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#Grand Rounds

Are Travel Vaccines Safe During Pregnancy?

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BACKGROUND AND PURPOSE:

  • The safety of travel vaccines for pregnant women is relatively unknown
  • Nasser et al. (Journal of Travel Medicine, 2019) studied the safety profiles of vaccines commonly given to travelers in pregnant women

METHODS:

  • Systematic review and meta-analysis
  • Study inclusion criteria
    • Case series | Cohort studies | RCTs
    • Only RCTs comparing vaccine to placebo or to no vaccine were included
  • Data analysis
    • Risk ratios (RR) and 95% CIs were calculated as the summary measure
  • Primary outcomes
    • Severe systemic adverse events
    • Maternal outcomes related to the course of pregnancy
    • Neonatal outcomes
    • Local adverse events

RESULTS:

  • Influenza vaccine
    • The safety of influenza vaccine was supported by high-quality evidence
  • Tdap vaccine
    • No evidence of any harm was found in the meta-analysis of RCTs
    • There was a slight increase in chorioamnionitis rate reported in 3 of 12 observational studies
  • Meningococcal vaccine
    • Determined as probably safe during pregnancy, as supported by RCTs comparing meningococcal vaccines to other vaccines
    • No RCTs comparing meningococcal vaccine with placebo or no vaccine
  • Hepatitis A and B vaccine
    • Data from observational studies support the safety of hepatitis A, hepatitis B
  • Rabies vaccine
    • Data from observational studies support the safety of rabies vaccine
  • Live attenuated yellow fever vaccine
    • Data from observational studies support the safety of the yellow fever vaccine
  • Little to no data were found about the safety of the following
    • Polio
    • Typhoid
    • Japanese encephalitis
    • Tick-borne encephalitis
    • MMR

CONCLUSION:

  • RCTs comparing vaccine to placebo or no vaccine support the safety of the influenza and Tdap vaccine in pregnancy
  • Meningococcal vaccine
    • Considered safe during pregnancy (moderate level of evidence)
    • Pregnant travelers are likely to be at very low risk of infection unless travelling to
      • Areas with outbreaks | Mass gatherings | Prolonged stay in low-income setting | Specific high risk geographic areas (e.g., African ‘meningococcal belt’)
  • Yellow fever vaccine
    • Associated with high mortality rates
    • Likely there is either no risk or risks very low (low-quality evidence)
    • WHO and CDC recommend that if a pregnant woman must travel to a country with a current high-transmission risk and exposure is prolonged, the benefits of vaccination would outweigh any theoretical risks
  • Rabies vaccine
    • Universally fatal and animal bites are possible during travel
    • Data on vaccine safety in pregnancy is scarce
    • “Probably safe to administer” (low-quality evidence)
    • Recommended that “the use of rabies vaccines be considered only for pregnant travellers who are unlikely to have access to post-exposure prophylaxis that includes both rabies vaccination and rabies immunoglobulin”
    • No limitations for post-exposure prophylaxis in pregnancy
  • Hepatitis A vaccine
    • Risk high in low-income countries
    • Hepatitis A in pregnancy has been associated with adverse outcomes such as preterm labor
    • Data on vaccine safety in pregnancy is scarce but “likely to be safe” (low-quality evidence)
    • If travel to country with high-transmission risk is unavoidable during pregnancy, vaccination “should be considered”
  • Hepatitis B vaccine
    • Since transmission is via sexual contact, contaminated needles, tattoos or contaminated blood products, risk of transmission during travel is unlikely for most travelers
    • Series of shots will likely not be practical for many pregnant women
    • Consider vaccine “only if known risk factor for hepatitis B is present” (low level evidence)
  • No evidence of harm for the polio, typhoid, Japanese encephalitis, tick-borne encephalitis and MMR vaccines, though data were limited

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Learn More – Primary Sources:

Are all vaccines safe for the pregnant traveler? A systematic review and metaanalysis

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Related ObG Topics:

Vaccination in Pregnancy: CDC Recommendations and ACOG Update
Are Tdap and Polio Vaccines Safe During Pregnancy?
Does Flu Vaccine During Pregnancy Have Long Term Adverse Effects on Children?

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