USE OF TETANUS/DIPHTHERIA/POLIO VACCINES IN PREGNANCY

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(Date of issue: October 2016, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on tetanus vaccine use in pregnancy is available at www.medicinesinpregnancy.org.

Summary

In the UK the Td-IPV vaccine Revaxis® is indicated for use in individuals over 10 years of age who require vaccination against tetanus, diphtheria and/or polio. Monovalent vaccines for these conditions are not available in the UK. 

There are currently no published studies specifically regarding use of Td-IPV vaccines, such as Revaxis® in pregnancy. Tetanus/diphtheria/pertussis/polio (Tdap-IPV) vaccines have however been widely used in the UK maternal pertussis vaccination programme. Data from over 6,600 Tdap-IPV-exposed pregnancies do not suggest increased risk to the fetus of stillbirth, low birth weight/intrauterine growth restriction, or reduced gestational length. There are insufficient first trimester exposure data to permit an evidence-based assessment of the risk of congenital malformations.

UK guidelines state that tetanus-containing vaccines can be given to pregnant women when protection is required without delay. If a woman with unknown or incomplete vaccination status requires immunisation against tetanus after week 16 of pregnancy, the Department of Health suggests that an initial dose of tetanus/diphtheria/pertussis/polio (Tdap-IPV) vaccine be given in place of Td-IPV vaccine, and that Td/IPV vaccine is then given at appropriate intervals to complete the course of immunisation against tetanus.

Exposure to tetanus/diphtheria/polio vaccine at any stage in pregnancy would not be regarded as medical grounds for termination of pregnancy or any additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.