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Section 1. Active and Passive Immunization
IMMUNIZATION IN SPECIAL CLINICAL CIRCUMSTANCES
Pregnancy 1
Immunization during pregnancy poses theoretic risks to the developing fetus. Although no evidence indicates that vaccines in use today have detrimental effects on the fetus, pregnant women should receive a vaccine only when the vaccine is unlikely to cause harm, the risk for disease exposure is high, and the infection would pose a significant risk to the mother or fetus. When a vaccine is to be given during pregnancy, delaying administration until the second or third trimester, when possible, is a reasonable precaution to minimize concern about possible teratogenicity.
The only vaccines recommended for routine administration during pregnancy in the United States, provided they are indicated (either for primary or booster immunization), are adult-type tetanus and diphtheria toxoids (Td); tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); and inactivated influenza vaccines. Pregnant women who have not received a Td-containing booster during the previous 10 years should be given Tdap, and women who are unimmunized or only partially immunized should complete the primary series. For complete recommendations regarding Td and Tdap use in pregnancy, see Pertussis, p 498. In developing countries with a high incidence of neonatal tetanus, Td routinely is administered during pregnancy without evidence of adverse effects and with striking
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