Inadvertent vaccination in pregnancy (VIP)

It is important that anyone who has been vaccinated with these vaccines during pregnancy can be immediately reassured that no known risk associated with giving these during pregnancy.

Please note that the live shingles vaccine (Zostavax®) is no longer available in the UK.

The Immunisation and Vaccine Preventable Diseases Division at the UK Health Security Agency (UKHSA, formerly Public Health England (PHE)) follows up women who have inadvertently been given certain vaccines in pregnancy (VIP) across the UK. These women would therefore not have been aware they were pregnant at the time of vaccination.

Through VIP surveillance we aim to analyse the details submitted by GPs and surgeries to better inform:

• pregnant women who are immunised
• their families
• health professionals who are responsible for their care

Notify UKHSA

If you or your patient have had measles, mumps and rubella (MMR), chicken pox or shingles vaccine inadvertently administered during pregnancy or shortly before conception, notify UKHSA, which runs UK-wide surveillance on the safety of vaccines given in pregnancy.

UKHSA tracks women who are inadvertently immunised whilst pregnant or shortly before pregnancy, with the following vaccines:

• measles, mumps and rubella (MMR) vaccine givenimmunisation from 30 days before last menstrual period to anytime during pregnancy
• chickenpox or shingles vaccineimmunisation given from 90 days before last menstrual period to anytime during pregnancy

If you are pregnant, meet the above criteria and would like to report your vaccination details, you can do so by submitting a completed notification form. Follow-up will normally be undertaken with the GP practice that you are registered with

Vaccination during pregnancy

There are no known risks for women who are vaccinated against measles, mumps, rubella, chickenpox or shingles during any stage of pregnancy or shortly before conception. More detailed information can be found for each vaccine:

• rubella-containing vaccine (including MMR) safety in pregnancy, chicken pox and shingles vaccine safety in pregnancy
• human papillomavirus (HPV) vaccine safety in pregnancy guidance

The UKHSA VIP surveillance previously collected information on women who received coronavirus (COVID-19) vaccine in pregnancy. These data are currently being analysed, for publication alongside other publicly available data. Please refer to the following if you would like further information on COVID-19 vaccination in pregnancy:

• COVID-19 vaccination: women of childbearing age, currently pregnant or breastfeeding
• COVID-19 vaccine weekly surveillance reports
• COVID-19 vaccines, pregnancy and breastfeeding, Royal College of Obstetricians and Gynaecologists (RCOG)

Patient consent

Whilst consent does not need to be obtained, it is recommended that details of this surveillance are discussed with the patient by any health professional reporting a case in one of their patients.

The Health Service Regulation 2002 stipulates that confidential patient information may be processed with a view to monitor and manage the delivery, efficacy and safety of immunisation campaigns.

The regulation states that the processing of confidential patient information for the purposes specified above may be undertaken by the Public Health Laboratory Service, since superseded by the Health Protection Agency, PHE and subsequently UKHSA.

Additional information sources

The UK teratology information service (UKtis) publishes information on the toxicity of drugs and chemicals in pregnancy.

The Electronic Medicines Compendium (EMC) publishes summaries of product characteristics (SPCs) and patient information leaflets (PILs).

The Medicines and Healthcare products Regulatory Agency (MHRA) produces guidance and information on COVID-19.

Shingles vaccine administration in pregnancy

Shingles vaccine (Zostavax®, Generic Name: Varicella Zoster Virus, marketed by Sanofi Pasteur MSD) is a live viral vaccine that is not recommended for use in pregnancy.

Most women of child-bearing age in the UK are known to be immune to chickenpox.

You can reassure a pregnant woman immunised with Zostavax that she is protected from infection if she both:

• has a past history of chickenpox or shingles, or 2 doses of a varicella containing vaccine
• is not immunosuppressed

This is the same advice you would give a woman with the same history if she was exposed to natural disease (chickenpox or shingles) whilst pregnant. See Viral rash in pregnancy.

If a pregnant woman has an uncertain history to chickenpox, or is not known to be immune, and receives Zostavax whilst pregnant, offer her testing to establish her immunity as early as possible.

Laboratory diagnosis of past infection is by VZV IgG antibody in serum.

If a woman with an uncertain or negative history of chickenpox is found susceptible (VZV IgG negative): contact immunisationlead@phe.gov.uk as soon as you have the result, to discuss the individual case.

The immunisation team may recommend varicella zoster immunoglobulin, given within 10 days of the Zostavax immunisation.

The virus in both varicella (chickenpox) and shingles vaccines has been weakened: it is safer in humans than infection by the wild virus. There is no known risk to the pregnancy or to the fetus from these vaccines.

Shingles vaccine contains a higher dose of the same varicella-zoster virus that is in the varicella vaccine.

As with varicella vaccine in pregnancy, report inadvertent immunisation with Zostavax to the UKHSA Vaccination in Pregnancy surveillance programme, to monitor the safety of such exposures.

Infectious diseases during pregnancy

The infectious diseases during pregnancy: screening, vaccination and treatment guidance gives an overview of risks to pregnant women from infections. It provides information on current screening, vaccination, treatment and prevention programmes.