Which Vaccines Should Pregnant Women Avoid?

The following vaccines can potentially be transmitted to the unborn child and may result in miscarriage, premature birth or birth defects.

• Hepatitis A: The safety of this vaccine hasn't been determined, so it should be avoided during pregnancy. Women at high risk for exposure to this virus should discuss the risks and benefits with their doctors.
• Measles, Mumps, Rubella (MMR): Women should wait at least one month to become pregnant after receiving these live-virus vaccines. If the initial rubella test shows that you are not immune to rubella, then you will be given the vaccine after delivery.
• Varicella: This vaccine, used to prevent chicken pox, should be given at least one month before pregnancy.
• Pneumococcal: Because the safety of this vaccine is unknown, it should be avoided in pregnancy, except for women who are at high risk or have a chronic illness.
• Oral Polio Vaccine (OPV) and Inactivated Polio Vaccine (IPV): Neither the live-virus (OPV) nor the inactivated-virus (IPV) version of this vaccine is recommended for pregnant women.
• HPV Vaccine: To prevent the human papillomavirus virus (HPV).

What Side Effects Can I Expect After a Vaccination?

Side effects may occur up to three weeks after vaccination. If you experience any severe side effects, be sure to tell your doctor.

• Hepatitis A: Soreness and redness at injection site, headache, fatigue, severe allergic reaction in very rare cases
• Hepatitis B: Soreness at injection site, fever
• Influenza: Redness and swelling at injection site that can last up to two days, fever
• Tetanus/Diphtheria: Low-grade fever, soreness and swelling at injection site
• Measles, Mumps, Rubella (MMR): Non-contagious rash, swelling of neck glands and cheeks, pain and stiffness of joints one to two weeks after vaccination
• Varicella: Fever, soreness or redness at injection site, rash or small bumps up to three weeks after vaccination
• Pneumococcal: Fever, soreness at injection site
• Oral Polio Vaccine (OPV): None
• Inactivated Polio Vaccine (IPV): Redness, discomfort at injection site

Is It Safe to Get Vaccinations During Pregnancy?

Why Should Pregnant Women Be Vaccinated?

Many women may not realize that they are not up-to-date on their immunizations and are susceptible to diseases that can harm them or their unborn child. Pregnant women should talk to their doctors to figure out which vaccines they may need and whether they should get them during pregnancy or wait until after their child is born.

Are Vaccines Safe?

All vaccines are tested for safety under the supervision of the FDA. The vaccines are checked for purity, potency and safety, and the FDA and CDC monitor the safety of each vaccine for as long as it is in use.

Some people may be allergic to an ingredient in a vaccine, such as eggs in the influenza vaccine, and should not receive the vaccine until they have talked to their doctor.

Which Vaccines Can I Receive While I'm Pregnant?

The following vaccines are considered safe to give to women who may be at risk of infection:

• Hepatitis B: Pregnant women who are at high risk for this disease and have tested negative for the virus can receive this vaccine. It is used to protect the mother and baby against infection both before and after delivery. A series of three doses is required to have immunity. The 2nd and 3rd doses are given 1 and 6 months after the first dose.
• Influenza (Inactivated): This vaccine can prevent serious illness in the mother during pregnancy. All women who will be pregnant (any trimester) during the flu season should be offered this vaccine. Talk to your doctor to see if this applies to you.
• Tetanus/Diphtheria/Pertussis (Tdap): Tdap is recommended during pregnancy, preferably between 27 and 36 weeks’ gestation, to protect baby fromwhooping cough. If not administered during pregnancy, Tdap should be administered immediately after the birth of your baby.

Can a Vaccine Harm My Unborn Baby?

A number of vaccines, especially live-virus vaccines, should not be given to pregnant women, because they may be harmful to the baby. (A live-virus vaccine is made using the live strains of a virus.) Some vaccines can be given to the mother in the second or third trimester of pregnancy, while others should only be administered either at least three months before or immediately after the baby is born.

