NAPLEX Question of the Week: Vaccines in Pregnancy

This week's question involves vaccination in pregnancy. Are you up for the challenge?
NAPLEX Question of the Week: Vaccines in Pregnancy
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A 23-year-old female presents to local retail pharmacy on 2-15-22. She is currently on week 29 of her pregnancy and PMH reveals that she has history of depression, asthma, and had an episode of varicella-zoster virus when she was 2 years old. She is currently on sertraline 50 mg once daily, albuterol 90 mcg per actuation PRN shortness of breath, fluticasone HFA 110mcg inhaled BID, and a multi-vitamin with folic acid once daily. Her doctor has recommended her to receive vaccinations to protect her and her baby and would like to get all the vaccinations done today. She is not planning to travel internationally and vaccination records reveal the following:

DOB: 6/10/1998, 23 YO F

Haemophilus influenzae type b vaccine (ActHIB) series complete on 11/15/1998

Rotavirus (Rotarix) series complete on 11/15/1998

Hepatitis vaccine (Energerix-B) series complete 1/16/1999

DTaP vaccine (Daptacel) Series complete on 7/20/2003

Poliovirus vaccine (IPOL) series complete on 7/20/2003

MMR (M-M-R II) series complete on 7/20/2003

Meningococcal ACWY vaccine (Menactra) series complete on 8/5/2014

Varicella vaccine (Varivax) one dose at the age of 1 on 6/10/1999

Influenza vaccine (Fluarix) one dose on 1/8/2021

COVID-19 vaccine (Moderna) series complete on 2/28/21

Which of the following vaccines can she receive today?

A. Influenza IIV vaccine

B. Influenza LAIV4 vaccine

C. Varicella vaccine second dose

D. PCV13 vaccine

E. Tdap vaccine

F. COVID-19 booster vaccine

G. HPV Vaccine first dose

Answers with rationale: 

Answer choices A, E, and F are correct

Vaccinations is one of the primary methods of preventing diseases such as the polio virus. Most individuals in the United States receive many of their vaccinations in their childhood. What is not commonly discussed is vaccinations during pregnancy, of which a few of the following vaccines are safe and indicated for administration during pregnancy. All the following recommendations are supported by the Center for Disease Control (CDC).

Answer choice A is correct as pregnant patients are more likely to have severe complications from the flu due to changes in body’s function, thus risking harm to the fetus. Annual influenza vaccinations are vital to the protection of the mom and the baby from influenza related complications. The IIV influenza vaccine is an inactivated vaccine, thus safe for administration for pregnant patients.

Answer Choice B is incorrect as LAIV4 influenza vaccine is a live vaccine, thus contraindicated in use in pregnant patients as this could harm the fetus as the live virus can cross the placenta, causing infection.

Answer Choice C is incorrect similar to the lines of the LAIV4 vaccine in that the varicella vaccine is a live vaccine and administration could harm the fetus. Even though the patient has not completed the varicella vaccination series, the patient has history of varicella-zoster infection, thus does not need to finish the series.

Answer Choice D is incorrect as the patient does not have an indication for PCV13. Although, the patient does have a chronic lung disease condition, asthma, the CDC does not recommend PCV for the age group of 19 – 64 unless the patient is on immunosuppressive therapy or is considered immunocompromised (HIV infection, cancer, recent solid organ transplant, etc.), has cochlear implants, or has CSF leaks. The patient would be eligible to receive the PPSV23 vaccine as the CDC recommends those with chronic lung conditions ages 19 – 64 to receive the vaccine.

Answer Choice E is correct as the CDC recommends the Tdap vaccine for pregnant patients in their third trimester (weeks 27 – 36) as the complication of pertussis is life threatening to newborns. Per CDC, 7 out of 10 newborns under the age of 2 months will perish form pertussis infection and the newborns cannot receive Tdap at that age. Having the Tdap vaccine during the third trimester will pass the mother’s antibodies to the fetus, giving the newborn some protection from pertussis.

Answer Choice F is correct as the CDC has approved the use of COVID-19 vaccinations in pregnant patients as the vaccines are safe and the benefits of protection against COVID-19 outweighs the risks posed by vaccination. The patient has received the Moderna vaccine prior to pregnancy and has been 5 months since her last dose, thus she is eligible to receive the Moderna booster vaccine or for a heterologous booster could receive the Pfizer mRNA or Johnson and Johnson adenovirus vaccine, with the Pfizer vaccine being preferred.

Answer Choice G is incorrect as the CDC does not recommend the HPV vaccine for pregnant women as more research is needed to support safe use in pregnant patients. Once the patient has delivered her baby, the patient would be eligible for the HPV vaccine.

A great resource for vaccinations in pregnancy can be found at the CDC website here: https://www.cdc.gov/vaccines/pregnancy/index.html

Have a great week everyone!

Dr. B

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