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JOGC

No 357 – Immunisation pendant la grossesse

Published:March 02, 2018DOI:https://doi.org/10.1016/j.jogc.2018.01.011

      Résumé

      Objectif

      Passer en revue les données actuelles et formuler des recommandations sur l'immunisation pendant la grossesse.

      Issues

      Les issues évaluées comprennent l'efficacité de l'immunisation, ainsi que les avantages et les risques pour la mère et le fœtus.

      Données

      Des recherches ont été effectuées dans les bases de données Medline et Cochrane en vue d'en tirer les articles publiés jusqu'en janvier 2017 sur l'immunisation pendant la grossesse.

      Valeurs

      Les données obtenues ont été examinées et évaluées par le Comité des maladies infectieuses de la SOGC sous la direction des auteures principales, et les recommandations ont été formulées selon les lignes directrices rédigées par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1).

      Avantages, inconvénients et coûts

      La mise en œuvre des recommandations formulées dans cette directive clinique devrait mener à une meilleure immunisation des femmes enceintes ou qui allaitent, à la réduction des risques d'immunisation contre-indiquée et à une meilleure prévention des maladies.

      Recommandations

      • 1.
        Les fournisseurs de soins devraient obtenir les antécédents vaccinaux pertinents des femmes recevant des soins prénataux et leur offrir les vaccins nécessaires (III-A).
      • 2.
        En général, les vaccins vivants et vivants atténués ne devraient pas être administrés durant la grossesse parce qu'ils posent un risque essentiellement théorique pour le fœtus (II-3B).
      • 3.
        Les femmes enceintes ayant reçu par inadvertance un vaccin vivant ou vivant atténué ne devraient pas être encouragées à interrompre leur grossesse en raison d'un risque de tératogénicité (II-2A).
      • 4.
        Les femmes non enceintes recevant un vaccin vivant ou vivant atténué devraient être avisées d'éviter de tomber enceintes pour au moins quatre semaines (III-B).
      • 5.
        Les vaccins viraux inactivés, les vaccins bactériens et les vaccins à base d'anatoxine peuvent être administrés sans danger durant la grossesse (II-1A).
      • 6.
        L'allaitement maternel n'est pas une contre-indication à la vaccination (immunisation passive-active, vaccin vivant, à l'exception de la fièvre jaune, ou vaccin inactivé) (II-1A).
      • 7.
        Toutes les femmes enceintes devraient se voir offrir les vaccins à base d'anatoxine contre la diphtérie et le tétanos ainsi que le vaccin acellulaire contre la coqueluche au deuxième ou au troisième trimestre – préférablement entre la 21e et la 32e semaine de grossesse, pendant chaque grossesse – peu importe leurs antécédents vaccinaux (II-2A).
      • 8.
        Toutes les femmes enceintes, quel que soit leur trimestre, et les femmes susceptibles d'être enceintes pendant la saison de la grippe devraient se voir offrir le vaccin antigrippal inactivé afin de prévenir la mortalité et la morbidité maternelles et infantiles liées à cette infection (I-1A).
      • 9.
        Les femmes enceintes chez qui on soupçonne ou on a diagnostiqué une grippe devraient être traitées par l'administration d'oseltamivir (Tamiflu, 75 mg p.o. b.i.d.), et ce, peu importe leurs antécédents vaccinaux (III-B).
      • 10.
        Les femmes enceintes qui présentent des facteurs de risque précis en raison de leurs comorbidités médicales ou d'une exposition particulière devraient se voir offrir les vaccins contre l'hépatite B, l'hépatite A, le méningocoque et le pneumocoque afin de prévenir la morbidité maternelle (III-A).

      Mots clés

      Sigles:

      dcaT (vaccin contre la diphtérie, la coqueluche et le tétanos), dT (vaccin contre la diphtérie et le tétanos), ECR (essai clinique randomisé), ER (embryopathie rubéolique), OMS (Organisation mondiale de la Santé), PI (pneumococcie invasive), RRO (rougeole, rubéole, oreillons), SGB (syndrome de Guillain-Barré), VIH (virus de l'immunodéficience humaine), VPH (virus du papillome humain)
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