While some vaccinations (such as influenza vaccine and Hepatitis B vaccine) can be administered during pregnancy, others are contraindicated (live, attenuated vaccines like MMR) during pregnancy, so they should be given before pregnancy is attempted.
Vaccinating women of childbearing potential before pregnancy protects women and their babies from serious infections during and after pregnancy.
Vaccinations
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Hepatitis A vaccine (inactivated)
Vaccinate individuals with the following indications:
- Requests vaccination
- Use of injection drugs
- Work with Hepatitis A (HAV) infected primates or with HAV in a research laboratory setting
- Chronic liver disease
- Treatment with clotting factor concentrates
- Travel or work in countries where HAV is moderately or highly endemic
- Member of a household planning to adopt a child or caring for newly adopted child from a county where hepatitis A is common
- Men who have sex with men
Dosing:
- Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications) 2 doses for all age groups (19-21, 22-26, 27-49 years).
- There is a combination Hepatitis A and Hepatitis B vaccine with a 3 dose and a 4 dose schedule.
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Hepatitis B (recombinant subunit)
Vaccinate persons with any of the following indications:
- Requests vaccination
- Sexually active but not in a long-term, mutually monogamous relationship
- Health-care personnel and public-safety workers exposed to blood or other potentially infectious body fluids
- Diabetics younger than 60 years
- End-stage renal disease
- HIV infection
- Chronic liver disease
- Household contacts and sex partners of persons with chronic HBV infection
- Clients and staff members of institutions for persons with developmental disabilities
- International travelers to countries with high or intermediate prevalence of chronic HBV infection
Dosing:
- Administer 2nd dose 1 month after the 1st dose; administer 3rd dose 6 months after 1st dose
- Administer missing doses to those with incomplete 3-dose series.
- There is a combination Hepatitis A and Hepatitis B vaccine with a 3-dose and a 4-dose schedule.
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Human papillomavirus (HPV) vaccine (recombinant)
- Best to vaccinate before potential exposure to HPV through sexual activity. Three dose regimen: second dose 1-2 months after first dose, third dose six months later.
- For females ages 13 through 26 years of age, if not previously vaccinated, administer a 3-dose series of bivalent or quadrivalent HPV vaccine
- Can be administered to immunocompromised individuals; however, immune response and vaccine efficacy might be less than in immunocompetent people
- Can be administered to people with a history of genital warts, abnormal cervical cytology (Pap smear), or positive HPV DNA test
Dosing:
- For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection 3 doses for 19-21 and 22-26 year old age groups.
- No recommendation for 27-49 year old age group.
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Influenza vaccine (inactivated or live attenuated)
- Persons 6 months of age and older, including pregnant women, can receive the trivalent inactivated vaccine (TIV), which is administered by injection. The intramuscular or intradermal TIV are options for adults aged 18–64 years.
- Healthy, non-pregnant adults younger than age 50 years without high-risk medical conditions can receive either intra-nasally administered live, attenuated influenza vaccine (LAIV) (FluMist) or TIV
- Health-care personnel who care for severely immuno-compromised persons (i.e., those who require care in a protected environment) should receive TIV rather than LAIV
Dosing:
- For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection 1 dose annually for all age groups (19-21, 22-26, 27-49).
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Measles, mumps, rubella (MMR) vaccine (live, attenuate)
- Determine rubella immunity for all women of childbearing age and vaccinate if not immune
- Adults born after 1957 and all healthcare personnel should have documentation of one or more doses of MMR unless vaccine is contraindicated or they have laboratory documentation of immunity. Provider diagnosis is adequate for measles and mumps but not rubella.
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The following populations should routinely receive a second MMR dose a minimum of 28 days after the
first:
- Students in postsecondary educational institutions
- Those who work in a health-care facility
- International travelers
- Administer a 2-dose MMR series to adults vaccinated in 1963-1967 with an inactivated measles vaccine or prior to 1979 with a killed mumps vaccine
Dosing:
- For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection 1 or 2 doses for all age groups (19-21, 22-26, 27-49 years).
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Meningococcal vaccination (quadrivalent, conjugate)
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Two types of vaccine (age related):
- Quadrivalent conjugated vaccine (MCV4) preferred for ages 55 years and younger
- Quadrivalent polysaccharide vaccine (MPSV4) is the only meningococcal vaccine licensed for people older than 55
- Administer 2 doses of meningococcal vaccine at least 2 months apart to at high risk of infection (e.g., anatomic or functional asplenia, persistent complement component deficiencies, HIV)
- Every 5 years, revaccinate adults previously vaccinated with MCV4 or MPSV4 who remain at increased risk for infection
Dosing:
- Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications) 1 or more doses for all age groups (19-21, 22-26, 27-49 years).
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Two types of vaccine (age related):
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Pneumococcal polysaccharide (PPSV) vaccination (conjugate)
Dosing:
- Recommended if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications) 1 or 2 doses for all age groups (19-21, 22-26, 27-49 years).
- Administer a one-time revaccination 5 years after the first PPSV vaccination to individuals ages 19 through 64 years (especially important for those who are immunocompromised or have chronic renal failure or functional or anatomic asplenia).
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Tetanus, diphtheria, acellular pertussis (Td/Tdap) vaccine (toxoid/toxin/subunit)
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Tdap is specifically recommended for:
- Pregnant women more than 20 weeks’ gestation
- Adults, regardless of age, who are close contacts of infants younger than age 12 months (e.g., parents, grandparents, or child care providers)
- Healthcare personnel
- Tdap can be administered regardless of interval since the most recent tetanus or diphtheria containing vaccine
Dosing:
- For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection substitute 1-time Tdap for Td booster; then boost with Td every 10 years for all age groups (19-21, 22-26, 27-49 years).
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Tdap is specifically recommended for:
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Varicella vaccine (live, attenuated)
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Important to vaccinate:
- All non-pregnant women of childbearing age
- Healthcare personnel and family contacts of immunocompromised people
- Those at high risk for varicella exposure or transmission (e.g., teachers; child care employees; residents and staff members of institutional settings, including military personnel)
- Adolescents and adults living in households with children
- International travelers
- Vaccination not needed if evidence of immunity to varicella (documentation of 2 doses of varicella vaccine at least 4 weeks apart; born in U.S. before 1980; verified history of disease or immunity)
Dosing:
- For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection 2 doses for all age groups (19-21, 22-26, 27-49 years).
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Important to vaccinate: