Galev A, Nacheva A
Akush Ginekol (Sofiia). 2014;53(1):51-6.
Vaccinations protect woman and her fetus against different infectious diseases, but their application on pregnant should be extremely responsible. In this review I present information about some infectious diseases and vaccines during pregnancy. Women, planning to get pregnant should be advised to do serological tests in order to find out their immune status against some infections, leading to fetal congenital malformations (rubella, chicken pox, hepatitis B) and if necessary to get vaccinated at least a month before pregnancy. Despite the lack of vaccines against Cytomegalovirus (CMV), parvovirus 19 and Toxoplasma gondii it is good to know woman's immune status against these infections in order to clarify the clinical approach in case of future contact with sick or carriers. Parvovirus 19 could cause fetal death, while CMV could be transmitted to the child. Immune women wouldn't get sick and wouldn't transmit Toxoplasmagondii to the fetus during pregnancy. Recommended vaccines before pregnancy include vaccines against flu, human papilloma virus, MMR (morbilli, measles, rubella), Tdap (tetanus, diphtheria, whooping cough), chicken pox. CDC-Atlanta recommends during pregnancy two vaccines--against flu, in case it wasn't done before pregnancy, and Tdap during every pregnancy between 27-th and 36-th gestation week. Whooping cough is very dangerous for the baby during the first two months after birth, while it is not yet vaccinated. From this point of view it is of best interest of the mother to have strong immunity in order to transfer antibodies during breastfeeding, as well as for the father and the rest who will take care for the newborn child to be vaccinated against whooping cough. During pregnancy vaccinations against tuberculosis, morbilli, measles, rubella, meningococcal disease, typhoid fever and chicken pox are contraindicated. In case of contact vaccinations against rabies, anthrax, small pox, poliomyelitis and yellow fever should be taken into consideration. Immediately after birth, if the vaccination against whooping cough is missed young mother vaccination is recommended. The vaccination is one of the greatest achievements of the modern medicine, but it is still an object of vigorous attacks, concerning used products safety. One of the most spreading fears is about sterility after vaccination. Over a period of three years (2009-2012) 563 women were vaccinated by SACMEH against HPV. Forty two of them (13.40%) interrupt vaccination due to pregnancy (18 of them after the first shot and 24 after the second shot). Our observations show, that this vaccine is carried out good by the patients, tit is safe and does not cause sterility.
疫苗接种可保护孕妇及其胎儿免受不同传染病的侵害,但其在孕妇中的应用应极其谨慎。在这篇综述中,我介绍了一些孕期传染病及相关疫苗的信息。计划怀孕的女性应接受血清学检测,以了解其对某些可导致胎儿先天性畸形的感染(风疹、水痘、乙肝)的免疫状态,如有必要,应在怀孕前至少一个月接种疫苗。尽管缺乏针对巨细胞病毒(CMV)、细小病毒B19和弓形虫的疫苗,但了解女性对这些感染的免疫状态有助于明确未来接触患者或携带者时的临床处理方法。细小病毒B19可导致胎儿死亡,而CMV可传播给胎儿。免疫的女性在孕期不会患病,也不会将弓形虫传播给胎儿。孕前推荐接种的疫苗包括流感疫苗、人乳头瘤病毒疫苗、MMR(麻疹、腮腺炎、风疹)疫苗、Tdap(破伤风、白喉、百日咳)疫苗、水痘疫苗。美国疾病控制与预防中心(CDC)亚特兰大分部建议孕期接种两种疫苗——如果孕前未接种,应接种流感疫苗,以及在妊娠第27至36周期间每次怀孕都接种Tdap疫苗。百日咳对出生后头两个月尚未接种疫苗的婴儿非常危险。从这个角度来看,母亲拥有强大的免疫力以便在母乳喂养期间传递抗体是最有利的,同时父亲及其他照顾新生儿的人也应接种百日咳疫苗。孕期禁忌接种抗结核、麻疹、风疹、脑膜炎球菌病、伤寒和水痘的疫苗。如接触过相关疾病,应考虑接种狂犬病、炭疽、天花、脊髓灰质炎和黄热病疫苗。婴儿出生后,若错过百日咳疫苗接种,建议年轻母亲接种。疫苗接种是现代医学最伟大的成就之一,但因其所用产品的安全性问题,它仍然是激烈抨击的对象。最普遍的担忧之一是接种疫苗后会导致不孕。在三年时间(2009 - 2012年)里,563名女性通过SACMEH接种了HPV疫苗。其中42人(13.40%)因怀孕中断接种(18人在第一针后,24人在第二针后)。我们的观察表明,患者对这种疫苗的接受度良好,它是安全的,不会导致不孕。