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Vaccination During Pregnancy Guide

Vaccination during pregnancy protects both parent and baby from serious diseases. This guide covers recommendations for whooping cough, influenza, COVID-19, and RSV vaccines, highlighting safety, timing, and benefits for newborn protection.

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Key Summary

  • Why it matters: Pregnancy naturally suppresses the immune system, increasing the risk of severe influenza, COVID-19, and RSV, as well as complications from whooping cough.
  • Key vaccines recommended:
    • Pertussis (dTpa): Between 20–32 weeks to protect infants until their own vaccinations begin.
    • Influenza: At any stage of pregnancy; reduces risks of stillbirth, preterm birth, and severe illness.
    • COVID-19: mRNA vaccines (Pfizer/Moderna) are safe and effective, lowering risks of ICU admission, preeclampsia, and poor neonatal outcomes.
    • RSV (Abrysvo): Between 28–36 weeks to protect infants in their first 6 months of life.
      • Infant protection: Antibodies passed via the placenta (and breast milk) protect babies who are too young to be vaccinated.
  • Safety: Large studies show maternal vaccination is safe for both parent and baby, with only mild side effects.

About Pregnancy And Vaccinations

People are particularly vulnerable during pregnancy and should receive the whooping cough (pertussis)  vaccine, the influenza vaccine, and now a COVID-19 vaccine and an RSV vaccine to protect themselves and their baby. As the immune system is naturally suppressed during pregnancy, patients face an increased risk of contracting influenza or COVID-19 and associated complications.

Influenza, whooping cough and COVID-19 are serious illnesses that can affect both the parent and baby. Most children will contract RSV at least once before they turn two years of age.[1] Vaccination can help keep parents and babies healthy and protect the newborn in the first 6 months of life.

Whooping Cough Vaccination During Pregnancy

Whooping cough is a highly infectious bacterial disease that causes severe bouts of coughing. In adults the symptoms can be mild, but for a baby who is not yet vaccinated it can be life-threatening.

Vaccination during pregnancy (preferably between 20-32 weeks) allows the body to produce antibodies that are passed on to the baby before birth.

These antibodies will protect the baby until they are able to receive their own vaccination at 6 weeks of age.

Studies have found that whooping cough vaccination during pregnancy is safe and effective for both parent and baby.

Studies from the US and UK involving more than 40,000 pregnant patients found only mild side effects, such as pain or redness in the arm where the vaccination was given. It does not increase the risk of serious pregnancy complications such as premature birth. The National Health and Medical Research Council (NHMRC) recommends that people who are pregnant be vaccinated in their mid-2nd trimester and early 3rd trimester (ideally at 20–32 weeks).

Recommendations

A single dose of pertussis-containing vaccine is recommended in each pregnancy

Patients who recently gave birth and did not receive pertussis-containing vaccine during pregnancy are recommended to receive the vaccine as soon as possible

A dTpa vaccine can be administered during the breastfeeding period[27].

Influenza Vaccination During Pregnancy

How does influenza affect the parent and baby?

Influenza is a potentially severe disease that can affect both the parent and baby. It can impact the parent during the second and third trimesters and the baby in the first few months after birth, even causing death.

What is the risk?

On average each year in Australia, influenza causes approximately 100 deaths and 5,100 hospitalisations.[2] Contracting influenza while pregnant results in a disproportionate amount of this burden. 

In Australia, the 2009 epidemic of influenza A(H1N1)pdm09 (commonly known as 2009 H1N1) resulted in increased admissions to intensive care. The highest excess ICU admission rate was in Aboriginal and / or Torres Strait Islander peoples (17/100,000) and during pregnancy (14/100,000):[3] 

  • Overall, nearly 10% of those admitted to ICU with AH1N1v while pregnant died
  • Over 10% suffered pregnancy losses
  • More than 50% of the remaining individuals delivered preterm, emphasising the severity of the disease in pregnancy[4] 

Considerable decreases in influenza cases have been reported since April 2020 due to the COVID-19 epidemic in Australia. Physical distancing, travel restrictions, emphasis on hygiene, changes in testing priorities, and the diversion of resources to the COVID-19 response may all have affected the numbers.[5][6] With the reopening of international borders in November 2021 and the increase in population movement, there was a notable resurgence of influenza activity in 2022 with the virus circulating early in the season. The persistent seasonal spread of influenza observed in 2023 is likely to continue, underscoring the importance of vaccination for vulnerable populations who are at a heightened risk of complications from the flu.[2]

What are the complications?

