Should
pregnant women receive the smallpox vaccine?
No.
Women who are pregnant or planning to become pregnant within 4 weeks after
vaccination should NOT get the smallpox vaccine. In addition, anyone who
has a close contact who is pregnant should not get the vaccine (close
contacts include anyone living in your household and anyone you have close,
physical contact with such as a sex partner or someone you share a bed
with). The smallpox vaccine is a live viral vaccine that is made from
a virus called vaccinia. Live virus vaccines are generally not recommended
during pregnancy. Pregnant women should not get the smallpox vaccine unless
they have been in contact with someone with smallpox disease. The vaccine
can cause a very rare but serious complication in the fetus called fetal
vaccinia (less than 50 cases of fetal vaccinia have ever occurred). However,
most babies born after smallpox vaccine exposure will be fine.
If a woman
is vaccinated she should prevent pregnancy for a month. She should wait
until the vaccination site has completely healed and the scab has fallen
off before trying to become pregnant after vaccination. Until that time,
effective measures should be taken to prevent pregnancy, such as birth
control pills, injections, implants, IUDs, or abstinence. Other methods
of birth control, such as condoms, diaphragms, spermicide, and natural
family planning are less effective.
Is
it safe for pregnant women to have contact with a person who has recently
received the smallpox vaccine?
Women
who are pregnant should not have close contact with anyone who has recently
(within the last 28 days) received the smallpox vaccine. A close contact
includes anyone living in your household and anyone you have close, physical
contact with (such as a sex partner or someone you share a bed with).
Other friends or people you work with are not considered close contacts.
What
if my obstetrician has been vaccinated?
The
close contact required for transmission of vaccinia infection to close
contacts is not likely to occur in the healthcare setting. Healthcare
workers who have received smallpox vaccine are taking precautions to practice
strict vaccination site care and hand hygiene, so that their patients
will not come into contact with the vaccination site, or with any materials
that have come into contact with the vaccination site.
If
pregnant women are vaccinated with the smallpox vaccine are there any
special risks to the fetus?
In
pregnant women, smallpox vaccination can cause a very rare but serious
complication called fetal vaccinia. Fetal vaccinia is an infection in
the unborn baby that can lead to premature delivery, skin rash with scarring,
stillbirth, or death of the baby after delivery. Sometimes a baby who
develops fetal vaccinia is born with skin scars but is otherwise healthy.
Fewer than 50 cases of fetal vaccinia have ever been reported in the world,
and only three of these cases were reported in the United States. When
smallpox vaccine was routinely given in the United States from 1967 to
1971, only one case of fetal vaccinia occurred among an estimated 90,000
to 280,000 pregnant women who received the vaccine. It is estimated that
5,700 to 17,000 of these pregnant women were receiving the vaccine for
the first time. Therefore, although the risk to the unborn baby is known
to exist, that risk is low and fetal vaccinia is very rare.
Are
babies born to pregnant women who have received smallpox vaccine at increased
risk for birth defects?
Smallpox
vaccine has not been shown to cause an increased risk of serious birth
defects.
Are
pregnant women who receive the smallpox vaccine more likely than other
pregnant women to have a miscarriage?
Smallpox
vaccine has not been clearly associated with an increased risk of miscarriage.
More research needs to be done to better answer this question.
Are
there any other special risks after birth for children who are born to
mothers who received smallpox vaccine during pregnancy?
Except
for the rare case of fetal vaccinia, smallpox vaccination of pregnant
women has not been linked with prematurity, low birth weight, or other
serious birth problems. Babies born without fetal vaccinia are not known
to have a greater risk of future medical problems.
Should
pregnant women who receive the smallpox vaccine undergo any special medical
tests?
There
is no known test that can reliably confirm before birth if a baby is infected
with vaccinia. Pregnant women who have received the smallpox vaccine should
receive regular prenatal care, and should discuss their smallpox vaccination
with their healthcare provider. There are tests that are being studied
in a research setting to confirm infection after birth, and these might
prove helpful in the future. These tests involve taking a sample of blood
from the umbilical cord after the baby is born and testing for the presence
of vaccinia virus or antibodies (substances that help fight off infection)
against the virus. Likewise, if a pregnancy ends in miscarriage or termination
the tissue from the fetus may be tested for the smallpox vaccine virus.
