 Hi everyone, I am Dr. Yashika Gudesar. I am head of the department at Manipal Hospital, Dwaraka in Obstetrics and Gynecology. 10th November is the World Immunization Day and I would like to highlight few points about immunization in females during pregnancy and otherwise also. So, first of all immunization, it is a very important thing to get yourself immunized and it is a protection to prevent ourselves from having few diseases. So, when a female comes to me for the first time, if she is planning a pregnancy and she has come for a preconceptional counseling, I usually ask them to go for a few tests like IgG Rubella and Varicella IgG. So, Varicella is a chickenpox and Rubella is also a viral disease for which a female should be vaccinated before they are planning for a pregnancy. So, if the IgG levels are low for a patient, most of the patients in our country are already immunized in their childhood with MMR vaccine. So, Rubella is usually vaccinated, usually is immune, the patient is immune to Rubella and for Varicella, most of us have had chickenpox in their childhood. So, they do not need a vaccination for chickenpox. So, if somebody does not have immunity for these two diseases, then we give them vaccination beforehand. For Rubella, it will be a single dose and for chickenpox, it will be two doses one month apart. If somebody has taken these two vaccines, they should not plan pregnancy for next three months. If somebody conceives in between, we do not ask for termination, but there is a risk for having a malformation. So, we advise against it. A young girl who is not planning a pregnancy, who is in a teenager or who has come to us for the first time for some infection or some disease, we take an opportunity to advise them to go for a cervical cancer vaccine. We all know cervical cancer is preventable and cervical cancer can be prevented by taking a HPV vaccine. HPV is human papilloma virus. It is a virus which causes this chances of increases the chance of cervical cancer in females. So, if we take the vaccine against the for HPV, so it prevents us from getting that infection. So, if a female is less than 15 years of age, she should take two doses. After starting from the 9 years of age till 15 years of age, she can take the vaccine. If one dose has been taken before the age of 15 years, she can take the second dose anytime in her lifetime. So, ideally it should be taken two doses before 15 years and if somebody who is more than 15 years of age and taking her first dose will be taking three doses. My advice to all my patients is till the age of 45, they can take the vaccine because cervical cancer doesn't happen anytime, it can happen at a time after the first exposure, after 10 years of first sexual encounter with the human papilloma virus. So, if somebody is active at the 35 years of age of 40, the first time they have encountered, they can have cervical cancer even at a later age. So, whenever you have some female has become sexually active or if the patient is married, the person is married or if nowadays in young girls also, we are vaccinating as early as possible. But many people in our age group who have not been vaccinated early can take the vaccine later on also. So, this vaccine has to be taken for the three doses, the course will be 0, 2 and 6. So, if you miss earlier we used to give it at the time period which has been determined. But lately WHO has said it is not necessary to take the vaccine on the same date. If somebody has missed the second dose or the third dose, they can take the vaccine later on whenever they remember it or they have got delayed. In a pregnancy, if a patient is pregnant, they come to me. So, the first vaccine which is given is the tetanus dose. Nowadays in our country, TT is already becoming obsolete and TD and Tdap is which has come into play. We are giving a single dose of Tdap which comes in the name of boostrix also, tetanus, diphthida and pertussis are there. After the weeks of 26 weeks, we can give the first dose. That can be given and then there is a second dose at the second vaccine which is important in pregnancy nowadays is the influenza vaccine. As we know, influenza is very common, swine flu was there earlier. So, we are giving this influenza vaccine which has to be taken otherwise daily for a non-pregnant person also or in pregnancy even if you have taken a first dose earlier, you have to take the second dose and influenza vaccine can be taken after 26 weeks anytime and Tdap can be taken between 28 weeks to 32 weeks anytime before the pregnancy and if somebody has missed the second dose, they can take it postpartum just after delivery. So, vaccination is very important during pregnancy and a non-pregnant. All females should be aware of the vaccines which they have not taken. So, please take care and take your vaccines, meet your gynecologist and take your vaccines in time. Thank you.