The natural suppression of the immune system during pregnancy may increase the risk of contracting influenza. Additionally, people have an increased risk of severe complications during pregnancy, including stillbirth, premature birth, and suboptimal foetal growth.

How can parents protect themselves and the baby?

Influenza vaccination protects against these complications. Although vaccination rates have recently increased,  the risk of influenza to the unborn baby is often underestimated. Not enough people understand that the baby cannot be vaccinated against influenza in the first 6 months of life. Multiple studies show that influenza vaccination at any stage of pregnancy is associated with a 20% reduction in the risk of stillbirth.

What do parents need to know during pregnancy?

According to Elizabeth McCarthy, Senior Lecturer Department of Obstetrics and Gynecology, University of Melbourne Perinatal Centre, Mercy Hospital for Women:

The influenza vaccine is nationally approved and free during pregnancy. The vaccine is the best way to protect the mother and baby. Vaccinating against influenza during pregnancy gives a 3 for 1 benefit:

  1. Protects the parent during pregnancy and in the early months of parenthood
  2. Protects the unborn baby by transplacental antibodies
  3. Protects the young infant by antibodies in breast milk

Recommendations

An influenza vaccination is recommended during pregnancy.

COVID-19 Vaccination During Pregnancy

COVID-19 can cause harm during pregnancy

People who contract COVID-19 during pregnancy are:

  • 4.37 times more likely to have complications while pregnant[7]
  • More likely to require care in an intensive care unit (ICU), to need a ventilator (for breathing support), or to die from the illness
  • More likely to have a caesarean birth,  preeclampsia or eclampsia, and blood clots[8]

When compared to the babies from pregnancies with no COVID-19, the babies of COVID-19 patients are:

  • More likely to be born prematurely
  • More likely to be admitted to a hospital newborn care unit
  • More likely to be stillborn
  • More likely to experience distress during birth

COVID-19 vaccination

Real-world evidence has demonstrated that the original mRNA vaccines from Pfizer and Moderna are safe for use during pregnancy and breastfeeding. While data on the newer variant vaccines during pregnancy is limited, there are no additional safety concerns compared to the original vaccines. However, there is currently less information available about the use of the Novavax vaccine during pregnancy.[9]

The Pfizer vaccine can be given as two doses, 3–6 weeks apart, and the Moderna vaccine can be given as two doses, 4–6 weeks apart.[24][25][26]

COVID-19 vaccination effectiveness during pregnancy

Results from a vaccination program in Israel show that the Pfizer COVID-19 vaccine is effective in preventing COVID-19 during pregnancy.[10] Research shows that antibodies produced during vaccination cross the placenta and may provide some protection to newborn babies.

In the UKOSS study of COVID-19 from 1 February to 30 September 2021, 1,714 people were admitted to hospital with symptomatic COVID-19 while pregnant:[11]

  • 98.1% of these individuals were unvaccinated
  • 1.5% had received one vaccine dose
  • 0.4% had received two doses

14% of the people hospitalised (235 individuals) were admitted to intensive care:

  • 98.7% of these individuals were unvaccinated
  • 1.3% (3 people) had received a single dose of vaccine
  • None had received two doses

During the third wave (Delta wave) of COVID-19 in the UK, the pregnancy-related deaths were mainly seen in unvaccinated people.

Data from vaccination programs across several countries indicate that the Pfizer and Moderna vaccines are effective in preventing SARS-CoV-2 infection and severe outcomes during pregnancy. To achieve optimal protection against the Omicron variant, it is necessary to receive two initial doses followed by a booster dose. Studies have shown that receiving  an additional booster dose while pregnant leads to lower rates of severe illness compared to those who receive only the initial two doses. During the Omicron surge, a two-dose vaccination regimen reduced the risk of severe COVID-19 complications by 48%, while three doses  (including the booster) reduced the risk by 76% compared to the unvaccinated.[9]

COVID-19 vaccine safety during pregnancy

Evidence from other countries shows that the Pfizer and Moderna COVID-19 vaccines are safe during pregnancy. A U.S. study[12] involving more than 35,000 pregnant individuals found that the side effects after vaccination were similar in both pregnant and non-pregnant participants. The possible side effects include pain at the injection site, tiredness, fever, headache, muscle and joint pain, chills, and diarrhoea.

Recommendations

A primary dose of COVID-19 vaccine is recommended during pregnancy, which can be given at any time.

  • Comirnaty JN.1 and Omicron XBB.1.5-based vaccines can be used in pregnancy. Although the latest mRNA COVID-19 vaccines (Comirnaty JN.1 and Omicron XBB.1.5-based vaccines) have not been formally studied during pregnancy, ATAGI considers them suitable and safe for use[28]. 

