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This report surveyed vaccination decisions during pregnancy based on the package inserts of vaccines approved in Japan, the USA, and Europe. Furthermore, it evaluates vaccination decision-making factors based on the characteristics of the target infections and the modality of the vaccines. Live vaccines known to cause fetal abnormalities are contraindicated for pregnant women, whereas vaccines for life-threatening infectious diseases are authorized for administration during pregnancy when the need is recognized, even for live vaccines. We compared the World Health Organization and European Medicines Agency guidelines on the development of vaccines for pregnant women and surveyed the details of the studies to collect information on SARS-CoV-2 vaccination during pregnancy. In compliance with the guidelines, for all SARS-CoV-2 vaccines, non-clinical reproductive and developmental toxicity studies and clinical trials including non-pregnant women of childbearing age were conducted prior to the vaccination of pregnant women. For all vaccines, information from registries on vaccination during pregnancy are used for post-marketing surveillance. While it is desirable to vaccinate women before pregnancy through planned immunization, whenever possible, pandemics such as H1N1 influenza and COVID-19 may require vaccination even during pregnancy. Necessary and sufficient studies for the decision of vaccination during pregnancy should be carried out promptly.

To determine changes in cervical muscle strength after laminoplasty and to evaluate the relation between muscle strength and neck pain, we measured maximum isometric muscle strength using a handheld dynamometer. We also investigated neck pain before surgery and every month after surgery in 21 subjects who had undergone French-door laminoplasty. Muscle strength decreased particularly 1 month after surgery, the extensor muscles being affected more than the flexors. The strength of both muscle groups increased gradually; and at 1 year after surgery they had regained their presurgical status. All of the subjects complained of severe neck pain after 1 month. Their complaints began to decrease a few months after surgery, although they were still present in nine patients at 1 year after surgery. The correlation between muscle strength and neck pain was strongly negative for extension and flexion in men and for extension in women. No correlation was found between flexor muscle strength and neck pain in women. The extension/flexion ratio was significantly high in the neck pain group 1 year after surgery. Our results suggest that symptoms within a few months after surgery are due to surgical trauma to the soft tissues but that chronic neck pain derives from an imbalance of the two muscle strengths.