The American College of Obstetricians and Gynecologists (ACOG) recommends its members encourage their patients to be vaccinated against human papillomavirus virus (HPV), influenza, tetanus, diphtheria, and pertussis, according to new guidelines published on the ACOG Web site March 21.
Committee Opinion number 558, to be published in Obstetrics & Gynecology on April 1, is the work of the Immunization Expert Work Group, the Committee on Obstetric Practice, and the Committee on Gynecologic Practice. ACOG has not made recommendations on vaccinations previously.
The opinion states “obstetrician–gynecologists should embrace immunizations as an integral part of their women’s health care practice.” The guidelines suggests physicians discuss immunizations with patients, and use prompts — whether electronic or paper — to note which patients need to be immunized. Physicians are further advised to designate a vaccine coordinator and backup coordinator to be responsible for ordering and storing vaccines. Physicians should institute standing orders to allow indicated vaccines to be administered without an individual physician order, the guidelines state.
The guidelines also recommended that office staff be educated and vaccinated.
“Studies have shown that office personnel may express their own uncertainty or lack of knowledge to patients, which can have a detrimental effect on a patient’s willingness to receive a vaccine. In contrast, other studies have shown that a 1-hour education effort for all office staff can markedly increase office immunization rates,” the guidelines state.
Physicians are cautioned to be aware of vaccine contraindications, such as, in some cases, egg allergy or Guillain-Barré syndrome. Further, all immunized patients must receive a vaccine information statement before each dose of vaccine, as required by the National Childhood Vaccine Injury Act of 1986.
The guidelines cover vaccine administration in pregnancy. The HPV vaccine is not recommended for pregnant women, although it does not contain live virus. However, reports of accidental administration of the vaccine during pregnancy “are reassuring,” the authors write. Live, attenuated virus vaccines, such as the vaccine for measles, mumps, and rubella or nasally delivered influenza vaccine, cannot be administered to pregnant women.
Conversely, the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) and the injectable influenza vaccines are safe for pregnant women and recommended. Both provide protection for newborns via passive antibody transfer to the fetus, the authors write.
Pregnant women are disproportionately vulnerable to severe bouts of influenza, including death, the authors report. Epidemiologic studies show that otherwise healthy pregnant women who contract seasonal influenza have an increased risk for cardiopulmonary events, a risk that increases with each trimester.
Obstet Gynecol. 2013;121:897-903.
— Jenni Laidman
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