Vaccines Every Woman Needs, Have You Got Them All?

What is Vaccination? Vaccination is the process of introducing a germ into the body so that the body develops immunity against it. It’s like training the body with a small fire drill so that when the real fire strikes, the body is well prepared to handle it and prevent complications.

The purpose of the drill in your building is never to prevent a fire but to prepare the residents to deal with it so that the calamity is overcome with minimum damages. Similarly, the vaccines will not PREVENT an infection but will prepare your body to fight it out with minimum damage.

Vaccination in Women becomes a separate topic for discussion because:

1. Women are more prone to certain infections by virtue of the anatomy when compared to men.
2. There are some “pre-pregnancy and pregnancy” specific vaccinations which needs to be taken for a healthier pregnancy.
3. Pregnancy or even planning for pregnancy makes certain vaccines unsuitable for Women.

Vaccinations in Adolescent Girls

1. MMR- If it is not given as a part of childhood immunisation, girls post 11 years of age should be given a dose of MMR. The recent drive of MMR in school children can be followed even if the childhood immunisation has been given. This is to provide them with a lifelong immunity against such infections. These infections cause a mild disease as an adult but can have devastating effects on the unborn baby if the woman contracts them in pregnancy
2. HPV- Vaccination against Human Papilloma Virus. This is the virus that can cause cervical cancer. This virus comes from the male organ (where it is naturally in certain amounts) as soon as the woman has her first penetrative sex. The woman’s body with her in-built immunity is expected to throw it out in the next 2 to 3 years. HPV vaccination boosts this immunity and fighting power. Ideally needs to be given before the woman has her first sexual intercourse.

Before 15 years, a girl needs 2 doses. Above 15 years up to 45 years, 3 doses are required.

Vaccinations in Pre-pregnancy

1. MMR if she has missed the bus in childhood or adolescence. Also if the blood tests show that her immunity levels against Rubella is not up to the mark. After taking pre-conceptional Rubella vaccination, a woman needs a gap of at least one whole month before getting pregnant.
2. HPV-All 3 doses have to be completed before embarking on pregnancy ideally. If she falls pregnant after one or 2 doses, the remaining doses should be deferred after childbirth.
3. Chicken Pox- an infection which can be more harmful to the unborn baby than the pregnant mother. So pre-pregnancy immunity needs to be checked and vaccination given if the immune levels are low.

Vaccinations in Pregnancy

1. Tetanus toxoid - Ideally 2 doses are needed. If the pregnancy happens within 5 years of the last fully immunized one, a single dose of tetanus is good enough.
2. TDAP - This vaccination against Tetanus/ Diphtheria and whooping cough given to pregnant women between 29 to 36 weeks protects the baby from the above diseases in the first 6 weeks till the baby receives this vaccination. Tdap has to be repeated in every pregnancy irrespective of the status of previous immunization.
3. Flu vaccinations - Against Influenza A and B (inactivated) is recommended preferably after 26 weeks of pregnancy so that both the mother the newborn also is protected till his/her own vaccinations.

‘Higher rates of Influenza associated complications recorded among pregnant women during the 2009 H1N1 pandemic resulted in recognising pregnancy as a high risk group and therefore vaccination is recommended in this group. Studies have demonstrated a 63% reduction in influenza illness among infants up to 6 months whose mothers received influenza vaccination during pregnancy’ (Recommendation by Federation of obstetricians and gynaecologists of INDIA FOGSI)

Live vaccines like MMR. Varicella, BCG, HPV are not recommended in pregnancy. However, certain post exposure vaccination is recommended even if they are live to save the life of the mother, for example, Rabies or small pox vaccinations.

Post-Birth vaccinations

1.All pending vaccinations should be completed

2. Influenza vaccination (inactivated variety) should be given as postnatal mothers are more vulnerable because of lowered immunity
3. FOGSI also recommend Cocooning which is immunisation by TDAP for all contacts handling an infant <12 months if they have not received TDAP before.

Adults and elderly

FOGSI recommends vaccination against HPV, Tetanus, Diphtheria and Influenza for women of all ages; boosters for Tetanus/Diphtheria every 10 years; Influenza vaccination every year.

COVID-19 vaccination in Women

1. Women above 18 years can safely take COVID-19 vaccination without any effect on fertility.
2. Currently available vaccines in India are not permitted for pregnant women as not enough clinical trials have been done to establish safety.
3. India also recommends a wait for 3 months for a pregnancy after COVID-19 vaccination.
4. CDC in the US is recommending mRNA vaccination ( Moderna, Pfizer-BioNTech, or Johnson & Johnson’s Janssen (J&J/Janssen) in pregnancy to volunteer population as the clinical trials in animals have not shown any concern. However, data on Humans are limited there too. Also does not recommend any gap between vaccination and getting pregnant.

Dr Sudeshna Ray is a senior Gynecologist and Obstetrician attached to Jaslok and H N Reliance hospitals, Mumbai. The views expressed are the author’s own.