Yellow fever vaccine Pregnancy and Breastfeeding Warnings
Yellow fever vaccine is also known as: YF-Vax
Yellow fever vaccine Pregnancy Warnings
In a study of 101 women vaccinated with the 17D-204 strain, most of whom were in the third trimester, the seroconversion rate was 38.6% compared to 81.5% for nonpregnant controls. No adverse events were reported in infants in this study and another study. No birth defects were reported by the Collaborative Perinatal Project in 3 mother-child pairs who were exposed to yellow fever vaccine during the first trimester. A report from the European Network of Teratology Information Systems concluded that there was not an association between adverse outcomes and vaccination, although the data sample was small. The rate of major malformations and abortions occurring after first trimester exposure was within expected ranges. One of 41 infants whose mothers were vaccinated during the first trimester tested positive for IgM antibodies in cord blood. No adverse sequelae were reported.
Yellow fever vaccine has been assigned to pregnancy category C by the FDA. Animal studies have not been reported. There are no large-scale controlled safety studies; however, congenital abnormalities have not been reported. The seroconversion rate to vaccines is significantly lower in pregnant women. Serologic testing should be considered to document an immune response. There is a concern that transplacental passage of the virus may occur. The theoretical risks of immunization may be outweighed by the risk of infection and complications to the mother and fetus if the mother is travelling to an area where there is a high risk of acquiring yellow fever infection. Nonimmune women should generally postpone vaccination and travel to endemic/epidemic areas during pregnancy. If travel and/or exposure is unavoidable, vaccination is preferable after the first trimester. Infants of vaccinees should be monitored for congenital infection and other possible adverse effects. Yellow fever vaccine should be given to a pregnant woman only if clearly needed. The U.S. Centers for Disease Control and Prevention (CDC) recommend postponing travel and yellow fever vaccination until 9 months after delivery. If a pregnant woman is traveling to or transiting through areas where a vaccination certificate is required but the disease is not currently a threat, the CDC advise carrying a physician's waiver along with documentation of the waiver on the immunization record.
Yellow fever vaccine Breastfeeding Warnings
There are no data on the excretion of yellow fever vaccine into human milk. There have been no reports of viral transmission to, or adverse events in nursing infants. However, there is a theoretical risk of transmission of the 17D virus to breast-feeding infants, which could result in encephalitis. The manufacturer states that nursing mothers may be vaccinated if travel to high-risk areas cannot be avoided or postponed. The U.S. Centers for Disease Control and Prevention (CDC) consider the administration of live virus vaccines compatible with breast-feeding. However, it should be remembered that neonates are too young to be vaccinated and will not be protected against infection.
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