Typhoid vaccine

There are two types of typhoid vaccine: the older, inactivated typhoid 'y vaccine, administered parenterally, and the oral live typhoid vaccine ยง with Salmonella typhi type 21a. The live vaccine does not protect ^ against paratyphoid A and B, but has a lower rate of side effects oi

Recommendation. To protect against maternal illness and neonatal tetanus, sufficient immune protection should be guaranteed during the pregnancy. As a rule, basic immunization is given In childhood; afterwards, a booster immunization is recommended every 10 years. If the booster has been neglected, it can be made up in the second or third trimester. The mother may also be immunized in the first trimester if this is indicated.

than does the inactivated vaccine. When a typhoid infection occurs during pregnancy, the risk of miscarriage is increased as a result of typhoid septicemia. For this reason, neither of these vaccines is absolutely contraindicated during pregnancy, according to the Advisory Committee on Immunization Practices. No adverse reactions are known from the vaccine (Mazzone 1994).

Recommendation. A preference for immunization with the oral typhoid vaccine has been expressed, because of its better efficacy and fewer adverse reactions, in particular fever.

2.7.16 Varicella vaccine

Varicella vaccine is a live attenuated viral vaccine that was licensed in 1995 in the US. Although indications of this vaccine in Europe are limited to children with deficient immunity of any cause, the problem of vaccination during pregnancy may arise in selected cases. A Pregnancy Registry for this vaccine was established in the US as a collaborative effort between the manufacturer (Mcrck Prcgnancy Registry Program, 2000) and the Centers for Disease Control and Prevention because congenital varicella syndrome has occurred in newborns of women who experienced primary infection with natural chickenpox during the first half of their pregnancies (lngardia 1999, Enders 1994). Congenital varicella syndrome is characterized by cutaneous scarring in a certain dermatome and/or hypoplasia of an extremity {Roberts 1990). Additional manifestations may include low birth weight, microcephaly, localized muscular atrophy, ocular anomalies, and neurological abnormalities.

The varicella vaccine registry obtained the outcomes of 362 prospectively registered pregnancies {Shields 2001). The rates of spontaneous abortions, late fetal deaths, and minor or major congenital anomalies were not increased. The reported defects showed no specific pattern. Timing of vaccine exposure and biologic plausibility do not support the assumption of a causal relationship between varicella vaccination and the congenital anomalies observed in the registry. Although the number of exposures is not sufficient to rule out a very low risk, data collected in the registry to date do not show congenital varicella syndrome in association with the vaccination.

Recommendation. Varicella vaccination is not recommended during pregnancy, but inadvertent vaccination does not seem to be at high risk for the fetus and does not require any intervention.

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