PREGNANCY AND IMMUNIZATION

Abstract

      Pregnancy is a period which immune system becomes weak and both mother and newborn is under infection risk. Live attenuated viral or bacterial vaccines, toxoid vaccines, inactive viral vaccines and immunglobulins can be used for immunization during that period. Always the most appropriate immunization agent must be selected with making profit and loss count, benefits of both mother and baby must be observed. As a rule, application of live viral or bacterial vaccines during pregnancy is contraindicated. Toxoid vaccines, inactive vaccines and immunglobulins are approved safe in pregnancy and they can be used at any period of pregnancy (ideally after the first trimestr).

Keywords

• Pregnancy,Newborn,Immunity,Vaccination,Immunglobulin

GEBELİK VE İMMUNİZASYON

Öz

     Gebelik, bağışıklık sisteminin zayıfladığı ve anne ile yenidoğanın enfeksiyon açısından risk altında bulunduğu bir dönemdir. Bu süreçte immunizayon (bağışıklama) amacıyla canlı virüs ve bakteri aşıları, toksoid aşılar, inaktif virus aşıları ve immunglobulinler kullanılmaktadır. Gebelere bir immunizasyon ajanı verilirken her zaman kar-zarar planlaması yapılarak en doğru immunizasyon ajanı seçilmeli, hem anne hem bebeğin yararı gözetilmelidir. Gebelikte kural olarak potansiyel risklerinden dolayı canlı viral ya da bakteriel aşıların yapılması kontrendikedir. Toksoid aşılar, inaktif aşılar veya immunglobulinler ise gebelikte güvenli kabul edilirler ve gerektiği taktirde gebeliğin herhangi bir döneminde (tercihen ilk trimestr tamamlandıktan sonra) kullanılabilirler.

Anahtar Kelimeler

• Gebelik,Yenidoğan,Bağışıklık,Aşı,İmmunglobulin

Kaynakça

1. 1. Warner, M.J. and Ozane, S.E., (2010). Mechanisms Involved in the Developmental Programming of Adulthood Disease. Biochemical Journal, 427(3):333-347.
2. 2. Robinson, D.P. and Klein, S.L., (2012). Pregnancy and Pregnancy-Associated Hormones Alter Immune Responses and Disease Pathogenesis. Hormones And Behavior, 62(3):263-271.
3. 3. Gonik, B., Fasano, N., and Foster, S., (2002). The Obstetrician-gynecologist's Role in Adult Immunization. American journal of obstetrics and gynecology, 187(4): 984-988. 4. Aslı Davas, B.Ö. ve İlgir, E., (2018). Türk Tabipler Birliği, Birinci Basamak Sağlık Çalışanları için Aşı Rehberi. Ankara: Nilay Etiler.
4. 5. Chu, H.Y. and Englund, J.A., (2017). Maternal immunization. Birth defects research, 109(5):379-386.
5. 6. Barss, V. and Weller, P.F., (2015). Immunizations during Pregnancy. Uptodate.
6. 7. DeSesso, J.M., et al., (2012). The Placenta, Transfer of Immunoglobulins, and Safety Assessment of Biopharmaceuticals in Pregnancy. Critical reviews in toxicology, 42(3): 185-210.
7. 8. Beyazova, U. and Aktaş, F., (2007). Çocukluk Çağı Aşılamaları Ve Erişkin Bağışıklaması Chıldhood Vacinatıon and Adult Immunıtation. Gazi Medical Journal, 18(2). 9. Guidelines for vaccinating pregnant women. Updated March. https://www.cdc.gov/vaccines/pregnancy/hcp/guidelines.html.
8. 10. Kim, D.K., Riley, L.E., and Hunter, P., (2018). Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018. Annals of internal medicine. 168(3): 210-220. 11. McMillan, M., et al., (2017). Safety of Tetanus, Diphtheria, and Pertussis Vaccination During Pregnancy. Obstetrics & Gynecology. 129(3): 560-573.

9. 12. Kretsinger, K., et al., (2006). Preventing Tetanus, Diphtheria, And Pertussis among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, Supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for Use of Tdap Among Health-Care Personnel. MMWR Recomm Rep, 55(RR-17):1-37.
10. 13. Yen, C., et al., (2015). Missed Opportunities for Tetanus Postexposure Prophylaxis—California, January 2008–March 2014. MMWR. Morbidity and mortality weekly report, 64(9):243.
11. 14. Grohskopf, L.A., (2016). Prevention and Control of seasonal Influenza with Vaccines. MMWR. Recommendations and Reports, 65.
12. 15. Perrett, K.P. and Nolan, T.M.¬, (2017). Immunization during pregnancy: impact on the infant. Pediatric Drugs, 19(4):313-324.
13. 16. Monto, A.S., et al., (2000). Clinical signs and symptoms predicting influenza infection. Archives of internal medicine, 160(21): 3243-3247.
14. 17. Enders, M., Biber, M., and Exler, S., (2007). Measles, Mumps and Rubella Virus İnfection in Pregnancy. Possible Adverse Effects on Pregnant Women, Pregnancy Outcome And The Fetus. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 50(11):1393-1398.
15. 18. McLean, H.Q., et al., (2013). Prevention of Measles, Rubella, Congenital Rubella Syndrome, And Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report: Recommendations and Reports, 62(4): 1-34.
16. 19. Kroger, A.T., Duchin, J.¬, and Vázquez, M., (2017). General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Atlanta, GA: US Department of Health and Human Services, CDC.
17. 20. Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians: use of reminder and recall by vaccination providers to increase vaccination rates. MMWR. Morbidity and mortality weekly report, 47(34):715. https://www.ncbi.nlm.nih.gov/pubmed/9746400.
18. 21. Marin, M., et al., (2014). Closure of Varicella-zoster Virus-Containing Vaccines Pregnancy Registry-United States, 2013. MMWR. Morbidity and mortality weekly report, 63(33):732-733.
19. 22. Marin, M., Meissner, H.C.¬, and Seward, J.F., (2008). Varicella Prevention in the United States: a Review of Successes and Challenges. Pediatrics, 122(3):e744-e751.
20. 23. Representatives, L., (1996). The Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices. MMWR Recomm Rep, (45):1-18.
21. 24. Chaudhry, S.A., Verma, N., and Koren, G., (2015). Hepatitis E Infection During Pregnancy. Canadian Family Physician, 61(7):607-608.
22. 25. Fiore, A.E., Wasley, A., and Bell, B.P., (2006). Prevention of Hepatitis A through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report: Recommendations and Reports, 55(7):1-CE-4.
23. 26. Chamroonkul, N. and Piratvisuth, T., (2017). Hepatitis B during Pregnancy in Endemic Areas: Screening, Treatment, and Prevention of Mother-to-child Transmission. Pediatric Drugs, 19(3):173-181.
24. 27. Mast, E.E., et al., (2005). A Comprehensive Immunization Strategy To Eliminate Transmission of hepatitis B Virus İnfection in the United States. MMWR, 54(16):1-32.
25. 28. O'Dempsey, T., et al., (1996). Immunization with a Pneumococcal Capsular Polysaccharide Vaccine During Pregnancy. Vaccine, 14(10):963-970.
26. 29. Grohskopf, L.A., et al., (2018). Prevention and Control of Seasonal Influenza With Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 İnfluenza Season. MMWR Recommendations and Reports, 67(3): 1.
27. 30. Practices, A.C.O.I., (2000). Preventing Pneumococcal Disease Among Infants And Young Children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 49(RR-9): 1.
28. 31. Diseases, C.O.I., (2005). Prevention and Control of Meningococcal Disease: Recommendations for Use of Meningococcal Vaccines in Pediatric Patients. Pediatrics, 116(2):496-505.
29. 32. Cetron, M.S., et al., (2002). Yellow Fever Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP), Morbıdıty And Mortalıty Weekly Report Recommendatıons and Reports RR, 51(17).
30. 33. Chu, H.Y. and Englund, J.A., (2014). Maternal Immunization. Clinical Infectious Diseases, 59(4): 560-568.
31. 34. Jackson, B.R., Iqbal, S., and Mahon, B., (2015). Updated Recommendations for the Use of Typhoid Vaccine. Advisory Committee on Immunization Practices, United States, 2015. MMWR. Morbidity and mortality weekly report, 64(11):305-308.
32. 35. Manning, S.E., et al., (2008). Human Rabies Prevention—United States, 2008: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep, 57(RR-3):1-28.
33. 36. Wharton, M., et al., (2003). Recommendations for Using Smallpox Vaccine in a Pre-Event Vaccination Program. 2003: National Emergency Training Center.
34. 37. Badell, M.L., et al., (2015). Risks Associated with Smallpox Vaccination in Pregnancy: A Systematic Review and Meta-Analysis. Obstetrics and Gynecology, 125(6):1439. 38. Hankins, D.G. and Rosekrans, J.A., (2004). Overview, Prevention, And Treatment of Rabies. in Mayo Clinic Proceedings. Elsevier.
35. 39. Ashford, D.A., Perkins, B.A., and Rotz, L.D., (2000). Use of Anthrax Vaccine in the United States; Recommendations of the Advisory Committee on Immunization Practices (ACIP).
36. 40. Goodrich, J.M., (2006). Smallpox: Virology, Clinical Presentation, and Prevention. Bioterrorism Preparedness: Medicine–Public Health–Policy, 2006: 93-121.
37. 41. Petrosky, E., et al., (2015), Use of 9-valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and Mortality Weekly Report, 64(11):300-304.
38. 42. Food and D. Administration, Product approval-prescribing information (Package insert). Gardasil (human papillomavirus quadrivalent (types 6, 11, 16, and 18) vaccine, recombinant), Merck & Co, Inc. Silver Spring, MD: US Department of Health and Human Services. Food and Drug Administration, 2014.
39. 43. Bozkurt, G. and Erdim, L., (2005), Güvenli Bağışıklamada Ebe ve Hemşirelerin Sorumlulukları. Journal of Anatolia Nursing and Health Sciences, 8(3).