[MCOH-EH] [EXTERNAL] Re: Pregnancy and Live Vaccines

[Swift, Melanie D., M.D., MPH]

You can also offer options for the “might be pregnant, not sure” new hires – give them time to do a home pregnancy test, offer antibody testing, or even provide a pregnancy test (knowing it might be negative in early pregnancy.

Just to keep the risk in perspective, remember that there’s never actually been a case of MMR-associated fetal rubella syndrome or any fetal anomaly. It’s a purely theoretical risk. There used to be a pregnancy registry that followed women who received MMR before knowing they were pregnant. Here’s the outcome, from this article<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093587/>:

“There have been no reports of congenital malformations attributable to the MMR vaccine virus. The Centers for Disease Control and Prevention (CDC) estimated the theoretical risk to the fetus of CRS following vaccination with the rubella vaccine to be 0% to 1.6%.2<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093587/#b2-0570555> In 1971, the CDC established the Vaccine in Pregnancy registry of women who had received rubella vaccines within 3 months before or after conception. By 1989 there were data on 1221 inadvertently vaccinated pregnant women. There was no evidence of an increase in fetal abnormalities or cases of CRS in the enrolled women or the 321 rubella-susceptible women; therefore, enrolment in the registry ended.

Motherisk conducted a prospective controlled study that included 94 women exposed to the rubella vaccine in the 3 months before conception or during the first trimester of pregnancy. The Motherisk team reported no difference in pregnancy outcomes or malformation rates between the exposed and the nonexposed groups, and no adverse effects consistent with CRS.4<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093587/#b4-0570555> These data have been confirmed in other immunization campaigns and studies.”

Also see page 13 of this ACIP statement on MMR: https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

Thanks,

Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Swift, Melanie D., M.D., MPH via MCOH-EH
Sent: Monday, September 18, 2023 4:45 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu>
Subject: [EXTERNAL] Re: [MCOH-EH] Pregnancy and Live Vaccines

ACIP recommends that anyone capable of bearing children be asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer "yes." Those who answer "no" should be advised to avoid pregnancy for one month following vaccination. Routine pregnancy testing is not necessary.

For an employer to require pregnancy testing for “females of childbearing age” – that’s fairly tricky employment waters. Now you’re forcing a conversation about sexual activity, sexual orientation, prior hysterectomy/tubal ligation. All of that is appropriate in the context of primary care or emergency medical care, but in the context of onboarding an employee, you don’t really need to go there.

Thanks,

Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Jakub Furmaga via MCOH-EH
Sent: Monday, September 18, 2023 8:49 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Cc: Jakub Furmaga <jfurmaga at me.com<mailto:jfurmaga at me.com>>
Subject: [EXTERNAL] [MCOH-EH] Pregnancy and Live Vaccines

Good morning,
I wanted to ask how everyone else is handling pregnancy testing before administering live vaccines (MMR and Varicella) to employees. Some have been accepting "I am not pregnant and not planning on becoming pregnant" as sufficient to clear them for receipt of the live vaccines. However is that sufficient? Many clinics/emergency departments perform urine pregnancy testing on all females of childbearing age before doing anything that could have negative repercussions on the fetus. Should we do the same when giving the live vaccines?

Jakub

Jakub Furmaga, MD
Medical Director of Occupational Health
UT Southwestern, Dallas
S
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