Which vaccine is contraindicated during pregnancy, Zoster (Herpes Zoster vaccine), Hepatitis B (Hepatitis B vaccine), Meningococcal (Meningococcal conjugate vaccine), or Human papillomavirus (HPV) (Human papillomavirus vaccine)?

Zoster (Herpes Zoster) Vaccine is Contraindicated During Pregnancy

The live attenuated zoster vaccine (Zostavax) is absolutely contraindicated during pregnancy, making option A the correct answer. 1, 2

Vaccine Status During Pregnancy

Contraindicated Vaccines

• Live attenuated zoster vaccine (Zostavax) is explicitly contraindicated during pregnancy due to the theoretical risk of placental transmission of the live virus 1, 2
• The recombinant zoster vaccine (RZV/Shingrix) should be delayed until after pregnancy if indicated, though it is not an absolute contraindication like the live vaccine 1
• Live attenuated vaccines are generally contraindicated during pregnancy because they may cause fetal viremia or bacteremia 3

Safe Vaccines During Pregnancy

• Hepatitis B vaccine can be safely offered to pregnant women at high risk for hepatitis B virus infection or who desire vaccination 1
• Meningococcal conjugate vaccines (MenACWY) are recommended for pregnant women with additional risk factors, and pregnancy should not preclude their use when otherwise indicated 1
• Meningococcal vaccines have not been associated with any safety concerns in pregnancy 1

Vaccines to Delay (Not Contraindicated)

• HPV vaccine should be delayed until after pregnancy, but this is a precautionary recommendation rather than an absolute contraindication 1, 4
• The Advisory Committee on Immunization Practices explicitly states HPV vaccination should be deferred during pregnancy 4
• No cases of congenital abnormalities have been documented from inadvertent HPV vaccination during pregnancy, but the vaccine is not recommended 1

Key Clinical Distinction

The critical difference is that live attenuated zoster vaccine poses theoretical risk of fetal infection through placental viral transmission, which is why it carries an absolute contraindication 1, 3. In contrast, hepatitis B (inactivated), meningococcal (conjugate/polysaccharide), and HPV (recombinant) vaccines do not contain live replicating organisms and therefore do not carry the same theoretical risk of fetal infection 1.