Is
smallpox vaccination or close contact with a recently vaccinated person
during pregnancy a reason to consider pregnancy termination?
There
have been less than 50 cases of fetal vaccinia ever reported in the world.
Because fetal vaccinia is so rare, smallpox vaccination during pregnancy
should not be a reason to consider termination of pregnancy.
Are
there special considerations at the time of delivery for women exposed
to smallpox vaccine during pregnancy?
Most
women who receive smallpox vaccine during pregnancy will deliver normal
babies, and standard delivery procedures should be followed. All pregnant
women who have received the smallpox vaccine during pregnancy should let
their healthcare provider and their baby’s healthcare provider know
about their vaccination.
Are
there special considerations for pregnant women who have a “robust”
reaction after smallpox vaccine?
Sometimes,
especially among first-time vaccinees, the smallpox vaccination reaction
is unusually large and painful. This is called a robust take. Robust takes
usually get better on their own in a few days, and only require rest and
observation. Pregnant women should not receive the smallpox vaccine. However,
if a pregnant woman is vaccinated, she should check with her healthcare
provider for further information if she has a robust take and before taking
any medication during pregnancy. There are no additional considerations
for pregnant women who have a robust reaction.
If
a pregnant woman who has received smallpox vaccine develops a serious
reaction what should she do?
Anyone
who thinks they are having a serious reaction to the smallpox vaccine
should either call the phone number provided on the “Post-Vaccination
and Follow-Up Information Sheet” given to them at the time of vaccination,
call their healthcare provider, or visit an emergency room.
Should
pregnant women who have received the smallpox vaccine receive Vaccinia
Immune Globulin (VIG)?
Vaccinia
Immune Globulin (VIG) is a treatment that can be used to help people who
have certain serious reactions to smallpox vaccine. VIG is made from the
blood of people who have gotten the smallpox vaccine more than once. It
contains substances (antibodies) that give protection from vaccinia infection.
Women should contact their healthcare provider regarding use of VIG. Currently,
CDC’s Advisory Committee on Immunization Practices does not recommend
preventive use of Vaccinia Immune Globulin (VIG) for pregnant women. However,
if a woman has another complication from smallpox vaccine that could be
treated with VIG, it is ok for her to receive it while she is pregnant.
If
a woman wants to get pregnant, how long does she need to wait after receiving
the smallpox vaccine?
A
woman should wait until the vaccine site has completely healed and the
scab has fallen off before trying to become pregnant after vaccination.
Generally, this means women who have received the smallpox vaccine should
wait at least four weeks (28 days) before becoming pregnant. Until that
time, effective measures should be taken to prevent pregnancy, such as
birth control pills, injections, implants, IUDs, or abstinence. Other
methods of birth control, such as condoms, diaphragms, spermicide, and
natural family planning are less effective.
If
a woman wants to get pregnant, how long does she need to wait if a close
contact has received the smallpox vaccine?
A
close contact includes anyone living in your household and anyone you
have close, physical contact with (such as a sex partner). A woman should
wait until the vaccine site in her close contact has completely healed
and the scab has fallen off before trying to become pregnant after vaccination.
Generally, this means a woman should wait at least four weeks (28 days)
after close contact with a vaccinated person before becoming pregnant.
Until that time, effective measures should be taken to prevent pregnancy,
such as birth control pills, injections, implants, IUDs, or abstinence.
Other methods of birth control, such as condoms, diaphragms, spermicide,
and natural family planning are less effective.
Should
a woman of child-bearing age get a pregnancy test before receiving a smallpox
vaccine?
Any
woman who thinks she could be pregnant should perform a pregnancy test,
by using her first morning urine, on the day vaccination is scheduled.