Patients who have previously been vaccinated are not routinely recommended to have a further dose of COVID-19 vaccine during pregnancy. However, they can consider a further dose of COVID-19 vaccine based on presence of underlying risk conditions and/or personal preference. 

RSV Vaccination During Pregnancy

RSV is a highly infectious virus, and most children will get it at least once before they turn 2 years of age.[13]

From 2006–2015, there were 63,814 hospitalisations with an RSV-specific principal diagnostic code; 60,551 (94.9%) were in children under 5 years of age.[14]

Between 2016 and 2019 there were more than 115,000 hospitalisations with an RSV diagnosis in Australia, of which approximately 75% were in children aged less than 5 years. Most of these children were otherwise healthy. For infants aged less than 6 months, the annual RSV hospitalisation rate over this period was approximately 6,200 per 100,000 population, with the highest rates in infants aged 0–2 months (approximately 7,200 per 100,000 population).[15]

From when RSV became a notifiable disease in 2021 to 24 July 2025, there have been 511,319 cases reported to the National Notifiable Disease Surveillance System, with 253,151 (49.5%) occurring in children aged <5 years[16]

RSV is associated with increased morbidity among preterm babies and infants born with chronic health conditions such as respiratory and/or cardiac complications.[17]

Vaccines

ABRYSVO is a recombinant respiratory syncytial virus (RSV) pre-fusion F protein vaccine formulated to actively immunise pregnant patients, particularly between 24–36 weeks of gestation, to prevent lower respiratory tract disease caused by RSV in infants from birth–6 months of age.[18] 

Vaccine effectiveness

Vaccination during pregnancy reduces the risk of severe RSV disease in infants under 6 months of age by around 70% (see Vaccine information). This protection results from the passive transfer of RSV-specific antibodies from the parent to the foetus during pregnancy via the placenta.[19]

Timing of vaccination

The recommended time for RSV vaccination during pregnancy is between 28–36 weeks gestation. Although Abrysvo is registered from 24–36 weeks gestation, administration from 24–<28 weeks of gestation is not routinely recommended until more safety and efficacy data is available for people at this stage of pregnancy and their newborn infants.[19]

RSV vaccine can be given at any time of the year, regardless of when someone is expected to deliver.

Recommendations

An RSV vaccine is recommended during pregnancy to protect the infant.

RSV Prevention In High-Risk Infants

High-risk infants are those who are more likely to develop complications from RSV. This group includes premature infants, those with heart or lung problems, and those who are immunocompromised.

Monoclonal antibodies

Palivizumab

Palivizumab is an injectable monoclonal antibody indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. It is given intramuscularly and is directed at a protein in RSV. It has been shown to reduce intensive care unit admissions for babies who have been hospitalised for RSV.[20][21]

Nirsevimab

Nirsevimab is an injectable, long-acting monoclonal antibody that provides protection against RSV disease for at least 5 months after a single dose. It is indicated for the prevention of RSV lower respiratory tract disease to protect all infants against severe disease during or entering their first RSV season, and young children under 24 months who are vulnerable to severe disease during their 2nd RSV season.[22][23]

As with RSV vaccines, RSV monoclonal antibody medications should only be prescribed by a medical practitioner and used according to the approved TGA indication.

Recommendations

Neonates and infants aged <8 months whose mothers were not vaccinated at least 2 weeks before delivery, or who are at increased risk of severe disease, are recommended to receive passive immunisation with an RSV-specific monoclonal antibody

Older infants and young children ≥8 to 24 months of age who are at risk of severe RSV disease are recommended to receive RSV-specific monoclonal antibody before their 2nd RSV season

