pregnancy. Mothers with a positive Pap smear have an increased risk of IUGR, especially for VLBW, which is independent of other risk factors. The results confirm previous findings in a small study and emphasise the need to consider the risks of both cancer and IUGR in all HPV vaccination programs."
More recent papers  
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More? References | Discussion Page | Journal Searches | 2019 References

Search term: Neonatal Vaccination | Postnatal Vaccination | Maternal Vaccination | Vaccination

Older papers  
These papers originally appeared in the Some Recent Findings table, but as that list grew in length have now been shuffled down to this collapsible table.

See also the Discussion Page for other references listed by year and References on this current page.

  • Trivalent inactivated influenza vaccine and spontaneous abortion[7] "Our final analysis included 243 women with spontaneous abortion and 243 matched control group women; 82% of women with spontaneous abortion had ultrasound confirmation of fetal demise. ...There was no statistically significant increase in the risk of pregnancy loss in the 4 weeks after seasonal inactivated influenza vaccination."
  • Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study[8] "This large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women. These findings should contribute to inform stakeholders and decision makers on the prescription of vaccination against influenza A/H1N1 in pregnant women."

Neonatal Vaccination

Vaccination of premature infants

A recent study has looked at Wheezing lower respiratory disease hazard ratios (HR) for vaccination of premature infants.[9] Premature infants are at increased risk of wheezing in association with respiratory syncytial virus (RSV) and rhinovirus infections. The study found no evidence of increased WLRD risk following routine vaccinations of premature infants. WLRD risk among non-fragile premature infants appears to be reduced for a few weeks after live attenuated vaccinations.

"Wheezing lower respiratory disease hazard ratios (HR) were not significantly elevated for any vaccine type among non-fragile or fragile premature infants. Among non-fragile infants the 8-14 days HR was significantly reduced for live attenuated MMR (0.68, 0.52-0.88) and Varicella (0.71, 0.53-0.94) vaccines, and similarly but insignificantly reduced for infrequently used live attenuated OPV vaccine (0.70, 0.46-1.06). There was a smaller significant reduction (0.83, 0.69-0.998) in the 15-30 days HR for MMR and a similar but not significant reduction (0.86, 0.71-1.05) in the 31-44 days HR for MMR. Hepatitis B vaccine (HBV), which is not a live vaccine, had significantly reduced 8-14 days (0.84, 0.72-0.98) and 31-44 days (0.88, 0.78-0.98) HRs among non-fragile infants. The apparent protective effect of HBV may be confounded by live vaccines administered simultaneously with the third dose of HBV. Among fragile infants there was a large significant reduction in the 8-14 days HR for live attenuated OPV vaccine (0.40, 0.23-0.70) and smaller significant reductions in the 8-14 days HR for inactivated DTaP (0.82, 0.71-0.95), Hib (0.83, 0.73-0.96), and PCV7 (0.84, 0.70-0.997) vaccines. Delays in vaccinating fragile infants may have made simultaneous administration of live vaccines and third doses of these inactivated vaccines more likely."

Australian Immunisation Handbook

Australian Immunisation Handbook
Australian Immunisation Handbook (2015)

The purpose of The Australian Immunisation Handbook[1] is to provide clinical guidelines for health professionals on the safest and most effective use of vaccines in their practice. These recommendations are developed by the Australian Technical Advisory Group on Immunisation (ATAGI) and endorsed by the National Health and Medical Research Council (NHMRC).

There is a specific section within the handbook for Vaccination of women planning pregnancy, pregnant or breastfeeding women, and preterm infants.


Links: AIH 10th edition (June 2015) | V3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants (June 2015) | AIH 9th edition (2008)


Australian Child Immunisation Programs 2013  
Age Vaccine
Birth
  • Hepatitis B (hepB)a
2 months
  • Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), Haemophilus influenzae type b, inactivated poliomyelitis (polio) (hepB-DTPa-Hib-IPV)
  • Pneumococcal conjugate (13vPCV)
  • Rotavirus
4 months
  • Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), Haemophilus influenzae type b, inactivated poliomyelitis (polio) (hepB-DTPa-Hib-IPV)
  • Pneumococcal conjugate (13vPCV)
  • Rotavirus
6 months
  • Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping cough), Haemophilus influenzae type b, inactivated poliomyelitis (polio) (hepB-DTPa-Hib-IPV)
  • Pneumococcal conjugate (13vPCV)
  • Rotavirusb
12 months
  • Haemophilus influenzae type b (Hib)
  • Meningococcal C (MenCCV)

  • Measles, mumps and rubella (MMR)
18 months
  • Varicella (chickenpox)
4 years
  • Diphtheria, tetanus, acellular pertussis (whooping cough) and inactivated poliomyelitis (polio) (DTPa-IPV)
  • Measles, mumps and rubella (MMR)
  Notes: Information provided for educational purposes only. Postnatal - Vaccination | Immunise Australia Program

a Hepatitis B vaccine: should be given to all infants as soon as practicable after birth. The greatest benefit is if given within 24 hours, and must be given within 7 days.

b Rotavirus vaccine: third dose of vaccine is dependent on vaccine brand used.

  Source: Australian Immunisation Handbook 10th edition (April 2013).[10] National Immunisation Program Schedule From 1 February 2013 to 30 June 2013 PDF Immunise Australia Program.

