Vaccine
PREGNANCY RECOMMENDATION: Compatible
BREASTFEEDING RECOMMENDATION: Compatible
PREGNANCY SUMMARY
Group B Streptococcus (GBS) capsular polysaccharides (CPS) vaccine has been used in pregnancy in an attempt to prevent infection in the newborn (1). The vaccine is considered safe in pregnancy.
FETAL RISK SUMMARY
Forty women at a mean gestational age of 31 weeks (range 26–36 weeks) were administered a single 50-mcg dose of type III CPS of GBS (1). No adverse effects were observed in the 40 newborns. The overall response rate to the vaccine, which is not commercially available, was 63%. Of the 25 infants born to mothers who had responded to the vaccine, at 1 and 3 months of age, 80% and 64%, respectively, continued to have protective levels of antibody (1). Although the vaccine is considered safe (2), as are other bacterial vaccines (3), the clinical effectiveness of the vaccine has not been determined and its use remains controversial (4–7).
In an attempt to improve on the immunogenic response in adults, researchers designed a GBS type III CPS–tetanus toxoid conjugate vaccine (8). Although administered to nonpregnant women, vaccination with the CPS–protein conjugate preparation resulted in enhanced immunogenicity compared with uncoupled vaccine. Although the results are encouraging, it is not known at the present time whether this vaccine will produce a similar response in pregnant women or whether it will prevent perinatal infection.
BREASTFEEDING SUMMARY
Although there are no reports describing the use of Group B streptococcal vaccine during lactation, the agent should represent no risk to a nursing infant.
References
1.Baker CJ, Rench MA, Edwards MS, Carpenter RJ, Hays BM, Kasper DL. Immunization of pregnant women with a polysaccharide vaccine of Group B streptococcus. N Engl J Med 1988;319:1180–5.
2.Faix RG. Maternal immunization to prevent fetal and neonatal infection. Clin Obstet Gynecol 1991;34:277–87.
3.CDC. Immunization Practices Advisory Committee. General recommendations on immunization. MMWR 1989;38:205–27.
4.Franciosi RA. Group B streptococcal vaccine in pregnant women. N Engl J Med 1989;320:807–8.
5.Baker CJ, Edwards MS. Group B streptococcal vaccine in pregnant women. N Engl J Med 1989;320:808.
6.Insel RA. Group B streptococcal vaccine in pregnant women. N Engl J Med 1989;320:808–9.
7.Linder N, Ohel G. In utero vaccination. Clin Perinatol 1994;21:663–74.
8.Kasper DL, Paoletti LC, Wessels MR, Guttormsen H-K, Carey VJ, Jennings HJ, Baker CJ. Immune response to type III Group B streptococcal polysaccharide-tetanus toxoid conjugate vaccine. J Clin Invest 1996;98:2308–14.