References

  1. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed August 2023
  2. Australian Government Department of Health. Influenza (flu) | The Australian Immunisation Handbook [Internet] 2023 [cited 18 Jul 2024]. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu
  3. Schaffer et al BMC Public Health 2012 12:869
  4. Knight M, Pierce M, Seppelt I, et al. Critical Illness with AH1N1v Influenza in Pregnancy: A Comparison of Two Population-based Cohorts. BJOG. 2011;118(2)232-9
  5. Department of Health Australian Influenza Surveillance Report and Activity Updates page last updated 1/10/2021
  6. Bright A et al Commun Dis Intell (2018) 2020;44 (https://doi.org/10.33321/cdi.2020.44.85) Epub 5/11/2020
  7. Herrera-Ceballos E, Herrera Ceballos M, Villalba García Y. Impact of SARS-CoV-2 infection in pregnant women and their babies. J Matern Fetal Neonatal Med. 2023;36(5):1077-1085. doi:10.1016/j.jmatern.2023.03.008. Available from https://www.sciencedirect.com/science/article/pii/S0213911123000535
  8. American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), Pregnancy, and Breastfeeding. 2023. Available from https://www.acog.org/womens-health/faqs/coronavirus-covid-19-pregnancy-and-breastfeeding
  9. Australian Government Department of Health. COVID-19 vaccination: Shared decision making guide for women who are pregnant, breastfeeding or planning pregnancy. 2024 Jan. Available from https://www.health.gov.au/sites/default/files/2024-01/covid-19-vaccination-shared-decision-making-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy.pdf
  10. Goldshtein I, Nevo D, Steinberg DM, et al. Association Between BNT162b2 Vaccination and Incidence of SARS-CoV-2 Infection in Pregnant Women. JAMA. Published online July 12, 2021. doi:10.1001/jama.2021.11035
  11. UKOSS study of COVID-19 vaccine during pregnancy, Infographic summary October 11, 2021
  12. Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med. Published online April 21, 2021. doi:10.1056/nejmoa2104983
  13. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed August 2023
  14. Saravanos G L Respiratory syncytial virus‐associated hospitalisations in Australia, 2006–2015; Med J Aust 2019; 210 (10): 447-453. || doi: 10.5694/mja2.50159
  15. National Centre for Immunisation Research and Surveillance (NCIRS). Respiratory syncytial virus (RSV): Frequently asked questions (FAQs). Available from https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked [6 June 2024].
  16. National Notifiable Disease Surveillance System. Available from https://nindss.health.gov.au/pbi-dashboard/ [Accessed 18 May 2024].
  17. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated December 2023
  18. Australian Product Information – ABRYSVO® (Recombinant Respiratory Syncytial Virus Pre-fusion F Protein) Vaccine. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2024-PI-01489- [Accessed 18 May 2024].
  19. Australian Government Department of Health and Aged Care. Respiratory syncytial virus (RSV). In: Australian immunisation handbook. Canberra: Australian Government Department of Health and Aged Care; 2023. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/respiratory-syncytial-virus-rsv#overview
  20. AstraZeneca Pty Ltd. (2021). Australian product information: SYNAGIS® (palivizumab) solution for injection [Product information]. Retrieved from https://medsinfo.com.au/product-information/document/Synagis_PI
  21. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated December 2023
  22. Australian Technical Advisory Group on Immunisation (ATAGI). (2024, March 26) Statement On The Use Of Nirsevimab For Prevention Of Severe Disease Due To Respiratory Syncytial Virus (RSV) In Infants https://www.nitag-resource.org/sites/default/files/2024-04/atagi-statement-on-nirsevimab-2024.pdf
  23. Sanofi-Aventis Australia Pty Ltd. (2023). Australian product information: BEYFORTUS™ (nirsevimab) solution for injection [Product information]. Retrieved from https://medsinfo.com.au/consumer-information/document/Beyfortus_CMI
  24. Therapeutic Goods Administration (TGA). Australian Product Information: COMIRNATY® Omicron XBB.1.5 (raxtozinameran) COVID-19 VACCINE. [Internet]. Canberra (ACT): Australian Government Department of Health; 2023. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-PI-02409-1&d=20240823172310101
  25. Therapeutic Goods Administration (TGA). Australian Product Information: COMIRNATY® Original/Omicron BA.4-5 COVID19 VACCINE. [Internet]. Canberra (ACT): Australian Government Department of Health; 2023. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-PI-01101-1&d=20240823172310101
  26. Therapeutic Goods Administration (TGA). Australian Product Information: SPIKEVAX XBB.1.5 (ANDUSOMERAN) COVID-19 VACCINE. [Internet]. Canberra (ACT): Australian Government Department of Health; 2023. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2023-PI-02413-1
  27. Australian Government Department of Health and Aged Care. Pertussis (whooping cough): Women who are pregnant or breastfeeding [Internet]. Canberra: Australian Government; 2024 [cited 2025 Jul 24]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pertussis-whooping-cough#women-who-are-pregnant-or-breastfeeding
  28. Australian Government Department of Health and Aged Care. COVID-19: Women who are pregnant or breastfeeding [Internet]. Australian Immunisation Handbook. Canberra: Department of Health and Aged Care; [cited 2025 Jul 17]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/covid-19#women-who-are-pregnant-or-breastfeeding

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