Pregnancy planning. Part II. Where to begin?

In Russia, there is a high sensitivity to rubella, these are the genetic characteristics of the ethnic composition of the country's population. It is important to vaccinate both women planning future pregnancies and the general population to reduce the prevalence of infection. Answering the question: “Should we be vaccinated against rubella?”, we also answer the question about eradicating this disease in the same way that humanity got rid of smallpox.

WHO uses 3 immunization strategies:

• immunization of girls 13-15 years old and women planning pregnancy in the future - exclusion of CRS;
• elimination of the virus in 10-20 years - administration of two doses (children at 12 months and adolescents at 13-15 years) and maximum vaccination coverage of various age groups of adults;
• elimination of the virus in 20-30 years - vaccinating only children and adolescents.

The rubella vaccine is included in the vaccination schedule as a vaccine against widespread infections that affect the entire population. The NEARMEDIC clinic performs rubella vaccinations in compliance with WHO recommendations and according to the national calendar.

Indications

The incubation period for rubella disease lasts 24 days. Infection is possible both 7 days before the rash appears and a week after recovery from the disease. This indicates a high risk of mass infection of the population. In addition, if there is an unvaccinated adult in the house, then there is a high probability of infection and serious consequences.

Rubella is an easily spread disease; in order to prevent the development of an epidemic chain reaction, the following are subject to vaccination:

• one-year-old children;
• women of childbearing age who have not been vaccinated and have not had this viral infection;
• men of childbearing age;
• all people who did not receive a vaccine as a child. This is especially true for students, medical staff, and frequent travelers.

If a woman is planning a pregnancy, it is better to get tested for antibodies to the virus in advance. If you do not have immunity to the disease, you should definitely get vaccinated. Since a pregnant woman who catches the infection can pass it on to her child. This can lead to serious consequences in the development of the fetus, especially its organs of hearing, vision and cardiovascular system. In general, the outcome of the consequences depends on the duration of pregnancy.

Complexes with this research

TORCH infections.
Avidity of IgG antibodies Diagnosis of TORCH infections with determination of avidity of IgG antibodies 5,920 R Composition Entry into IVF Examination when a woman enters the IVF procedure 23,020 R Composition

Non-child immunity Diagnosis of rubella, measles, chickenpox and mumps viruses RUR 2,950 Composition

IN OTHER COMPLEXES

• Immunity strength 2 140 R
• IVF planning RUB 12,990
• Examination during pregnancy. 1st trimester 16,690 RUR
• Miscarriage RUB 40,070
• Pregnancy planning. Diagnosis of infections RUB 8,620

Contraindications

There are a number of cases in which the vaccine is contraindicated:

• allergy to substances included in the vaccine; presence of an immunodeficiency state;
• pregnancy;
• period of breastfeeding;
• infectious disease, vaccination is postponed until recovery;
• immunosuppressive conditions due to taking corticosteroids, chemotherapy;
• if you have had a blood transfusion within the last few months;
• postoperative recovery.

Why can't you get pregnant after vaccination?

You cannot become pregnant immediately after vaccination.
This is explained by the fact that during the post-vaccination period, the protective forces weaken: immune cells are actively engaged in recognizing and destroying the introduced virus. With this condition, a woman becomes susceptible to various diseases that can negatively affect the development of the fetus.

To protect against rubella infection, medications containing a live attenuated pathogen are used. A weakened virus can cross the placental barrier and negatively affect the embryo . The probability of fetal infection is 3%.

Another reason why you cannot get pregnant immediately after vaccination is the possibility of improper formation of specific immunity due to the increased load on the body. Therefore, it is recommended to use contraceptives for some time after rubella prevention.

Does a child need vaccinations?

Although rubella is not a fatal disease, there are factors that confirm the need to vaccinate your child. These include:

1. If a child is not vaccinated before the age of six, there is a chance that he may develop progressive rubella panencephalitis. The outcome of this disease is fatal.
2. In the case of a three-component vaccine, the child will receive protection not only from rubella, but also from measles and mumps, and therefore will not become infected with them, and will not suffer possible complications from diseases.
3. Rubella causes serious complications if infected in adulthood. In order to prevent this, it is better to get vaccinated in childhood.

Should you get vaccinated or not: pros and cons

Women have different attitudes towards vaccinations. Some consider vaccination to be the only right decision to protect themselves and their unborn child from fatal pathologies. Others are wary of getting immunized because of the potential for side effects and complications.

Doctors insist on preventing rubella before pregnancy. To understand whether it is worth getting vaccinated, you need to consider and weigh all the pros and cons.