NSW

There have been significant changes to the vaccines offered in the NSW vaccination program over time:

  • 1988, NSW conducted a Bicentennial measles campaign which offered measles vaccine to all child care and primary school age children.
  • 1998 the national Measles Control Campaign, which was the first national mass vaccination program since the 1950s polio campaigns, offered measles, mumps, rubella vaccine to all primary school children laying the groundwork that has resulted in the World Health Organization declaration of measles elimination in Australia
  • 2003 the meningococcal C vaccine was offered to all 1 – 19 year olds over a two year period
  • 2004 a hepatitis B vaccine catch up program was conducted for Year 7 students who had not received a primary course of vaccine and continued until 2013.
  • 2007 the three-dose course of human papillomavirus (HPV) vaccine was offered to female students in Years 10-12 . In 2008 it was offered to female students in Years 7 – 10, and routinely to female students in Year 7 from 2009 and was introduced routinely for male students in Year 7 in 2013 with a catch-up program for male students in Year 9 in 2013 and 2014 only
  • booster dose of diphtheria-tetanus-pertussis (dTpa) vaccine was offered to students in Years 7-12 in 2004, in Year 7 in 2005, in Year 10 from 2009-2012 and has been routinely offered to students in Year 7 from 2010 onwards
  • catch-up dose of varicella (chicken pox) vaccine has been offered to students in Year 7 since 2006

(From NSW Health - Communicable Diseases)

USA Recommended Immunizations for Children

(Birth through 6 years)

USA recommended immunizations for children 2013.jpg


Links: Vaccines | Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Persons Aged 0 Through 18 Years — United States, 2013

References

  1. 1.0 1.1 The Australian Immunisation Handbook 10th edition (2015) Canberra: Australian Government Department of Health. ISBN: 978-1-74241-861-2 Online ISBN: 978-1-74241-862-9.
  2. Getahun D, Fassett MJ, Peltier MR, Takhar HS, Shaw SF, Im TM, Chiu VY & Jacobsen SJ. (2019). Association between seasonal influenza vaccination with pre- and postnatal outcomes. Vaccine , , . PMID: 30799158 DOI.
  3. Zhong Z, Haltalli M, Holder B, Rice T, Donaldson B, O'Driscoll M, Le-Doare K, Kampmann B & Tregoning JS. (2019). The impact of timing of maternal influenza immunization on infant antibody levels at birth. Clin. Exp. Immunol. , 195, 139-152. PMID: 30422307 DOI.
  4. Fathima P, Snelling TL, de Klerk N, Lehmann D, Blyth CC, Waddington CS & Moore HC. (2019). Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012): A Record Linkage Cohort Study. Pediatr. Infect. Dis. J. , 38, 169-175. PMID: 29620723 DOI.
  5. Fortner KB, Nieuwoudt C, Reeder CF & Swamy GK. (2018). Infections in Pregnancy and the Role of Vaccines. Obstet. Gynecol. Clin. North Am. , 45, 369-388. PMID: 29747736 DOI.
  6. Ford JH, Li M, Scheil W & Roder D. (2019). Human papillomavirus infection and intrauterine growth restriction: a data-linkage study. J. Matern. Fetal. Neonatal. Med. , 32, 279-285. PMID: 28889772 DOI.
  7. Irving SA, Kieke BA, Donahue JG, Mascola MA, Baggs J, DeStefano F, Cheetham TC, Jackson LA, Naleway AL, Glanz JM, Nordin JD & Belongia EA. (2013). Trivalent inactivated influenza vaccine and spontaneous abortion. Obstet Gynecol , 121, 159-65. PMID: 23262941 DOI.
  8. Rubinstein F, Micone P, Bonotti A, Wainer V, Schwarcz A, Augustovski F, Pichon Riviere A & Karolinski A. (2013). Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study. BMJ , 346, f393. PMID: 23381200
  9. Mullooly JP, Schuler R, Mesa J, Drew L & DeStefano F. (2011). Wheezing lower respiratory disease and vaccination of premature infants. Vaccine , 29, 7611-7. PMID: 21875634 DOI.
  10. Australian Immunisation Handbook 10th edition (April 2013) Immunise Australia Program


Journals

Vaccine is the journal for those interested in vaccines and vaccination. Homepage | PubMed

Reviews

Bozzo P, Narducci A & Einarson A. (2011). Vaccination during pregnancy. Can Fam Physician , 57, 555-7. PMID: 21571717

Hamlin J, Senthilnathan S & Bernstein HH. (2008). Update on universal childhood immunizations. Curr. Opin. Pediatr. , 20, 483-9. PMID: 18622208 DOI.

Articles

Akinsanya-Beysolow I, Jenkins R & Meissner HC. (2013). Advisory Committee on Immunization Practices (ACIP) recommended immunization schedule for persons aged 0 through 18 years--United States, 2013. , 62, 2-8. PMID: 23364302

Pham H, Geraci SA & Burton MJ. (2011). Adult immunizations: update on recommendations. Am. J. Med. , 124, 698-701. PMID: 21658665 DOI.

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Cite this page: Hill, M.A. (2019, June 25) Embryology Postnatal - Vaccination. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Postnatal_-_Vaccination

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