Pregnancy is a vulnerable and severely risk-prone period

Pregnancy is a
vulnerable and severely risk-prone period for both mother and child; travelling
whilst being so further exposes both mother and child to foreign pathogens due
to a weakened immune system which is characteristic of pregnancy. Potential contraindications to
travelling whilst pregnant included obstetrical risk factors (history of
miscarriage, previous cervix/labour/delivery complications, etc.) and medical
risk factors (hypertension, diabetes, chronic organ system dysfunction, etc.).1

Vaccines are usually
inactive or weakened forms of pathogens given to stimulate an immune response –
identifying its foreign, attacking it and then remember it to prevent future
infection, therefore, developing immunity to the particular disease. During
pregnancy, there is a ‘theoretical risk of perinatal infection’2,
posed to both the mother and infant via a process called vertical transmission
which is the passage of a pathogen from mother to infant via either the
placenta, breast milk or direct contact during or after birth causing disease.3

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For Influenza, it
was found that ‘immunization was the best strategy for flu prevention’2 thus
in a randomized study the administering of the inactivated influenza vaccine (IIV)
revealed a 70% reduction in flu illness.2 For the Tdap vaccine,
‘passive infant immunity’2 had been documented following
immunization of the mother, with the optimal timing for immunization
being recommended within the third trimester to allow for a substantial antibody
response to be formed. Rubella cases also declined over time as the MMR vaccine
was more recognised, leading to the ‘elimination of rubella virus
transmission.’2 Similarly, as the Varicella vaccine became
routinely administered, ‘disease incidence dropped by 90%’.2

Hepatitis A virus (HAV)
cases decreased from 2,979 to 1,3982 after the widespread of
the HAV vaccination. Hepatitis B virus (HBV) vaccine was found to
result in a ‘protective antibody response greater than 90%’2 deeming
it the best preventative measure, however, should only be considered
for those at a high risk of developing the infection. Pneumococcal vaccines
saw a 47% reduction in disease development following vaccination, with
meningococcal demonstrating an ‘appropriate maternal antibody response’2 as
well as ‘transplacental antibody transfer’2 leading to the
development of infant immunity. 

Yellow fever
vaccines, when given during an outbreak, found no adverse effects for both
mother and child. Japanese encephalitis is seen as the most common
‘vaccine-preventable disease cause of encephalitis’ 2 however
due to the lack of adequate studies within pregnancy, the effectiveness was not
established. Similarly, with Typhoid vaccine, despite consisting of two types
of vaccines, there was ‘no supporting data on the efficacy and safety
of either during pregnancy’.2 Both Anthrax and Rabies vaccines
were recommended as post-exposure prophylaxis. The results from limited studies
implied no associated between the rabies vaccination and adverse effects within
pregnancy, regardless pre-exposure vaccines were only to be considered
if the ‘risk was deemed high’.2

To summarize,
immunization prior to conception would be ideal for the
prevention of vaccine-preventable diseases, however, Influenza and Tdap vaccines are
recommended whereas MMR and Varicella are recommended postpartum
and others such as Hepatitis A and B, Pneumococcal and meningococcal
are to be administered dependent upon risk factors.2 Inactivated
vaccines are deemed somewhat safe for use during pregnancy however regarding other
forms of vaccines, it should be considered whether the severity
of the repercussions of infection during pregnancy outweighs the risks
associated with the vaccination when administering the vaccine.