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التطعيم أثناء الحمل




Immunobiological Agent
Indications for Immunization
الاستعمال اثناءالحمل During Pregnancy
Dosing Schedule الجرعة
Comments التعليق

Live Attenuated Virus Vaccines ممنوعة في الحمل – تطعيمات عبارة عن فيروسات حية وضعيفة

Measles الحصبة
Contraindicated—see Immune Globulins below
Single dose, preferably as measles-mumps-rubella (MMR)a
Vaccinate susceptible women postpartum. Breast feeding is not a contraindication
Mumps التهاب الغدة النكفية
Contraindicated
Single dose, preferably as MMR
Vaccinate susceptible women postpartum
Rubella الحصبة الالمانية
Contraindicated, but congenital rubella syndrome has never been described after vaccination
Single dose, preferably as MMR
Teratogenicity of vaccine is theoretical, not confirmed to date; vaccinate susceptible women postpartum
Poliomyelitis Oral = live attenuated; SC = enhanced-potency inactivated virusb شلل الاطفال
Not routinely recommended for women in the United States, except women at increased risk of exposure
Primary: Two doses of enhanced-potency inactivated virus SC at 4–8 wk intervals and a 3rd dose 6–12 mo after 2nd dose
Immediate protection: One dose oral polio vaccine (in outbreak setting)
Vaccine indicated for susceptible women traveling in endemic area or in other high-risk situations
Yellow fever الحمي الصفراء
Contraindicated except if exposure is unavoidable
Single dose SC
Postponement of travel preferable to vaccination, if possible
Varicella الجديري
Contraindicated, but no adverse outcomes reported in pregnancy
Two doses needed, with 2nd dose given 4–8 wk after 1st dose
Teratogenicity of vaccine is theoretical. Vaccination of susceptible women should be considered postpartum
Other
Influenza الانفلونزا
All women, regardless of trimester, who will be pregnant during the influenza season.
One dose IM every year
Inactivated virus vaccine
Rabies مرض الكلب
Indications for prophylaxis not altered by pregnancy; each case considered individually
Public health authorities to be consulted for indications, dosage, and route of administration
Killed virus vaccine
Hepatitis B التهاب الكبد – ب
Preexposure and postexposure for women at risk of infection
Three-dose series IM at 0, 1, and 6 mo
Vaccine produced from purified surface antigen developed by recombinant technology. Used with hepatitis B immune globulin for some exposures. Exposed newborn needs birth dose vaccination and immune globulin ASAP. All infants should receive birth dose of vaccine
Hepatitis A التهاب الكبد – أ
Preexposure and postexposure if at risk (international travel)
Two-dose schedule 6 mo apart
Inactivated virus

Inactivated Bacterial Vaccines تطعيمات عبارة عن بكتيريا غير نشطة – مسموح بها في الحمل

Pneumococcus الالتهاب الرئوي
Indications not altered by pregnancy. Recommended for women with asplenia; metabolic, renal, cardiac, pulmonary diseases; smokers; immunosuppressed
In adults, one dose only; consider repeat dose in 6 yr for high-risk women
Polyvalent polysaccharide vaccine
Meningococcus الالتهاب السحائي
Indications not altered by pregnancy; vaccination recommended in unusual outbreaks
One dose; consult public health authorities
Quadrivalent polysaccharide vaccine
Typhoid التيفويد
Not recommended routinely except for close, continued exposure or travel to endemic areas
Killed vaccine
Primary: 2 injections, > 4 wk apart
Booster: 1 dose; schedule not yet determined
Killed or live attenuated oral bacterial vaccine. Oral vaccine preferred
Anthrax الحمي القلاعية
See text discussion
6-dose primary vaccination, then annual booster vaccination
Preparation from cell-free filtrate of B anthracis. No dead or live bacteria. Teratogenicity of vaccine theoretical
Toxoids اللقاحات
Tetanus-diphtheria
Lack of primary series, or no booster within past 10 yr
Primary: 2 doses at 1–2-mo interval with 3rd dose 6–12 mo after the 2nd
Booster: Single dose IM every 10 yr after completion of primary series
Combined tetanus-diphtheria toxoids preferred: adult tetanus-diphtheria formulation. Updating immune status should be part of antepartum care

Specific Immune Globulins للوقاية من المرض في حالات التعرض للمرض – جلوبين مناعي خاص

Hepatitis B
Postexposure prophylaxis
Depends on exposure. See Chap. 50, Hepatitis B
Usually given with hepatitis B virus vaccine; exposed newborn needs immediate prophylaxis
Rabies
Postexposure prophylaxis
Half dose at injury site, half dose in deltoid
Used in conjunction with rabies killed virus vaccine
Tetanus
Postexposure prophylaxis
1 dose IM
Used in conjunction with tetanus toxoid
Varicella
Should be considered for exposed pregnant women to protect against maternal, not congenital, infection
1 dose IM within 96 hr of exposure
Also for newborns or women with varicella within 4 days before or 2 days following delivery

Standard Immune Globulins جلوبين مناعي عام

Hepatitis A
Postexposure prophylaxis
0.02 mL/kg IM for 1 dose of immune globulin
Given ASAP and within 2 wk of exposure; infants born to women who are incubating the virus or are acutely ill at delivery should receive 1 dose of 0.5 mL ASAP after birth
Hepatitis A virus vaccine should be used with hepatitis A immune globulin
Measles
Postexposure prophylaxis
.25 mL/kg (maximum of 15 mL) for 1 dose
Given within 6 days of exposure
ID = intradermally; IM = intramuscularly; PO = orally; SC = subcutaneously; ASAP = as soon as possible.
aTwo doses necessary for students entering institutions of higher education, newly hired medical personnel, and travel abroad.
bInactivated polio vaccine recommended for nonimmunized adults at increased risk.
Adapted from the Centers for Disease Control and Prevention, Recommendations of the Advisory Committee on Immunization Practices, 2003a, 2004.




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