Hepatitis A (HAV)

Hepatitis A is the most common of the two enterically (relating to, or being within the intestine) transmitted hepatitis viruses (hepatitis A virus and hepatitis E virus) in the U.S. and is one of the two vaccine-preventable hepatitis infections (hepatitis A and B). In children the infection is usually mild and without symptoms. However, in adults the severity generally increases with increasing age. Nonetheless, full recovery is expected in about 99% of all infections. HAV infection usually resolves on its own over several weeks, but occasionally relapses occur. Hepatitis A does not lead to chronic hepatitis.

Hepatitis A is spread primarily through person-to-person contact, or via food or water contaminated by feces from an infected person. In rare cases, it can be spread through contact with infected blood. Basic precautions like washing hands with soap and water following bowel movements and before food preparation can reduce the incidence. Hepatitis A is prevented through vaccination. The Centers for Disease Control and Prevention (CDC) recommend hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Following the initial dose, a booster dose is given 6-12 months later. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus but vaccination is preferred since it provides long-term immunity lasting at least 20 years.

If you are traveling to any countries with poor sanitary conditions then you should get vaccinated at least one month before departure. You should also avoid tap water when traveling internationally and practice good hygiene and sanitation. People who should be vaccinated against hepatitis A include:

• Travelers (tourists, business, missionaries, military, peace-keepers)
• Users of illegal injected drugs
• Native peoples of America
• Restaurant workers and food handlers
• Children living in communities that have high rates of hepatitis
• Children and workers in day care centers
• People engaging in anal/oral sex or with STDs or HIV
• People with chronic liver disease
• If you eat raw shellfish frequently, ask your physician about being vaccinated.
• Laboratory workers who handle live hepatitis A virus.

About hepatitis

Online Q&A
Reviewed July 2016

Q: What is hepatitis?

A: Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Q: What are the different hepatitis viruses?

A: Scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.

Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.

Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Types

Each type has different characteristics and is transmitted in different ways, but symptoms tend to be similar.

The three  main types of hepatitis are known as hepatitis A, B, and C. Each is caused by a different virus. All three types can be acute, lasting for 6 months or less, and types B and C can be chronic, lasting for longer.

Hepatitis A

In the United States (U.S.), 1,390 cases of hepatitis A were reported in 2015.

It is often mild, and most people make a full recovery, after which they are immune and therefore protected from the virus in the future. However, if it progresses, symptoms can be severe or life-threatening.

People in parts of the world with poor sanitation are particularly at risk of contracting HAV.

There are safe and effective vaccines that protect against this virus.

Causes, symptoms, and treatment of hepatitis A

Find out more details about Hepatitis A

READ NOW

Hepatitis B

Hepatitis B can be transmitted when a person:

• has unprotected sexual intercourse with an infected person
• shares a needle with an infected person, often for illegal drug or steroid use
• has a tattoo created with unsterilized needles
• is accidentally pricked, for example, health workers dealing with sharp objects
• shares personal items, such as a toothbrush or razor, with an infected person
• is bitten by someone who is infected

An infected mother can pass the virus on to her infant when breast-feeding.

The liver of a person infected with hepatitis B swells. Severe damage can result.

HBV infection can become chronic. This can lead to complications, including scarring of the liver, or cirrhosis. It can also cause a type of cancer known as hepatocellular carcinoma.

In 2015, 887,000 deaths worldwide were linked to HBV, mostly as a result of complications such as these.

In the U.S., there were 3,370 reported cases of HBV, but the Centers for Disease Control and Prevention (CDC) estimate that the real figure may be around 21,900.

There is not currently a cure for HBV. However, the incidence rate has dropped in countries where the vaccine is available, and this vaccine is 95 percent effective against the infection.

There is a safe and effective vaccine that can protect against HBV.

Everything you need to know about hepatitis B

Find out more about Hepatitis B

READ NOW

Hepatitis C

HCV can lead to liver damage and swelling. Around 1 in 4 people with HCV get cirrhosis, and this can lead to liver cancer.

Donated blood is now tested for HCV, but people who received organ transplants or blood donations before testing became part of the donation process may be at risk.

