HPV Vaccine is Contraindicated in Pregnancy
The HPV vaccine is the correct answer—it is explicitly contraindicated during pregnancy and should be delayed until after delivery. 1, 2, 3
Why HPV is Contraindicated
The Advisory Committee on Immunization Practices explicitly states that quadrivalent HPV vaccine is not recommended for use in pregnancy, and if a woman is found to be pregnant after initiating the vaccination series, the remainder of the 3-dose regimen should be delayed until after completion of the pregnancy. 1
The CDC and ACOG recommend that HPV vaccination be deferred until after pregnancy completion, though this is a precautionary recommendation rather than an absolute contraindication based on theoretical fetal risk. 2, 3
If a vaccine dose has been inadvertently administered during pregnancy, no intervention is needed—registry data from over 1,000 exposed pregnancies show no clear pattern of adverse outcomes or malformations. 1, 4, 5
Why the Other Options Are SAFE in Pregnancy
Whooping Cough (Tdap) - SAFE and RECOMMENDED
Tdap is routinely recommended during each pregnancy between 27-36 weeks' gestation, regardless of prior vaccination history, to maximize transplacental antibody transfer and protect the newborn. 2, 6
This vaccine is explicitly safe and strongly recommended by ACOG, CDC, and AAP for all pregnant women. 2, 6, 3
Flu (Inactivated Influenza Vaccine) - SAFE and RECOMMENDED
The inactivated influenza vaccine is strongly recommended for all pregnant women during any trimester because pregnant women face disproportionately higher risks from influenza infection, including severe illness and adverse pregnancy outcomes. 2, 6, 3
Only the live attenuated influenza vaccine (LAIV/nasal spray) is contraindicated in pregnancy—the inactivated form is safe. 2, 6, 3
VSV (Vesicular Stomatitis Virus-based vaccines)
VSV-vectored vaccines (such as the Ebola vaccine rVSV-ZEBOV) are live viral vectors and would theoretically be contraindicated in pregnancy due to the risk of placental transmission, similar to other live vaccines. 3
However, VSV is not a standard vaccine option in routine clinical practice, and the question context suggests this is a distractor rather than the primary answer.
Key Clinical Distinction
Live attenuated vaccines are absolutely contraindicated in pregnancy due to theoretical risk of placental viral transmission and fetal infection, including MMR, varicella, live attenuated zoster vaccine, and live attenuated influenza vaccine (nasal spray). 3
HPV vaccine is NOT a live vaccine—it is a recombinant protein vaccine—but it is still contraindicated as a precautionary measure because of limited safety data during pregnancy, not because of theoretical fetal infection risk. 1, 2, 7