A patient presents for prenatal care in the second trimester. She was born outside the United States and has never had any routine vaccinations. Which of the following vaccines is contraindicated in pregnancy?
Immunization in pregnancy often brings about much concern for both patient and physician. Teratogenic concerns regarding the vaccine must be weighed against the potential for harm from the infectious agent. In the case of hepatitis A and B, rabies, tetanus, and varicella, patients may be treated with hyperimmunoglobulin or pooled immune serum globulin. Inactivated bacterial vaccines can be used for cholera, plague, and typhoid, as appropriate. Vaccines for measles and mumps are generally considered to be contraindicated, as these are live viruses, although the rubella vaccine, which is known to have been administered inadvertently to more than 1000 pregnant women, has never caused a problem and in fact can be used in selected circumstances of exposure.