Zoster Vaccine is Contraindicated During Pregnancy
The Zoster (Herpes Zoster) vaccine is absolutely contraindicated during pregnancy because it is a live attenuated vaccine that poses theoretical risk of placental viral transmission to the fetus. 1
Understanding the Contraindication
The live attenuated zoster vaccine (Zostavax) carries an absolute contraindication during pregnancy due to the theoretical risk that the live virus could cross the placenta and infect the developing fetus. 1 This is consistent with the general principle that all live attenuated vaccines are contraindicated during pregnancy because they contain replicating organisms that could potentially cause fetal infection. 1, 2
The recombinant zoster vaccine (RZV/Shingrix) should also be delayed until after pregnancy if indicated, though it does not carry the same absolute contraindication as the live vaccine. 1
Why the Other Options Are Safe
Hepatitis B Vaccine
- Can be safely administered during pregnancy for women at high risk for hepatitis B virus infection or who desire vaccination. 3, 1
- This is an inactivated vaccine that does not contain live replicating organisms and therefore poses no theoretical risk of fetal infection. 1
- The CDC specifically recommends offering this vaccine to pregnant patients who are at high risk or request it. 3
Meningococcal (ACWY) Vaccine
- Recommended for pregnant women with additional risk factors and pregnancy should not preclude its use when otherwise indicated. 1
- Meningococcal conjugate vaccines are safe, immunogenic, and have not been associated with any safety concerns in pregnancy. 3
- Vaccination can be recommended if a woman is at high risk of meningococcal disease or in the context of an outbreak. 3
Human Papillomavirus (HPV) Vaccine
- Should be delayed until after pregnancy, but this is a precautionary recommendation rather than an absolute contraindication. 1
- This is a recombinant vaccine (not live) and does not carry the same theoretical risk of fetal infection as live vaccines. 1
- The recommendation to defer is based on lack of sufficient data rather than evidence of harm. 1
Key Clinical Distinction
The critical difference is that zoster vaccine contains live attenuated virus capable of replication, while hepatitis B, meningococcal, and HPV vaccines are either inactivated or recombinant and cannot replicate. 1 This fundamental difference in vaccine platform determines the contraindication status during pregnancy.
Live attenuated vaccines contraindicated during pregnancy include: measles, mumps, rubella (MMR), varicella (chickenpox), live attenuated influenza vaccine (nasal spray), smallpox (vaccinia), and zoster. 1, 2, 4
Common Pitfall to Avoid
Do not confuse "should be delayed" (HPV) with "absolutely contraindicated" (zoster). 1 While both are not routinely given during pregnancy, only the live attenuated zoster vaccine carries an absolute contraindication due to theoretical risk of placental viral transmission and fetal infection. 1
Answer: A. Zoster