Postnatal - Vaccination

Embryology - 2 Dec 2023        Expand to Translate
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Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.

Introduction

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)

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."

WHO - "In 2018, an estimated 19.4 million infants worldwide were not reached with routine immunization."

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

Links: Viral Infection | Infectious Diseases School Exclusion

neonatal diagnosis

Some Recent Findings

Coverage rates of the children vaccination programme in Greenland "In order to estimate the current coverage rate among all children in Greenland, we conducted an observational cross-sectional study identifying all children in Greenland eligible for a vaccination between 1 March 2018 and 16 June 2019. we found an overall national coverage of 85.4%. The national coverage for the vaccinations given at birth was 97.1%, dropping to 94.3%, 87.7% and 83.6% at ages 3, 5 and 12 months. Among children eligible for the Measles, Mumps and Rubella-vaccinations, the national coverage was 76.9% for children aged 15 months and 64.1% for children aged 4 years, but dropping to 40.9% in the districts. At preschool, the national coverage was 79.9%. Among the 12-year-old, the national coverages of the two vaccinations against Human Papilloma Virus were 88.4% and 71.6%, respectively, and for the three Hepatitis B-vaccinations 89.8%, 84.1% and 69.6%. A subgroup-analysis and test of an SMS-reminder system in Nuuk improved the coverage from 57.8% to 75.5% locally. Overall, we found a high national coverage rate among the newborn in Greenland. The national coverage rates of the remaining vaccinations were below the WHO-recommendations, however with great regional differences." (No) Association between seasonal influenza vaccination with pre- and postnatal outcomes "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 "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 "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."

More recent papers

This table allows an automated computer search of the external PubMed database using the listed "Search term" text link. This search now requires a manual link as the original PubMed extension has been disabled. The displayed list of references do not reflect any editorial selection of material based on content or relevance. References also appear on this list based upon the date of the actual page viewing. References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability. More? References | Discussion Page | Journal Searches | 2019 References | 2020 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. Infections in Pregnancy and the Role of Vaccines "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 "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." Trivalent inactivated influenza vaccine and spontaneous abortion "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 "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. 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 (2015)

The purpose of The Australian Immunisation Handbook 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). 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)

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

References

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.

External Links

External Links Notice - The dynamic nature of the internet may mean that some of these listed links may no longer function. If the link no longer works search the web with the link text or name. Links to any external commercial sites are provided for information purposes only and should never be considered an endorsement. UNSW Embryology is provided as an educational resource with no clinical information or commercial affiliation.

WHO Global Vaccine Action Plan 2011-2020

2018 WHO - diphtheria-tetanus-pertussis vaccination

"The Global Vaccine Action Plan (GVAP) ― endorsed by the 194 Member States of the World Health Assembly in May 2012 ― is a framework to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all communities"

During 2018:

• Diphtheria-tetanus-pertussis (DTP3) vaccine to about 86% of infants worldwide (116.3 million infants) protecting them against infectious diseases that can cause serious illness and disability or be fatal. By 2018, 129 countries had reached at least 90% coverage of DTP3 vaccine.

• Hib vaccine had been introduced in 191 countries. Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Global coverage with 3 doses of Hib vaccine is estimated at 72%. There is great variation between regions. The WHO Regions of the Americas and South East Asia are estimated to have 87% coverage, while it is only 23% in the WHO Western Pacific Region.

• Rotavirus vaccine was introduced in 101 countries by the end of 2018, including four in some parts of the country. Global coverage was estimated at 35%. Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world.

Links: Global Vaccine Action Plan 2011-2020 | GVAP English PDF

Australia

• Department of Health and Ageing Immunise Australia Program The Immunise Australia Program aims to increase national immunisation rates by funding free vaccination programs, administering the Australian Childhood Immunisation register and communicating information about immunisation to the general public and health professionals.
• Australian Immunisation Handbook. 9th edition (2008) | AIH 10th edition (April 2013)
  • 2.3 Groups with Special Vaccination Requirements updated July 2009

Canada

• Immunize Canada / Immunisation Canada | Parents information

United Kingdom

• Department of Health Immunisation information | Green Book and Vaccine Update
• Joint Committee on Vaccination and Immunisation

USA

• CDC Vaccines | Immunization Schedules | Possible Side-effects from Vaccines | Advisory Committee on Immunization Practices | Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Persons Aged 0 Through 18 Years — United States, 2013

Terms

• Children Vaccination Programme (CVP) BCG: Bacille Calmette-Guerin; :
• Electronic medical Record system (EMR)
• Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenza B (DTPHiB)
• Hepatitis B (HBV)
• Human Papilloma Virus (HPV)
• Measles, Mumps, Rubella (MMR)
• Global Vaccine Action Plan (GVAP)
• The WHO European Vaccine Action Plan (EVAP)

Glossary Links

Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link

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Cite this page: Hill, M.A. (2023, December 2) Embryology Postnatal - Vaccination. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Postnatal_-_Vaccination

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© Dr Mark Hill 2023, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G