Other at-risk groups include healthcare workers who are exposed to sharps, users of intravenous drugs, and infants born to mothers with HCV.

The number of cases of HCV in the U.S. rose nearly threefold between 2010 and 2015 when 2,436 cases were reported. However, the CDC estimate that 33,900 infections occurred in 2015, including those not reported.

What's to know about viral hepatitis?

Hepatitis refers to an inflammation of the liver cells and damage to the liver. There are different types and causes, but the symptoms can be similar.

The liver's functions include detoxifying the blood, storing vitamins, and producing hormones. Hepatitis can disrupt these processes and create severe health problems throughout the body.

At least five viruses can cause hepatitis. The three most common are hepatitis viruses A, B and C. Infection with any of these three can be fatal.

Other types of hepatitis can result from overconsumption of alcohol or an autoimmune condition. This article will look at hepatitis A, B, and C. These are forms of hepatitis transmitted by a virus.

In the United States, the incidence of hepatitis A has been falling for the last 20 years, but acute hepatitis C has seen an increase of 44 percent between 2011 and 2012.

Complications of hepatitis

Chronic hepatitis B or C can often lead to more serious health problems. Because the virus affects the liver, people with chronic hepatitis B or C are at risk for:

• chronic liver disease
• cirrhosis
• liver cancer

When your liver stops functioning normally, liver failure can occur. Complications of liver failure include:

• bleeding disorders
• a buildup of fluid in your abdomen, known as ascites
• increased blood pressure in portal veins that enter your liver, known as portal hypertension
• kidney failure
• hepatic encephalopathy, which can involve fatigue, memory loss, and diminished mental abilities due to the buildup of toxins, like ammonia, that affect brain function
• hepatocellular carcinoma, which is a form of liver cancer
• death

People with chronic hepatitis B and C are encouraged to avoid alcohol because it can accelerate liver disease and failure. Certain supplements and medications can also affect liver function. If you have chronic hepatitis B or C, check with your doctor before taking any new medications.

Tips to prevent hepatitis

Hygiene

Practicing good hygiene is one key way to avoid contracting hepatitis A and E. If you’re traveling to a developing country, you should avoid:

• local water
• ice
• raw or undercooked shellfish and oysters
• raw fruit and vegetables

Hepatitis B, C, and D contracted through contaminated blood can be prevented by:

• not sharing drug needles
• not sharing razors
• not using someone else’s toothbrush
• not touching spilled blood

Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms and dental dams can help decrease the risk of infection. You can find many options available for purchase online.

Vaccines

The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. Experts are currently developing vaccines against hepatitis C. A vaccination for hepatitis E exists in China, but it isn’t available in the United States.

How hepatitis is treated

Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.

Hepatitis A

Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.

The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine.

Hepatitis B

Acute hepatitis B doesn’t require specific treatment.

Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.

Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis C

Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.

People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

Currently, there is no vaccination for hepatitis C.

Hepatitis D

No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people.

Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop.

Hepatitis E

Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.

Autoimmune hepatitis

Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition.

Azothioprine (Imuran), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids.

Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.

How hepatitis is diagnosed

History and physical exam

To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.

During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.

Liver function tests

Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.

Other blood tests

If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions like autoimmune hepatitis.

Ultrasound

An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close at your liver and nearby organs. It can reveal:

• fluid in your abdomen
• liver damage or enlargement
• liver tumors
• abnormalities of your gallbladder

Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.

Liver biopsy

A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.

This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.

Common symptoms of hepatitis

If you have infectious forms of hepatitis that are chronic, like hepatitis B and C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function.

Signs and symptoms of acute hepatitis appear quickly. They include:

• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

Causes of noninfectious hepatitis

Alcohol and other toxins

Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes referred to as alcoholic hepatitis. The alcohol directly injures the cells of your liver. Over time, it can cause permanent damage and lead to liver failure and cirrhosis, a thickening and scarring of the liver.

Other toxic causes of hepatitis include overuse or overdose of medications and exposure to poisons.

Autoimmune system response

In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes ongoing inflammation that can range from mild to severe, often hindering liver function. It’s three times more common in women than in men.