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. 2021 Apr 16;118(15):262–268. doi: 10.3238/arztebl.m2021.0020

Table 2. Vaccination recommendations for women with regard to vaccination-preventable diseases with impact on pregnancy-associated health of the mother and/or child*.

Vaccination-preventable disease Cause of the pregnancy-associated risk for the mother and/or child Disease in pregnant women Risk to the unborn child Risk to the young infant Vaccine type STIKO vaccination recommendation for pregnant women
Influenza Pregnancy-induced changes in immune response and cardiopulmonary adaption; lack of passive immunity Pneumonia with severe course in pregnancy (especially in the second and third trimester), increased risk of hospitalization, need of intensive care treatment, death Abortions, preterm births and stillbirths Increased complication, hospitalization and mortality rates among infants aged <6 months Inactivated split virus vaccines or subunit vaccines Vaccination with a quadrivalent IIV with current, WHO-recommended antigen combination for all pregnant women from second trimester, in case of increased health risk due to an underlying disease from first trimester
Pertussis Missing or low passive immunity in infants Not influenced by pregnancy Dependent on the severity of the maternal disease Increased risk of serious complications, hospitalization, death in newborns and infants aged < 6 months Inactivated combination vaccine (Tdap, Tdap-IPV) Vaccination in each pregnancy between WG 28 and 32; if increased risk of preterm delivery, in the second trimester
Measles First infection in pregnancy; lack of passive immunity Potentially increased complication rate in pregnancy (pneumonia, hepatitis, encephalitis; anecdotal case reports) Potentially increased risk of abortions and preterm births (anecdotal case reports) Neonatal measles, increased risk of complications and SSPE (especially with early postnatal disease) Live attenuated vaccine (MMR) Contraindicated in pregnancy
Rubella Vertical transplacental transmission Not influenced by pregnancy Spontaneous abortion, preterm birth, stillbirth Congenital rubella syndrome (malformations), developmental disorders, late sequelae Live attenuated vaccine (MMR) Contraindicated in pregnancy
Varicella First infection in pregnancy; vertical transplacental transmission Complicated by varicella pneumonia, severe course in pregnancy (anecdotal case reports) Spontaneous abortion, stillbirth (anecdotal case reports) Congenital varicella syndrome/embryofetopathy with skin changes, neurological, ocular and skeletal anomalies, as well as other malformations; neonatal varicella with severe course and high mortality in case of peripartum infection Live attenuated vaccine Contraindicated in pregnancy

* Adapted from (2, 10, 40)

IIV, inactivated influenza vaccine; IPV, inactivated polio vaccine; MMR, measles-mumps-rubella; SSPE, subacute sclerosing panencephalitis, WG, weeks’ gestation; STIKO, Standing Committee on Vaccination; WHO, World Health Organization