Health professionals and expecting mothers alike are often unsure if vaccines will adversely affect the health of the unborn baby. However, the decades-old debate about the safety of administering travel vaccines to pregnant women can finally be put to rest.
There’s been enough research conducted and surveillance done on this matter by international authority in health, the World Health Organisation and local health authority, MOH, to provide adequate defense for administering many types of vaccines – some vaccines, when administered during pregnancy, are perfectly safe and a few are even recommended to be administered to pregnant women because of the numerous tangible benefits they provide to mother and baby.
These vaccines, when administered to a pregnant woman, will give her immunity against diseases that can prove to be very dangerous to both herself and her unborn child – some examples being whooping cough (pertussis) and the flu.
Additionally, after birth, they offer the baby some form of protection against the disease till it’s old enough to be vaccinated. The two combined, form a solid case for the vaccination of expecting women who are travelling and even those who are not but still wish to be cautious.
Read on to find out which travel vaccines are recommended for expecting mothers, which should be avoided by them, at which point of pregnancy these recommended vaccines should be administered and other important information.
However, if you’re pregnant, MOH recommends that you consult your obstetrician or gynaecologist before making a decision – they can evaluate your medical history and travel plans and give you a better idea of which vaccines may benefit you and which ones you should avoid.
What are the types of vaccines?
To better understand why some vaccines have been proven to be completely safe for pregnant women and why a few others may pose some theoretical risks to the health of the unborn baby, it’s important to know that there are two main categories of vaccines: inactivated vaccines and live attenuated vaccines.
Inactivated Vaccines
Inactivated vaccines come in different types, but what the vaccines covered by this umbrella term have in common is that they do not contain live viruses or bacteria. They usually either comprise bacteria or viruses that have been killed or units of bacteria or viruses which cannot trigger illness. These vaccines work by creating an immune response in those who receive the vaccine. They do not carry any risk of causing diseases in persons who are vaccinated, even those who do not have the best immune systems.
However, the downside is that inactivated vaccines are less effective than live vaccines and do not protect you from an illness for as long as or as well as live vaccines do. They also may require more than one dose. Subcategories of inactivated vaccines include subunit vaccines (e.g. hepatitis B vaccine) and toxoid vaccines (e.g. diphtheria, tetanus and pertussis vaccine). Some examples of inactivated vaccines are the flu and whooping cough vaccines.
Live Attenuated Vaccines
Live attenuated vaccines, commonly known as live vaccines, contain live strains of viruses or bacteria – these viruses or bacteria are often weakened so that there is minimal risk of them causing disease in those who receive the vaccines. Much like inactivated vaccines, they work by creating immune responses in those who receive the vaccine, but the difference is that these immune responses are stronger and longer lasting than the responses caused by inactivated vaccines.
Live vaccines generally provide protection that is more effective and that also lasts longer than that provided by inactivated vaccines. However, this also means that they’re not suitable for those with weak or compromised immune systems – theoretically, the live bacteria or viruses may multiply rapidly and cause disease in these people. Some examples of live attenuated vaccines are the Measles, Mumps and Rubella (MMR) vaccine and the yellow fever vaccine.
Which vaccines should be avoided during pregnancy?
Now that you have a better idea of the types of vaccines that exist, you may be able to work out the reasoning behind why it’s better for pregnant women to avoid receiving certain types of vaccines. Since live attenuated vaccines contain live strains of disease-causing bacteria or viruses, they theoretically pose a small risk of infecting the person who receives it.
This is a chance that expecting mothers ideally shouldn’t take because not only are their immune systems compromised, if they are infected with the disease or if the bacteria or virus strains somehow reach the foetus, their babies may be infected by the disease and may be born with birth defects.
Remember that this is only theoretical and that studies have shown no connection between pregnant women receiving live vaccines and babies being born with birth defects – it’s merely precautionary.
Below are examples of live vaccines which the World Health Organisation does not recommend for pregnant women and which should only be administered under exceptional circumstances:
Measles, Mumps and Rubella (MMR) vaccine
The MMR vaccine contains live strains of measles, mumps and rubella viruses and thus, there is a theoretical risk that a pregnant woman who is administered the vaccine may be infected with one of the aforementioned diseases, especially because her immune system has been weakened by pregnancy.
MOH recommends that pregnant women do not get the MMR vaccine. However, it advises women who are planning a pregnancy to ensure that they are adequately immunised against measles, since the disease may affect their unborn child.
The WHO hasn’t identified any confirmed safety risks caused by the vaccine, but to avoid any risk, it’s best for women to be vaccinated after they have given birth.
