<\/p>\n
Case #4:<\/span><\/span><\/p>\n \u00a0<\/span><\/p>\n \u00a0<\/span><\/p>\n A 25-year old woman comes to \u00a0<\/span><\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>\u00a0\u00a0\u00a0 <\/span><\/span>What immunizations would you \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>What \u00a0<\/span><\/em><\/strong><\/p>\n It \u00a0<\/span><\/p>\n This woman is planning a trip to India, an endemic area \u00a0<\/p>\n
\nyour office for a routine visit, and advice concerning immunization before her
\nsummer trip to India.<\/span><\/p>\n
\noffer this patient?\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>\u00a0<\/span><\/span><\/em><\/strong><\/p>\n
\nconcerns would you have regarding immunizations and her reproductive history?<\/p>\n
\nwould be important to document first that she was up-to-date on her scheduled
\npediatric immunizations.\u00a0 <\/span>It would also
\nbe essential to ask about her last menstrual history and possibility of
\npregnancy.\u00a0 <\/span>Obviously, any unnecessary
\nmedications or procedures should be avoided, when possible, in pregnancy.\u00a0 <\/span>However, most risks associated with vaccines
\nare largely theoretical, and one must look at potential benefit versus risk on
\nan individual basis.\u00a0 <\/span>This is especially
\nthe case when the exposure to infection is likely, the infection is
\nparticularly dangerous to the mother or fetus, and the necessary vaccine is
\nunlikely to cause harm.\u00a0 <\/span>Furthermore,
\nnewer information continues to confirm the safety of vaccines given
\ninadvertently during pregnancy.\u00a0 <\/span>In any
\nwoman of reproductive age who is not pregnant, or likely to become pregnant in
\nthe next 3 months, it would be worthwhile to document titers to rubella, and if
\ntiters were negative, to offer the MMR vaccine.\u00a0 <\/span>One could also screen for chickenpox as a child, and if the
\npatient could not remember having the childhood illness, checking titers and
\nimmunizing against varicella as well.
\n<\/span>This would offer protection against future perinatal exposure of the
\ninfant, as well as prevent the severe illness that usually characterizes
\nvaricella during pregnancy.\u00a0 <\/span>In certain
\nhigh risk populations one could consider offering Hepatitis B vaccine as well.<\/span><\/p>\n
\nfor Hepatitis A.\u00a0 <\/span>She should be offered
\nthe Hep A vaccination.\u00a0 <\/span>The first dose
\nshould be given at least 4 weeks prior to departure, and a second dose offered
\n6-12 months later in persons requiring long-term protection.\u00a0 <\/span>It is unclear whether there is any value in
\nadministering Hep A vaccination in postexposure cases of people who have been
\nin contact with patients with Hep A, but it should replace the use of
\nimmunoglobulin to prevent Hep A.\u00a0 <\/span>Safety
\nduring pregnancy has not been established, so benefits must outweigh the
\nrisks.\u00a0 <\/span>Breastfeeding is not a
\ncontraindication to the use of this vaccine For all questions about which
\nvaccines and prophylaxis are recommended for travel to different regions of the
\nworld, visit the very helpful CDC website \u00a0<\/span>http:\/\/www.cdc.gov\/travel\/<\/a>
\n.<\/p>\n