VACCINE, MENINGOCOCCAL

Fetal Risk Summary

Meningococcal polysaccharide vaccine is a killed bacteria (cell wall) vaccine (1,2). Animal reproduction studies have not been conducted with the vaccine (1).

The risk to the fetus from vaccination during pregnancy is unknown. In one study, vaccination resulted in transfer of maternal antibodies to the fetus, but the transfer was irregular and was not dependent on maternal titer or the period in pregnancy when vaccination occurred (3).

A 1998 study evaluated the pregnancy outcomes of 34 women who received meningococcal vaccine during pregnancy (4). The trimesters of exposures were 4 (11.8%) in the 1st, 17 (50.0%) in the 2nd, and 13 (38.2%) in the 3rd. There were 34 singleton deliveries with a mean follow-up of the offspring of 13.2 months (range 1–24 months). Excluding one congenital malformation, there was no increase in the observed unusual birth events compared with the expected rates. In fact, there were significantly fewer cases of newborn cardiac murmurs and physiologic jaundice in offspring of vaccinated mothers. One birth defect observed in an infant of a mother vaccinated at 33 weeks' gestation was consistent with the oromandibular limb hypogenesis spectrum (Charlie M syndrome) (expected frequency <0.00002%). This pattern of defects would probably have occurred very early in gestation (4). The cause of Charlie M syndrome is unknown; it has not yet been identified as a genetic defect and it has not been associated with teratogens. All of the infants had normal growth and development in the follow-up period (4).

The use of the vaccine during pregnancy is controversial (5). Although an earlier publication of the American College of Obstetricians and Gynecologists recommended that the vaccine be used during pregnancy only when the risk of maternal infection is high (6), the current 1991 version, Technical Bulletin No. 160, does not discuss this vaccine (7).

In a 1996 study, 75 mothers received meningococcal vaccine in the last trimester of pregnancy (8). No adverse effects in the newborns attributable to the vaccine were observed.

Breast Feeding Summary

No data are available.

References

1. Product information. Menomune -A/C/Y/W-135. Aventis Pasteur, 2001.
2. Amstey MS. Vaccination in pregnancy. Clin Obstet Gynaecol 1983;10:13–22.
3. Carvalho ADA, Giampaglia CMS, Kimura H, Pereira OADC, Farhat CK, Neves JC, Prandini R, Carvalho EDS, Zarvos AM. Maternal and infant antibody response to meningococcal vaccination in pregnancy. Lancet 1977;2:809–11.
4. Letson GW, Little JR, Ottman J, Miller GL. Meningococcal vaccine in pregnancy: an assessment of infant risk. Pediatr Infect Dis 1998;17:261–3.
5. Linder N, Ohel G. In utero vaccination. Clin Perinatol 1994;21:663–74.
6. American College of Obstetricians and Gynecologists. Technical Bulletin. No. 64, May 1982.
7. American College of Obstetricians and Gynecologists. Immunization during pregnancy. Technical Bulletin. No. 160, October 1991.
8. O'Dempsey TJD, McArdle T, Ceesay SJ, Banya WAS, Demba E, Secka O, Leinonen M, Kayhty H, Francis N, Greenwood BM. Immunization with a pneumococcal capsular polysaccharide vaccine during pregnancy. Vaccine 1996;14:963–70.