Vaccines II: MMR, Varicella, and HPV
/Let’s tackle the second part of our vaccinations series with some of the more common live-virus vaccines: MMR, Varicella, and HPV. Check out the CDC vaccine guides linked here.
MMR
Measles, mumps, and rubella - all are live attenuated strains of the virus
Should NOT be given during pregnancy
Immunity is about 97% against measles and rubella after 2 doses, and 88% against mumps after 2 dose
Given ideally before pregnancy to protect against congenital rubella
Otherwise, after pregnancy and not during
This is because during pregnancy, the adaptive immune system is not as robust as when one is not pregnant and higher risk of the live attenuated virus actually causing disease.
If an adult is not immune to MMR (and we screen for rubella during pregnancy), at least one dose should be given postpartum.
Ingredients
Chicken embryo cell culture - medium
Human diploid lung fibroblasts - medium
Vitamins, amino acids, sucrose, glutamate, human albumin, sorbitol, gelatin, sodium phosphate, sodium chloride
Fetal bovine serum - medium
Neomycin - antibiotic
Side effects
Can get rash, temperature, loss of appetite 2-3 days
Can get a VERY mild form of measles or mumps
Extremely rare: severe allergic reaction
Varicella
Protects against chickenpox and shingles
88-98% effective at preventing varicella after two doses, and 85% effective after 1 dose.
Ideally given before pregnancy to protect against chickenpox complications during pregnancy (ie. pneumonia) and congenital varicella syndrome or neonatal varicella.
Don’t give it during pregnancy.
Ingredients
Human diploid cells with DNA and protein
Sucrose, gelatin
Sodium chloride, monosodium-glutamate, sodium phosphate, potassium phosphate, potassium chloride, EDTA
Neoomycin
Fetal bovine serum
Side effects
Common: sore arm, fever, mild rash, temporary pain and stiffness
Severe: (very uncommon) - severe infection, pneumonia
HPV
Gardasil 9 protects against human papilloma virus 16, 18 (causes 80% of cervical cancer cases), 6, 11 (90% of genital wart cases), and another 5 types (31,33,45, 52, 58) that can lead to cervical cancer.
3 separate shots for people aged 15-45 - high efficacy, with close to 100% prevention of HPV virus
If 9-14, 2 shots are sufficient
Not currently recommended during pregnancy
Good time to give it: immediately pp in hospital (dose 1), then 6 weeks pp
Ingredients
Vitamins, amino acids, mineral salts, carbohydrates
Amorphous aluminum hydroxyphosphate sulfate
Sodium chloride
Polysorbate 20
Neomycin, yeast protein
Side effects
Common: pain, redness, swelling of arm where shot was given
Less likely: fever, headache, feeling tired, nausea, muscle or joint pain.