Pregnancy and Immunizations Questions

1. Your 20 year old pregnant patient completed her childhood vaccine series and had appropriate boosters at age 12. She visits you for her first obstetrical visit in October. Lab work indicates rubella-immune with a blood type A negative. Which vaccines below are recommended to give her now?

a. Influenza injection only

b. Influenza nasal vaccine only

c. Quadrivalent HPV vaccine

d. Influenza nasal vaccine and Hepatitis B

2. You give the patient in Question #1 the recommended vaccine(s). After delivery, which vaccine is indicated by the CDC?

a. Hepatitis B

b. Quadrivalent HPV

c. Tdap

d. MMR

3. Regarding influenza, it is recommended that pregnant patients

a. Avoid the vaccine since it was not tested .

b. Avoid the vaccine since influenza does not cause serious illness in pregnant women.

c. Receive the vaccine since influenza causes serious illness in pregnant women.

d. Receive the vaccine because it would definitely prevent influenza illness in neonates.

4. A 26 year old woman comes to you for pre-conception counseling. She cannot remember having chickenpox as a child. Her lab tests indicate she is not immune to rubella or varicella.

a. You give her no vaccines in case she is already pregnant.

b. You administer varicella vaccine and will give MMR after delivery.

c. You administer MMR only.

d. You administer MMR and varicella vaccine

.


5. If you give the woman in Question #4 the indicated vaccine(s), how long after receiving rubella and/or varicella vaccines should this woman avoid conception?

a. 2 weeks

b. 4 weeks

c. 8 weeks

d. 12 weeks

6. An Rh negative mother delivers an Rh positive infant and Anti-D immunoglobulin (Rhogam) is given after delivery. If she is rubella non-immune, what should you do?

a. Wait 4 weeks and then give MMR.

b. Give MMR simultaneously with Rhogam in different arms and check rubella IgG in 3 months.

c. Give MMR simultaneously in the same arm as Rhogam.

d. MMR should not be given for 6 months.

7. If she becomes pregnant, which of the following women should get Tdap during pregnancy?

a. A 32 year old childcare provider with 1 Td booster

b. A 22 year old computer programmer who got a Td booster at age 16

c. A 32 year old mother whose last Td booster was at 24 years old who has a 6 year old boy at home

d. An 18 year old college bound student with one Td booster

8. Which of the following vaccine is FDA approved category B?

a. Bivalent HPV

b. Inactivated seasonal Influenza

c. Hepatitis B

d. Tdap

9. Which of the following vaccines poses a proven threat to the fetus if given to a pregnant woman?

a. Meningococcal

b. Td

c. Inactivated seasonal influenza

d. None of the above

10. Your 19 year old pregnant patient’s prenatal labs show she is rubella non-immune. She attended public school through high school and all her immunizations are up-to-date. What is the most likely cause of her non-immune test result?

a. She never received her second dose of MMR.

b. She had rubella as a child, which invalidates the test.

c. She has rubella antibodies, but at a level below detection.

d. She received her first dose of MMR at 15 months and her second at 6 years old.


Pregnancy and Immunizations Answers

1. a. During influenza season, trivalent influenza vaccine, NOT live-attenuated vaccine, should be given to all pregnant women or potentially pregnant women. Quadrivalent HPV is currently not approved for use in pregnancy.

2. c. After delivery, this woman should receive Tdap. She is rubella-immune and does not need MMR.

3. c. Because pregnant women had greater morbidity and mortality with influenza, they should receive the vaccine (including H1N1). A neonate theoretically, not definitely, receives passive immunization from maternal vaccination.

4. d. Since this woman is not immune to rubella or varicella, she should receive the MMR and varicella vaccines.

5. b. Pregnancy should be avoided for 4 weeks after vaccination with MMR and varicella.

6. b. Rhogam and MMR can be given simultaneously in different sites postpartum. The rubella IgG titer should be confirmed by serological testing 3 months after administration.

7. a. A childcare provider is considered high-risk for pertussis and should receive Tdap DURING pregnancy. She is > 31 years old and has had only 1 tetanus booster. She does not have “presumed sufficient” tetanus immunity and should be boosted with Tdap during pregnancy.

8. a. Bivalent HPV vaccine is the only listed vaccine that is FDA approved Category B.

9. d. None of these vaccines cause fetal harm. An example of a vaccine that puts the fetus at risk is vaccinia (smallpox) vaccine.

10. c. This patient most likely has low level antibodies. She should be revaccinated with MMR vaccine postpartum.

AFMRD Presents: A Comprehensive Immunization Curriculum for Family Medicine Residency Programs