Vaccine, Pneumococcal Polyvalent in Pregnancy and Breastfeeding

Risk Factor: CM
Class: Serums, toxoids, and vaccines / Vaccines

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Pneumococcal vaccine polyvalent is a killed bacteria vaccine that contains a mixture of purified capsular polysaccharides from 23 types of Streptococcus pneumoniae (1,2). Animal reproduction studies have not been conducted with the vaccine (1,2).

The risk to the fetus from pneumococcal polysaccharide vaccine during the 1st trimester of pregnancy is unknown (1,2,3 and 4). However, the Immunization Practices Advisory Committee (ACIP) states that there are no reports of adverse consequences in newborns whose mothers were inadvertently vaccinated during pregnancy (4).

The American College of Obstetricians and Gynecologists Technical Bulletin No. 160 recommends that the vaccine be used in pregnancy only for high-risk patients (3). The American College of Physicians concurred with a similar recommendation made in a previous (1982) Technical Bulletin (5). A 1991 review stated that maternal antibodies induced by pneumococcal polyvalent vaccine cross the placenta and may offer significant protection to the newborn (6).

A study conducted in Bangladesh and published in 1995 described the administration of pneumococcal polyvalent vaccine to healthy women at 3034 weeks' gestation (7). Meningococcal vaccine was administered to a control group. The immunologic response of the infants resulting from the maternal immunization was monitored from birth to 5 months of age. The results indicated that sufficient amounts of specific immunoglobulin G serum antibody passed to the fetus to provide passive immunity to invasive pneumococcal infection in early infancy. The authors concluded that, in geographic regions where such infections are a serious public health problem, maternal immunization would be a safe and inexpensive method to reduce the incidence of the disease, if subsequent studies did not show that passive immunity of the infants interfered with active immunization later in life (7).

In a 1996 study, pneumococcal polyvalent vaccine was administered in the 3rd trimester in an attempt to protect against pneumococcal disease in the infant during the first few months of life (8). The degree and duration of protection was uncertain because the pneumococcal antibodies in the infants disappeared rapidly. A 1998 Reference noted that large studies are needed to determine if maternal administration of the vaccine can decrease infant mortality and morbidity (9). Because of the high cost of vaccinations with newly developed conjugate vaccines, one author thought that vaccination of pregnant women with the polysaccharide vaccine may be the most practical method for preventing pneumococcal sepsis in young infants in developing countries (10).

Breast Feeding Summary

In a study conducted in Bangladesh (described above), marked increases of specific immunoglobulin A (IgA) antibody titers were measured in the colostrum of mothers who had received pneumococcal polyvalent vaccine at 3034 weeks' gestation (7). Antibody titers remained higher than controls up to 5 months after delivery.

References

  1. Product information. Pneumovax. Merck, 2001.
  2. Product information. PNU-Mune. Lederle Pharmaceutical, 2001.
  3. American College of Obstetricians and Gynecologists. Immunization during pregnancy. Technical Bulletin. No. 160, October 1991.
  4. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46:(No. RR-8):124.
  5. Health and Public Policy Committee, American College of Physicians. Pneumococcal vaccine. Ann Intern Med 1986;104:11820.
  6. Faix RG. Maternal immunization to prevent fetal and neonatal infection. Clin Obstet Gynecol 1991;34:27787.
  7. Shahid NS, Steinhoff MC, Hoque SS, Begum T, Thompson C, Siber GR. Serum, breast milk, and infant antibody after maternal immunisation with pneumococcal vaccine. Lancet 1995;346:12527.
  8. O'Dempsey TJD, McArdle T, Ceesay SJ, Banya WAS, Demba E, Secka O, Leinonen M, Kayhty H, Francis N, Greenwood BM. Immunization with a pneumococcal capsular polysaccharide vaccine during pregnancy. Vaccine 1996;14:96370.
  9. Mulholland K. Maternal immunization for the prevention of bacterial infection in young infants. Vaccine 1998;16:14646.
  10. Glezen WP. Pneumococcal polysaccharide vaccine in pregnancy. Pediatrics 1999;104:14178.

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