Inadvertent Vaccination in Pregnancy

Overview

This Guidelines summary contains advice for health professionals on the management of pregnant women who are inadvertently vaccinated against COVID-19; chickenpox (varicella); shingles; or measles, mumps, and rubella (MMR).

Reflecting on your Learnings

Reflection is important for continuous learning and development, and a critical part of the revalidation process for UK healthcare professionals. Click here to access the Guidelines Reflection Record.

Notify UK Health Security Agency

• If you or your patient have had MMR, chickenpox, or shingles vaccine inadvertently administered during pregnancy or shortly before conception, notify the UKHSA, which runs UK-wide surveillance on the safety of vaccines given in pregnancy
• Complete the Notification form for vaccines administered in pregnancy (VIP)
• The UKHSA tracks women who are inadvertently immunised while pregnant or shortly before pregnancy with the following vaccines:
  • MMR vaccine immunisation from 30 days before last menstrual period to anytime during pregnancy
  • chickenpox or shingles immunisation from 90 days before last menstrual period to anytime during pregnancy
• If a patient is pregnant, meets the above criteria, and would like to report their vaccination details, they can do so by submitting a completed notification form.

Vaccination During Pregnancy

• There are no known risks for women who are vaccinated against MMR, chickenpox, or shingles during any stage of pregnancy or shortly before conception. More detailed information can be found for each vaccine:
  • rubella-containing vaccine (including MMR) safety in pregnancy; chickenpox and shingles vaccine safety in pregnancy
  • HPV vaccine safety in pregnancy guidance (PHE archived content)
• The UKHSA VIP surveillance previously collected information on women who received COVID-19 vaccine in pregnancy. These data are currently being analysed for publication alongside other publicly available data. Refer to the following if you would like further information on COVID-19 vaccination in pregnancy:
  • COVID-19 vaccination: women of childbearing age, currently pregnant, or breastfeeding
  • COVID-19 vaccine weekly surveillance reports
  • COVID-19 vaccines, pregnancy, and breastfeeding, Royal College of Obstetricians and Gynaecologists.

Patient Consent

• While consent does not need to be obtained, it is recommended that details of this surveillance are discussed with the patient by any health professional reporting a case in one of their patients
• The Health Service (Control of Patient Information) Regulations 2002 stipulate that confidential patient information may be processed with a view to monitor and manage the delivery, efficacy, and safety of immunisation campaigns
• The regulation states that the processing of confidential patient information for the purposes specified above may be undertaken by the Public Health Laboratory Service, since superseded by the Health Protection Agency, and subsequently the UKHSA. 

Shingles Vaccine Administration in Pregnancy

• Shingles vaccine (varicella-zoster virus [VZV], marketed by Sanofi Pasteur MSD) is a live viral vaccine that is not recommended for use in pregnancy
• Most women of childbearing age in the UK are known to be immune to chickenpox
• You can reassure a pregnant woman immunised with the VZV vaccine that she is protected from infection if she both:
  • has a past history of chickenpox or shingles, or two doses of a varicella-containing vaccine
  • is not immunosuppressed
• This is the same advice you would give a woman with the same history if she was exposed to natural disease (chickenpox or shingles) while pregnant—see Viral rash in pregnancy
• If a pregnant woman has an uncertain history with regard to chickenpox, or is not known to be immune, and receives the VZV vaccine while pregnant, offer her testing to establish her immunity as early as possible
• Laboratory diagnosis of past infection is by VZV immunoglobulin G (IgG) antibody in serum
• If a woman with an uncertain or negative history of chickenpox is found susceptible (VZV IgG negative): contact immunisationlead@phe.gov.uk as soon as you have the result, to discuss the individual case
• The immunisation team may recommend varicella-zoster immunoglobulin, given within 10 days of the VZV immunisation
• The virus in both varicella (chickenpox) and shingles vaccines has been weakened: it is safer in humans than infection by the wild virus. There is no known risk to the pregnancy or to the fetus from these vaccines
• Shingles vaccine contains a higher dose of the same VZV that is in the varicella vaccine
• As with varicella vaccine in pregnancy, report inadvertent immunisation with the VZV vaccine to the UKHSA Vaccination in Pregnancy surveillance programme, to monitor the safety of such exposures.

Infectious Diseases During Pregnancy

• This guidance gives an overview of risks to pregnant women from infections. It provides information on current screening, vaccination, treatment, and prevention programmes.

Additional Information Sources

• The UK Teratology Information Service publishes information on the toxicity of drugs and chemicals in pregnancy
• The European Medicines Agency’s Electronic Medicines Compendium publishes summaries of product characteristics and patient information leaflets
• The Medicines and Healthcare products Regulatory Agency produces guidance and information on COVID-19.