vaccinations during pregnancy

A 30 year old pregnant lady in her 20th week of gestation. She is asking you about routine vaccinations during pregnancy and you told her that routine immunizations during pregnancy is best avoided because of theoretical risks to the fetus, however many vaccines are safe and can be given during pregnancy period and in special conditions . Which one of the following vaccines is contraindicated in this lady :

a) Tetanus toxoid.
b) Influenza vaccine.
c) Pneumococcal vaccine.
d) Rubella.
e) Diphtheria toxoid.


The correct answer is D

Explanation
Because of the theoretical risks to the fetus and real litigation to the practitioner, routine immunization of pregnant women is best avoided. However, wherever hygienic conditions during delivery can not be guaranteed, it is essential to ensure that pregnant women are immune to tetanus: the transfer of maternal anti-toxin is an important means of preventing neonatal tetanus, and pregnant women can safely receive tetanus as well as diphtheria toxoids.

Although live-virus vaccines in general should withheld during pregnancy, polio and yellow fever vaccines are exceptions and may be administered if the risk of exposure to disease is great. If indicated, some inactivated vaccines (HBV, influenza and pneumococcal vaccines) are safe for pregnant women. Known pregnancy is considered a contraindication to the receipt of rubella, measles, mumps and varicella vaccines. Although of theoretical concern, no cases of congenital rubella syndrome or abnormalities attributable to rubella vaccine virus have been observed in infants born to susceptible mothers who received rubella vaccine during pregnancy.