Arguments in favor of rubella vaccination before conception:

• vaccination forms stable and long-lasting immunity;
• The rubella virus is easily transmitted and can cause fetal death and the birth of a child with defects. More than 50% of children are born with health conditions incompatible with life. prevention allows you to minimize disastrous consequences;
• vaccine effectiveness reaches 100%;
• immunization is well tolerated by most women;
• availability of a choice of vaccines;
• availability of prevention;
• Under 25 years of age you can get vaccinated for free.

Arguments against immunization:

• the need to renew protective forces through revaccination;
• slow antibody production;
• the presence of a number of contraindications;
• after vaccination you cannot become pregnant for three months;
• there is a possibility of complications developing.

There are more arguments for vaccination against rubella in preparation for pregnancy, and they are more significant. Thanks to prevention, it was possible to minimize the incidence of disease. Today, cases of rubella pathology are rare.

Recommendations for immunization should be made by the doctor individually in each specific case, based on the vaccination history, examination results, characteristics of the body and the patient’s health status.

Before you start planning for a baby, experts recommend taking a test for the concentration of antibodies in the blood.

Rules

For vaccination to be effective, you need to adhere to certain rules and vaccination techniques:

• Vaccination must be administered by a qualified nurse;
• Before the procedure, the child must be examined by a pediatrician. If it does not reveal any contraindications, the child is allowed to undergo vaccination after drawing up an examination protocol;
• the procedure is carried out using a sterile syringe with a special needle suitable for subcutaneous injections;
• According to the instructions, the ampoule with the vaccine should be opened only before starting the injection. It is contraindicated to draw the drug into a syringe in advance;
• treat the ampoule with an antiseptic solution before opening;
• Before the vaccine is administered, the skin is treated with an antiseptic; after administration, the injection site is also treated;
• The vaccine is given subcutaneously or intramuscularly. One-year-old children are vaccinated in the thigh, and starting from the age of six - in the shoulder or under the shoulder blade;
• the injection is not administered into the buttocks, because there is a lot of subcutaneous tissue there, and this can lead to the formation of compactions, which will reduce the effectiveness of immunization.

According to the plan and scheme of the National Vaccination Calendar, the vaccine must be given twice. Since after the first immunization the body does not yet provide complete protection against infection.

Hepatitis A

The safety of hepatitis A vaccination during pregnancy has not been studied; however, since the hepatitis A vaccine is based on inactivated hepatitis A virus, the possibility of infection is theoretically very small. The risk associated with vaccination must be weighed against the possible risk of developing hepatitis A in a pregnant woman, especially if the risk of exposure to infection is high [18 ].

Literature:

1. Munoz FM, Englund JA, Infect. Dis. Clin. North Amor. 2001: 15(1): 253-271.
2. Silvers MJ. Steploe MM. Prim. Care Clin. Off. Pracl. 2001:28: 1-9.
3. AnmncanCollegeotObntotnciansandGynecoiogisls, Committee on Obstetric Practice. Immunization during pregnancy. ACOG Com Opin. 2003; 282.
4. Centers for Disease Control arxl Prevention. General recommendations on immunization, recommendations of tl»e Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) MMWR Morb. Mortal. Wkly Rep. 2002; 51 (RR02): 1-36.
5. Centers for Disease Control and Prevention. Guidelines for vaccinating pregnant women. 2004. Available at: https://www.in.gov/iHdh/programs/immunization/lmmunzationSchedGuldelines%20for%20Vaccinating%20Pregnant%20Women.pdf. Accessed January 25.2008.
6. American Academy of Pediatrics: Poliowus infections. In Pickering LK (ed): 2000 Red Book Report of the Committee on Infectious Diseases, ed 25. Elk Grove Village. IL. American Academy of Pediatrics. 2000. pp. 465 470.
7. DaSilva MM, Prom KA. Johnson FA. et at. JAMA 1958:1681 -1685-
8. Linder N. Hands!ler R. Fruman O. et al Pedi.itr Infect. Ois J. 1994; 13:959-962
9. Naleway AL. Smith WJ, Mullooly JP. Epidemiol Rev. 2006; 28: 47-53.
10. Centers for Disease Control and Prevention Connecticut. 1994-1995 and United States. 1979-1994. MMWR Morb Mortal. Wkly Rep. 1996: 45: 584 -587.
11. Estaban R. Vaccine 1995; 13(suppl 1): S35 - S36.
12. Silveira CM. Caceres VM, Dutra MG. Lopes-Camelo J. CastMla EE Bulletin WHO. 1995:73.605-608
13. AmencanColk*geofKtetriciansandGynecologists. ACOG N(ws Release November 29, 2002.
14. HacktoyBKJ Nurse Midwifery 1999.44:106-117. 15- Centers for Disease Control and Prevention. MMWR Morb. Modal. Wkly Rep. 1996: 45 (RR* 11): 1-25.
15. Pastuszak AL. Levy M. Schick In el al N. Engl. J Med 1994; 330: 901 905
16. Englund. J. et al. Path 2007: 137: S16 - S19 18 COC. MMWR 2006: 55 (No. RR-7): 15
17. CDC. MMWR 2006; 55 (No. RR-7): 15.