Yellow fever vaccine
The yellow fever vaccine, similar to the MMR vaccine, contains a live strain of the yellow fever virus and thus poses a risk of infection for the pregnant woman and her unborn child. For avoidance of doubt, it’s best that these women receive the vaccination after giving birth, as there is a theoretical risk of their babies being born with birth defects. Remember once again that the risk is merely theoretical and that a connection between the two has not been made.
Nevertheless, the yellow fever vaccine is a live vaccine and MOH recommends that pregnant women do not receive live vaccines.
What are the circumstances in which contraindicated vaccines may be administered during pregnancy?
If you are a pregnant woman who is travelling to an area or are living in an area which poses a high risk of transmission of disease, it may be best to speak to your health provider about being vaccinated, even if the vaccine is a live attenuated one. This is especially true in cases where the risk of being infected by the disease when not immunised is much higher than the inherent risk that the vaccine carries.
Pregnant women are generally not recommended to travel to places which pose high risk of transmission of any sort of disease, but if you absolutely must travel, it may be better to go after being vaccinated against that particular disease.
The risk of mortality if you contract a disease such as yellow fever is extremely high and if you’re an expecting mother who is travelling to a region that poses a high risk of transmission of yellow fever, it’s best for you to make sure that you are protected against the disease before you step foot in there.
Speak to your health provider or obstetrician about whether the benefits of receiving live vaccines during pregnancy may outweigh the risks in some cases.
Which vaccines are recommended during pregnancy?
MOH especially recommends certain vaccines for pregnant women because of the tangible benefits they provide to both mother and baby – both during and after pregnancy. These vaccines are inactivated vaccines and do not pose a high risk of causing disease in expecting mothers or their babies. Note that doesn’t mean that all inactivated vaccines are safe to be administered during pregnancy.
MOH’s recommendations of these vaccines are based on the fact that a pregnant woman’s immune system is weakened – this means that it may be more likely for her to contract a certain disease and develop complications from this disease when compared to a woman who isn’t pregnant.
If administered at the right time, the following vaccines will not only protect a pregnant woman and her unborn baby against a disease, they may also provide the baby with some form of protection against the disease after it is born and until it is old enough to be vaccinated.
The flu is a rather common ailment and may not be regarded as particularly dangerous to healthy people who have well-functioning immune systems. The risk that it poses to expecting mothers, however, is far higher – it may more easily infect pregnant women than others, is more likely to cause complications in them and may even infect the unborn baby and cause it to have birth defects.
This is why under the National Adult Immunisation Schedule, MOH recommends that pregnant women receive their flu shots during pregnancy – to give both mother and baby suitable protection from the ailment.
If you are pregnant and travelling to or living in a region where there has been an outbreak of the flu, it’s all the more crucial that you get yourself vaccinated.
2. Whooping cough (pertussis) vaccine
Whooping cough is a serious disease that can cause several complications in even previously healthy individuals, so it can be particularly deadly to expecting mothers and their unborn babies. Moreover, newborns are particularly at risk of developing the disease and those who do develop it have a high risk of mortality.
All these, put together, form a solid case for the vaccination of pregnant women against whooping cough during a certain period of her pregnancy. The immunity the mother receives from the vaccine is transferred to the unborn baby as well and as a result, the baby is protected from whooping cough after birth till it is ready to be routinely immunised.
Under the National Adult Immunisation Schedule, MOH strongly recommends that pregnant women get one dose of the Tdap vaccine, which protects against pertussis among other diseases, during each pregnancy. The vaccine should be administered between the 16th and 32nd week of pregnancy to ensure that immunity is best passed on to the baby.
The NHS recommends pregnant women who have a high risk of developing Hepatitis B to receive the vaccine. The complications that hepatitis B may cause to both mother and baby can be avoided if the vaccination is administered. Moreover, the disease can be caused by transfer of fluids such as blood between persons, so it is very likely that an unborn baby will contract the disease from its infected mother.
The vaccine will protect pregnant women from developing the disease during the course of their pregnancy and will even provide newborns with some form of protection against the disease. For women travelling to regions where there is a high risk of contracting Hepatitis B, the vaccine is highly recommended.
When during pregnancy should vaccines be administered?
