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Appendices

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Section 1. Active and Passive Immunization

Immunization in Special Clinical Circumstances

Pregnancy 19

Immunization during pregnancy poses theoretical risks to the developing fetus. Although no evidence indicates that vaccines currently in use have detrimental effects on the fetus, pregnant women should receive a vaccine only when the vaccine is unlikely to cause harm, the risk of 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 theoretical 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) and inactivated influenza vaccines. The American Academy of Pediatrics (AAP) recommends that pregnant women who have not received a Td-containing booster during the previous 2 years should be given tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, and women who are unimmunized or only partially immunized should complete the primary series. For complete recommendations regarding use of Td and Tdap vaccines in pregnancy, see Pertussis, p 504. In developing countries with a high incidence of neonatal tetanus, Td vaccine routinely is administered during pregnancy without evidence of adverse effects and with striking decreases in the occurrence of neonatal tetanus.

Studies indicate that women who are pregnant with absence of other underlying medical conditions are at increased risk of complications and hospitalization from influenza. . . . [Go to Full Text]


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