What are the recommendations for Yellow Fever and Cholera vaccinations during pregnancy?

From the Guidelines

Pregnant women should only receive yellow fever and cholera vaccinations if travel to high-risk areas is unavoidable and the risk of disease outweighs the potential risks associated with vaccination. The yellow fever vaccine is a live attenuated vaccine that poses theoretical risks to the developing fetus, so it's typically not recommended during pregnancy unless the risk of disease is high 1. For cholera, the inactivated oral vaccine is considered safe for use in pregnancy, with the World Health Organization (WHO) recommending that pregnant and lactating women be included in cholera vaccination campaigns due to the high potential benefit and minimal potential risk 1.

Key Considerations

• The risk of yellow fever infection outweighs the small theoretical risk to mother and fetus from vaccination in areas where the disease is endemic 1.
• Pregnant women who must travel to areas with high risk of yellow fever should be vaccinated after discussing risks and benefits with a healthcare provider 1.
• The inactivated oral cholera vaccine can be considered for pregnant women at high risk for disease, with no increase in pregnancy adverse outcomes reported in studies 1.
• Preventive measures such as insect repellents, protective clothing, and careful hand hygiene are essential for pregnant women traveling to endemic regions to prevent yellow fever and cholera.

Recommendations

• Yellow fever vaccination should only be administered to pregnant women if travel to endemic areas cannot be postponed and the risk of disease is high 1.
• Inactivated oral cholera vaccine can be considered for pregnant women at high risk for disease, with careful discussion of risks and benefits 1.
• Pregnant women should focus on preventive measures when traveling to endemic regions, including using insect repellents containing DEET, wearing protective clothing, and staying in accommodations with screens or air conditioning for yellow fever prevention, and drinking only bottled or purified water, avoiding raw foods, and practicing careful hand hygiene for cholera prevention.

From the FDA Drug Label

Do not use if pregnant or breast-feeding. The Dukoral (PO) vaccine, which is used for Cholera vaccination, has a clear warning against its use in pregnant women.

• The FDA drug label for Dukoral (PO) explicitly states that it should not be used in pregnant or breast-feeding women 2. There is no information provided about Yellow Fever vaccination during pregnancy. The FDA drug label does not answer the question regarding Yellow Fever vaccination during pregnancy.

From the Research

Recommendations for Yellow Fever Vaccination During Pregnancy

• The yellow fever vaccine is a live attenuated virus and is generally contraindicated in pregnant women due to the potential risk of fetal viremia/bacteremia 3.
• However, if travel to a yellow-fever endemic zone is mandatory, vaccination may be recommended in pregnant women, preferably during the first trimester, as the immunological response appears to be better at that time 4.
• There is no evidence to support a major risk of yellow-fever-vaccine-related complications in mothers or children, but most reported series have been small 4.
• A study in mice found that in utero exposure to the yellow fever vaccine may induce behavioral alterations in the pups that may persist to adulthood in the absence of observed maternal toxicity or disruption of physical development milestones or reflex ontogeny 5.

Recommendations for Cholera Vaccination During Pregnancy

• Cholera vaccination may be offered to women at high risk of exposure, but there is limited information available on the safety and efficacy of cholera vaccines in pregnant women 3.
• In general, inactivated vaccines, such as those used for cholera, are considered safe for use in pregnant women, but the risk-benefit ratio should be carefully evaluated on a case-by-case basis.

General Considerations for Vaccination During Pregnancy

• Vaccination during pregnancy is important for active immunity of the mother and passive immunity of the neonate against serious infectious diseases 3.
• Live vaccines are contraindicated during pregnancy, while inactivated vaccines are generally safe 3, 6.
• The decision to vaccinate a pregnant woman should be made on a case-by-case basis, taking into account the risk of exposure to the disease, the potential benefits and risks of vaccination, and the gestational age of the pregnancy 4, 6.