Different vaccines may be recommended to be administered during different trimesters or periods of pregnancy, but here is a general recommendation by the NHS on when the following vaccines should be administered to pregnant women:
Pregnant women should get the flu jab as soon as possible and at any point in their pregnancy – preferably once they find out that they are pregnant, and especially if flu season is coming up. This will protect them and their unborn babies from the illness right from the beginning of the pregnancy. Remember that you will have to get another flu jab during your next pregnancy as well as the protection from this one will not extend to that pregnancy.
The whooping cough vaccine is recommended to pregnant women between weeks 16 and 32 of their pregnancy. This particular window of time is recommended by the NHS so that the immunity provided by the vaccine can be passed on from mother to baby. This will ensure that newborns have sufficient protection against the disease as well.
It is recommended that pregnant women who are travelling to areas which pose a risk of Hepatitis B or who have a higher risk of contracting the disease receive the vaccine at least a month before travel or as early on in their pregnancy as possible, respectively. The vaccine can be administered even if the pregnancy is in its late stage as it is during birth that there is the highest risk of the baby contracting the disease from the mother.
What are some of the vaccines that should be administered before pregnancy and when?
Some vaccines are safer when they are administered to women a certain period of time before pregnancy – these are largely live attenuated vaccines. If you are planning to have a baby, make sure that you consult a health professional beforehand to check if you may need to receive certain vaccines:
1. Measles, Mumps and Rubella (MMR) vaccine
Since the MMR vaccine is a live attenuated one, the NHS recommends that women receive the vaccine at least one month before getting pregnant.
Women who receive the yellow fever vaccine because they are travelling to areas which pose a high risk of the disease should wait at least 28 days after receiving the vaccine to get pregnant, according to NaTHNaC. Remember that it’s not advisable for pregnant women to travel to areas with a high risk of transmission of yellow fever.
3. Chickenpox (varicella) vaccine
It is recommended that women looking to conceive receive the chickenpox vaccine at least one month before getting pregnant.
Do check with your travel health professional about the window of time required after receiving a certain vaccine before you can conceive and whether it is recommended that you refrain from travelling to certain regions just before you are planning to get pregnant or when you are pregnant.
Are anti-malarial pills safe for pregnant women?
The NHS recommends, as a rule of thumb, that women who are trying to get pregnant or who are pregnant avoid travelling to areas which have a high risk of transmission of malaria. The disease can be particularly deadly to unborn baby and mother and can result in severe complications and even death, so you should take utmost precautions to avoid getting infected.
One way to protect yourself from the mosquito-borne disease is to start a course of anti-malarial pills. However, only some of these pills are recommended during pregnancy and this too, only if expecting mothers are travelling to areas with a risk of transmission.
The following malaria pills have been deemed to be safe for pregnant women who are travelling to areas with a risk of transmission of malaria:
- Chloroquine and proguanil – however, these pills may not protect you against the disease if you’re travelling to many high-risk regions, including Africa. A 5mg folic acid supplement should also be taken when you are taking proguanil.
- Mefloquine AFTER the first trimester – these pills should NOT be taken by women who are in their first twelve weeks of pregnancy
The following malaria pills should not be taken by pregnant women:
- Mefloquine DURING the first trimester – these pills should only be taken by women after the first twelve weeks of their pregnancy
- Doxycycline – these pills will affect the formation of milk teeth in the baby
- Atovaquone/proguanil – there is no evidence to prove that these pills are safe to be taken during pregnancy
Avoid travelling to areas with a risk of transmission of malaria best as you can when you are pregnant. If you cannot avoid this, make sure you take the following precautions when you are in high-risk areas:
- Protect yourself with mosquito repellent – make sure that the type of repellent is recommended for use for pregnant women
- Remain indoors after nightfall until after the day breaks once again
- Choose a screened, air-conditioned room to sleep in or cover your sleeping area with a mosquito net that has been treated with insecticide
- Wear long-sleeved shirts and trousers
- Kill any mosquitos in your room with mosquito spray or a mosquito coil before you go to bed
Should pregnant women avoid travelling to high risk areas?
If you are pregnant and looking to travel to areas that have a risk of transmission of any sort of disease, remember to consult your travel health professional before making any decisions.
It is generally recommended that you try to avoid travelling to these areas during pregnancy but if it’s absolutely necessary, your travel health professional will be able to evaluate your condition and recommend whether you should receive certain vaccines as a precaution before you travel.
Remember, it’s important that you protect yourself and your unborn baby against diseases such as flu and whooping cough so schedule an appointment with us now if you haven’t yet been vaccinated or unsure about your immunity.
If you’re planning to get pregnant and foresee that you will be travelling this year, remember to also pay us a visit so that we can decide if you may need to be vaccinated before pregnancy.