Table 1. ACIP recommendations regarding immunization during pregnancy or lactation

Possible side effects

Vaccination against rubella in children is easily tolerated without complications if the correct procedure is followed. However, within 6-12 days after vaccination, an increase in temperature to 39.5 degrees may be observed. There is no need to worry if this condition lasts no more than two days. High fever may also be accompanied by chills and muscle pain.

Vaccination may cause rashes. But this is a fairly common reaction of the child’s body to vaccination. The rash appears as red spots that cover the face, body and limbs. They do not pose any health hazard and disappear on their own without a trace.

Although most often the vaccination takes place without any side complications, they are still possible in the form of the following symptoms:

1. Enlarged lymph nodes.
2. The appearance of a lump at the injection site. Redness and swelling may also occur. Such manifestations may last a couple of weeks, this is not a cause for concern.
3. If boys are vaccinated with a combined vaccine (the so-called three-component vaccine against three infections), the boy’s testicles may be painful and swollen. This also does not entail any serious consequences.
4. Reactions such as cough, runny nose, redness of the throat and other short-term symptoms are also considered normal.

An adult body tolerates vaccination much more difficult.

Chicken pox

Infection of a pregnant woman can lead to the development of congenital chickenpox syndrome in the fetus, characterized by limb atrophy, strictures, microcephaly, cortical atrophy, and chorioretinitis. cataracts and other defects [15]. Compared to the first trimester, the risk of developing congenital varicella syndrome is slightly higher in the period from 13 to 20 weeks. pregnancy [16]. The effect of the vaccine on the fetus has not been proven. The risk of developing congenital varicella syndrome after infection with wild type virus is 0.4-2.0%; When using an attenuated vaccine, the risk of developing congenital varicella syndrome should theoretically be lower or completely absent [16].

How to reduce the likelihood of complications

In order to avoid consequences after vaccination, you should familiarize yourself with the following recommendations:

• If you have any allergic reactions, you should take antihistamines 2-3 days before vaccination. This is a way to reduce the risk of developing infection;
• It is not recommended to eat a lot before vaccination;
• exclude the use of vitamin D 3-4 days before vaccination. You can resume after 5-6 days.

Once the injection has been administered, the person should not immediately leave the medical facility. If the patient suddenly becomes ill and symptoms of adverse reactions appear, it will be better if medical assistance is provided as quickly as possible.

If a person does not have a fever after vaccination, then walking is not contraindicated for him. But it is better not to visit crowded places for several days.

Hepatitis B

Compared with adults, newborns and infants infected with hepatitis B virus have a greater risk of developing severe liver damage and even death or chronic liver damage.

The hepatitis B vaccine includes hepatitis B surface antigen (HbsAg) particles. which are unable to cause infection. CDC believes that its use cannot cause harm to the fetus [10]. In contrast, almost 90% of children born to mothers infected with hepatitis B virus in the last trimester developed chronic hepatitis if they were not vaccinated at the time of birth [11].

Which drug should I choose?

Many vaccines are registered for immunization against rubella. Children aged one to one and a half years, and then at the age of 6, are usually given combined vaccines (measles-rubella-mumps) "Priorix" (Belgian) and "MMR II" (American). Those girls who have not been immunized are vaccinated at the age of 10-13 years with a vaccine directly against rubella.

The rubella vaccine before pregnancy can also be single-component. But you can also get the trivalent vaccine if you need immunity against other infections, such as measles. Among the single-component anti-rubella vaccines, it should be noted: the French “Rudivax”, the English “Ervevax”, as well as the Russian vaccine against rubella.

Preference is given to foreign drugs, which are considered more purified and therefore cause almost no side effects. Women are vaccinated subcutaneously in the shoulder. Those aged 18-25 still have the opportunity to get immunized for free. You will have to buy the vaccine yourself. Vaccination is indicated throughout the entire childbearing period once every 10 years.