Which vaccines are recommended for pregnant women in the Philippines?

Vaccines Required for Pregnant Women in the Philippines

All pregnant women in the Philippines should receive Tdap vaccine between 27-36 weeks of gestation and inactivated influenza vaccine during any trimester of pregnancy, as these are the only vaccines routinely recommended for universal administration during pregnancy. 1, 2

Universally Recommended Vaccines During Pregnancy

Tdap (Tetanus, Diphtheria, Pertussis) Vaccine

• Administer between 27-36 weeks of gestation during every pregnancy, regardless of prior vaccination history. 1, 2
• This timing maximizes transplacental antibody transfer to provide passive immunity protecting newborns during their most vulnerable first months of life before they can receive their own vaccinations. 1, 2
• If not given during pregnancy, administer immediately postpartum before hospital discharge. 1, 2
• For unvaccinated or incompletely vaccinated women, complete the primary three-dose series during pregnancy with doses spaced at least 4 weeks apart for the first two doses and 6-12 months for the third dose. 1, 2

Influenza Vaccine (Inactivated)

• Administer during any trimester of pregnancy. 1, 2
• Only use inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)—never live attenuated influenza vaccine (LAIV), which is absolutely contraindicated. 2
• Pregnant women face 7.2% higher hospitalization rates and disproportionately high mortality risk from influenza compared to non-pregnant women. 1
• Protection extends to the newborn through transplacental antibody transfer. 1, 3

Risk-Based Vaccines (Not Routine, But Safe When Indicated)

Hepatitis B Vaccine

• Recommended for pregnant women at high risk: more than one sexual partner in the past 6 months, history of sexually transmitted infections, recent or current injection-drug use, or HBsAg-positive sexual partner. 1, 4
• All pregnant women must be screened for HBsAg during the first trimester of every pregnancy. 4
• Pregnancy is not a contraindication to hepatitis B vaccination for otherwise eligible women. 1, 4

Pneumococcal Vaccine

• Can be administered if the pregnant woman has underlying medical conditions increasing risk for pneumococcal disease complications. 1

Hepatitis A Vaccine

• May be administered to pregnant women at risk of exposure. 1, 4

Travel-Related Vaccines (When Exposure Risk is High)

• Yellow fever vaccine: Only if traveling to high-risk areas where the small theoretical risk is outweighed by infection risk. 1
• Inactivated polio vaccine (IPV): Preferred over OPV if complete series can be administered before anticipated exposure. 1
• Japanese encephalitis (inactivated): May be considered if traveling to endemic areas with significant exposure risk. 1
• Rabies (inactivated): Safe for post-exposure prophylaxis; pregnancy is not a contraindication given the high case fatality rate. 1

Absolutely Contraindicated Vaccines During Pregnancy

Live vaccines are contraindicated due to theoretical risk to the developing fetus: 1, 2, 5

• MMR (measles, mumps, rubella)
• Varicella
• Live attenuated influenza vaccine (LAIV)
• Any live bacterial or viral vaccines

Critical Caveat

• Although rubella vaccine is contraindicated during pregnancy, no cases of congenital rubella syndrome have been documented in infants born to mothers inadvertently vaccinated during pregnancy. 1
• Women found non-immune to rubella should be vaccinated immediately postpartum, preferably before hospital discharge. 1, 6

Key Implementation Points

Timing Considerations

• When possible, administer vaccines during the second or third trimester to minimize perception of association with first-trimester pregnancy losses, though this is based on theoretical concerns rather than documented risk. 1

Documentation Requirements

• Thoroughly document vaccination history to determine whether primary series or booster doses are needed. 2
• For women with unknown tetanus vaccination history, assume no prior vaccination and complete the three-dose primary series. 1

Common Pitfalls to Avoid

• Do not delay Tdap until postpartum when it can be safely given during pregnancy—this leaves the newborn unprotected during the highest-risk period. 1, 2
• Do not substitute Td for Tdap during pregnancy when Tdap is indicated, as pertussis protection for the newborn is critical. 1, 2
• Do not withhold inactivated vaccines due to unfounded safety concerns—inactivated vaccines pose no special risk during pregnancy. 1, 5, 7
• Do not administer live vaccines during pregnancy except in rare circumstances where exposure risk clearly outweighs theoretical fetal risk (e.g., yellow fever in endemic travel). 1

Breastfeeding Considerations

• Neither killed nor live vaccines affect the safety of breastfeeding for mothers or infants. 1
• Breastfeeding is not a contraindication to any vaccine. 1, 2
• All postpartum vaccines can be administered to breastfeeding mothers without interruption of feeding. 1, 2