However, even the most sensitive tests may not be able to detect early
pregnancies (those less than two weeks along). Thus, if a woman thinks
she might be pregnant, she should not get the smallpox vaccine.
If
the pregnancy test is negative can a woman still be pregnant?
Yes.
A urine pregnancy test may not be able to detect a very early pregnancy.
In addition, sometimes a test performed on dilute (watered-down) urine
may not be able to detect a pregnancy.
At
what time of the month is a woman least likely to be pregnant?
A
woman is least likely to be pregnant during the early days of her menstrual
period.
What
is being done to learn more about how to prevent pregnant women from being
exposed to smallpox vaccine and what happens to their babies if pregnant
women are exposed?
CDC,
together with state health departments and the Food
and Drug Administration, is conducting a public health response to
learn how some women received the smallpox vaccine while they were pregnant
or just before they became pregnant. This is being done in order to help
prevent pregnant women from being exposed to smallpox vaccine in the future.
CDC has also established the National Smallpox Vaccine in Pregnancy Registry.
This registry will follow women during their pregnancies and their babies,
after they are born, to better understand what happens to pregnant women
and their babies who have been exposed to smallpox vaccine.
How
do I sign up for the Registry if I have received the smallpox vaccine?
Pregnant
women who have received the smallpox vaccine, or pregnant women whose
close contacts have received the smallpox vaccine, may contact their healthcare
provider or their state health department for help in enrolling in the
registry. Health-care providers
and staff from state health departments are encouraged to report all
exposed pregnant women to the registry by calling 404-639-8253.
If
there were ever a case of smallpox, would pregnant women be vaccinated?
If
there is a smallpox outbreak, recommendations on who should get vaccinated
will change. Anyone who is exposed to smallpox should get vaccinated,
because they will be at greater risk from the disease than they are from
the vaccine. Public health authorities will recommend who should be vaccinated
at that time and what measures people can take to protect themselves from
smallpox.
Is
smallpox vaccine safe for women who are breastfeeding?
Women
who are breastfeeding should not get the vaccine. This advice is
true even if women are pumping and then bottle-feeding breast milk.
It is unknown whether the vaccine virus or antibodies pass on to
the baby through breast milk.
Is
it safe for women who received smallpox vaccine during pregnancy
to breastfeed their babies?
Pregnant women should not receive the smallpox vaccine unless they have been exposed to smallpox. If a pregnant woman is vaccinated or if a woman becomes pregnant after vaccination, breastfeeding should not take place until the vaccination scab has separated from the vaccination site.
If
a woman who is breastfeeding receives the smallpox vaccine should
she stop nursing?
Yes.
Breastfeeding should not take place until the vaccination scab
has separated from the vaccination site. A woman who desires to
maintain her milk supply may continue to pump breast milk, but
the milk should be discarded until her scab fully separates.
Is
it safe for a woman to breastfeed her baby if a close contact received
the smallpox vaccine?
Yes.
However, anyone who receives the smallpox vaccine should remember
to wash their hands with soap and warm water after direct contact
with the vaccination site, or anything that has touched the vaccination
site (bandages, clothing, towels, bedding, etc.). This is will
help prevent the spread of vaccinia virus to contacts, including
young babies.
If
a breastfeeding mother who has close contact with a recently vaccinated
person develops a rash, should she stop nursing?
If
a breastfeeding mother who has had close contact with a person
recently vaccinated against smallpox develops a rash, she should
check with her healthcare provider to determine if the rash is
related to the smallpox vaccine. If she has a vaccine-related rash,
breastfeeding should not take place until all scabs from the rash
have fallen off. A woman who desires to maintain her milk supply
may continue to pump breast milk, but the milk should be discarded
until her scabs fully separate.
If
there were ever a case of smallpox, would breastfeeding women be
vaccinated?
If
there is a smallpox outbreak, recommendations on who should get
vaccinated will change. Anyone who is exposed to smallpox should
get vaccinated, because they will be at greater risk from the disease
than they are from the vaccine. Public health authorities will
recommend who should be vaccinated at that time and what measures
people can take to protect themselves from smallpox.
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