No images? Click here MEDICAL ADVISORY: COVID-19 Vaccine Strongly Recommended for Pregnant, Breastfeeding or Individuals Trying to ConceiveIssued by: M. Mustafa Hirji, MD, MPH, FRCPC, Medical Officer of Health & Commissioner (Acting) As the evidence evolves, it is becoming clear that pregnant and postpartum individuals represent a population at increased risk of COVID-19-related morbidity. Severe COVID-19 infection during pregnancy has important implications for both maternal and fetal health. Although most pregnant individuals who become infected with SARS-CoV-2 will have mild-to-moderate symptoms and many can be asymptomatic, both Canadian and international data from large studies spanning multiple jurisdictions demonstrate that approximately 7-11% of pregnant women will require hospitalization for COVID-related morbidity and between 1-4% of pregnant women require admission to an intensive care unit (ICU). Analysis as of October 3, 20201 from the Institute for Clinical Evaluative Sciences (ICES) on vaccine uptake shows that Niagara is well below the provincial average in vaccinating pregnant individuals. Specifically, Niagara is seventh lowest out of 34 health units in Ontario, with only 57% of pregnant individuals that have received a first dose of COVID-19, and only 49% having received a second dose. Given the risk of infection severe illness from COVID-19 is increased in pregnancy with pregnant women disproportionately admitted into ICU or put on ventilators, Public Health is asking health care providers to make a strong recommendation for patients in these populations to get fully vaccinated:
Risk of Exposure All people who are unvaccinated are almost certain to get infected as society moves to lift social restrictions and allow the virus to spread freely. Cases among fully vaccinated individuals are far less likely (8-fold). Serious illness (e.g. needing hospitalization or being on a ventilator) is very rare among fully vaccinated people (25 times less likely than an unvaccinated person). Almost all people hospitalized are unvaccinated. COVID-19 Vaccination Strongly Recommended by Experts Both the Society of Obstetricians and Gynaecologists of Canada and the National Advisory Committee on Immunization (NACI) recommend pregnant or breastfeeding individuals get a complete series with an mRNA COVID-19 vaccine. Individuals can get vaccinated against COVID-19 in any stage during pregnancy or while breastfeeding. Unless otherwise contraindicated, couples or individuals planning to conceive should receive the COVID-19 vaccination as soon as possible. If your patient is on fertility treatments, ask them to talk to their fertility specialist. Evidence Shows mRNA COVID-19 Vaccines are Safe during Pregnancy and While Breastfeeding, and Do NOT Impact Fertility Initially, health care providers had only limited data that could support evidence-informed recommendations about the COVID-19 vaccine for pregnant and breastfeeding populations. At that time, the Ministry decision-making tools emphasized the need for health care providers to talk to their patient about the risks and benefits so patients could make an informed choice. We now have the evidence to show the mRNA COVID-19 vaccines are safe for these populations. As well, we have evidence of significantly increased risk for pregnant women and their unborn child if they do get COVID-19 infection. Pregnant Individuals and Their Babies Data now includes a year of outcomes for pregnant people and their babies. No safety concerns were identified in a study of more than 35,000 pregnant people who received an mRNA COVID-19 vaccine within 30 days of conception. The latest preliminary data from Ontario do not suggest an increased risk for concerns during pregnancy, or complications for the baby at birth. Breastfeeding Individuals Recent data shows that mRNA from vaccines do not transfer into human milk. Anti-COVID-19 antibodies produced by the breastfeeding person have been shown to transfer through the milk and provide protection to the infant for the first months of life. Female and Male Fertility According to Public Health Ontario, to date there is no evidence of an association between COVID-19 vaccination and menstrual irregularities. Several clinic studies are in progress and the evidence will continue to be monitored. There is also no evidence to date to suggest that COVID-19 vaccination impacts male fertility. Studies evaluating male sperm parameters before and after receiving two doses of mRNA vaccine have not demonstrated differences. Evidence has however shown a rare impact on male fertility after COVID-19 infection. Pregnancy, breastfeeding and fertility concerns are not medical exemptions to COVID-19 vaccination. For information on medical reasons that do apply for exemptions, read Public Health’s memo, Ministry of Health guidance, and the College of Physicians and Surgeons of Ontario FAQs for Physicians. Make a Strong Recommendation for Your Patients to be Vaccinated
Other Vaccines Recommended During Pregnancy The National Advisory Committee on Immunization (NACI) recommends that COVID-19 vaccines may be given at the same time as, or any time before or after, other vaccines, including live, non-live, adjuvanted or unadjuvanted vaccines.
Give or recommend your patients receive the COVID-19 vaccine at the earliest opportunity. Acellular pertussis vaccine (one dose of Tdap) should be administered in every pregnancy, ideally between 27 and 32 weeks of gestation. Adults 18 years of age and older are eligible to receive a single publicly funded dose of the Tdap vaccine, irrespective of receiving a prior dose of Tdap in adolescence. Inactivated influenza vaccination is particularly recommended for all pregnant women as they are amongst those at high risk of influenza-related complications or hospitalization. Niagara Region Public Health is not holding community influenza clinics this year, so please vaccinate clients in your office or direct them to a pharmacy. More Information
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