Pregnant women can now get a free RSV shot. What other vaccines do you need when you’re expecting?
- Written by: Archana Koirala, Paediatrician and Infectious Diseases Specialist, University of Sydney
From today, February 3[1], pregnant women in Australia will be eligible for a free RSV vaccine under the National Immunisation Program[2].
This vaccine is designed to protect young infants from severe RSV (respiratory syncytial virus). It does so by generating the production of antibodies[3] against RSV in the mother, which then travel across the placenta to the baby.
While the RSV vaccine is a new addition to the National Immunisation Program, it’s one of three vaccines provided free for pregnant women under the program, alongside ones for influenza and whooping cough[4]. Each offers important protection for newborn babies.
The RSV vaccine
RSV is the most common[5] cause of lower respiratory infections (bronchiolitis and pneumonia) in infants. It’s estimated that of every 100 infants born in Australia each year, at least two will be hospitalised with RSV[6] by six months of age.
RSV infection is most common roughly between March and August in the southern hemisphere, but infection can occur year-round[7], especially in tropical areas.
The vaccine works by conferring passive immunity (from the mother) as opposed to active immunity (the baby’s own immune response). By the time the baby is born, their antibodies are sufficient to protect them during the first months of life when they are most vulnerable to severe RSV disease.
The RSV vaccine registered for use in pregnant women in Australia, Abrysvo, has been used since 2023 in the Americas[8] and Europe[9]. Real-world experience there shows it’s working well.
For example, over the 2024 RSV season in Argentina[10], it was found to prevent 72.7% of lower respiratory tract infections caused by RSV and requiring hospitalisation in infants aged 0–3 months, and 68% among those aged 0–6 months. This research noted three deaths from RSV, all in infants whose mothers did not receive the RSV vaccine during pregnancy.
This was similar to protection seen in a large multinational clinical trial[11] that compared babies born to mothers who received this RSV vaccine with babies born to mothers who received a placebo. This study found the vaccine prevented 82.4% of severe cases of RSV in infants aged under three months, and 70% under six months, and that the vaccine was safe.
In addition to the maternal vaccine, nirsevimab, a long-acting monoclonal antibody[13], provides effective protection against severe RSV disease. It’s delivered to the baby by an intramuscular injection, usually in the thigh.
Nirsevimab is recommended for babies born[14] to women who did not receive an RSV vaccine during pregnancy, or who are born within two weeks of their mother having received the shot (most likely if they’re born prematurely). It may also be recommended for babies who are at higher risk of RSV due to a medical condition, even if their mother was vaccinated.
Nirsevimab is not funded under the National Immunisation Program, but is covered[15] under[16] various state[17] and territory-based programs[18] for infants of mothers[19] who fall[20] into the above categories[21].
But now we have a safe and effective RSV vaccine for pregnancy, all pregnant women should be encouraged to receive it as the first line of prevention. This will maximise the number of babies protected during their first months of life.
Flu and whooping cough
It’s also important pregnant women continue to receive flu and whooping cough vaccines in 2025. Like the RSV vaccine, these protect infants by passing antibodies from mother to baby.
There has been a large whooping cough outbreak in Australia[22] in recent months, including a death of a two-month-old infant[23] in Queensland in November 2024.
The whooping cough vaccine, given in combination with diphtheria and tetanus, prevents more than 90% of whooping cough cases[24] in babies too young to receive their first whooping cough vaccine dose.
Similarly, influenza can be deadly in young babies[25], and maternal flu vaccination substantially reduces[26] hospital visits associated with influenza for babies under six months. Flu can also be serious for pregnant women[27], so the vaccine offers important protection for the mother as well.
COVID vaccines are safe in pregnancy[28], but unless a woman is otherwise eligible, they’re not routinely recommended[29]. You can discuss this with your health-care provider.
When and where can you get vaccinated?
Pregnant women can receive these vaccines during antenatal visits through their GP or in a specialised antenatal clinic.
The flu vaccine[30] is recommended at any time during pregnancy, the whooping cough vaccine from 20 weeks[31] (ideally before 32 weeks), and the RSV vaccine from 28 weeks[32] (before 36 weeks).
It’s safe to receive multiple vaccinations at the same clinic visit[33].
We know vaccination rates have declined in a variety of groups[35] since the pandemic, and there’s evidence emerging that suggests this trend has occurred in pregnant women too.
A recent preprint[36] (a study yet to be peer-reviewed) found a decrease of nearly ten percentage points in flu vaccine coverage among pregnant women in New South Wales, from 58.8% in 2020 to 49.1% in 2022. The research showed a smaller drop of 1.4 percentage points for whooping cough, from 79% in 2020 to 77.6% in 2022.
It’s important to work to improve vaccination rates during pregnancy to give babies the best protection in their first months of life.
We know pregnant women would like to receive information about new and routine maternal vaccines early in pregnancy. In particular, many pregnant women want to understand how vaccines are tested for safety, and their effectiveness, which was evident during COVID.
GPs and midwives[37] are trusted sources of information on vaccines in pregnancy. There’s also information available online on Sharing Knowledge About Immunisation[38], a collaboration led by the National Centre for Immunisation Research and Surveillance.
References
- ^ February 3 (www.health.gov.au)
- ^ National Immunisation Program (www.health.gov.au)
- ^ production of antibodies (theconversation.com)
- ^ influenza and whooping cough (www.health.gov.au)
- ^ most common (www.thelancet.com)
- ^ at least two will be hospitalised with RSV (onlinelibrary.wiley.com)
- ^ can occur year-round (www.sciencedirect.com)
- ^ Americas (www.fda.gov)
- ^ Europe (ec.europa.eu)
- ^ 2024 RSV season in Argentina (framerusercontent.com)
- ^ large multinational clinical trial (journals.lww.com)
- ^ StoryTime Studio/Shutterstock (www.shutterstock.com)
- ^ monoclonal antibody (theconversation.com)
- ^ for babies born (immunisationhandbook.health.gov.au)
- ^ is covered (www.health.nsw.gov.au)
- ^ under (www.health.wa.gov.au)
- ^ various state (www.health.vic.gov.au)
- ^ territory-based programs (health.nt.gov.au)
- ^ infants of mothers (adelaidephn.com.au)
- ^ who fall (www.health.tas.gov.au)
- ^ the above categories (www.health.qld.gov.au)
- ^ large whooping cough outbreak in Australia (theconversation.com)
- ^ death of a two-month-old infant (www.theguardian.com)
- ^ prevents more than 90% of whooping cough cases (pubmed.ncbi.nlm.nih.gov)
- ^ deadly in young babies (www.cdc.gov)
- ^ substantially reduces (jamanetwork.com)
- ^ serious for pregnant women (www.health.gov.au)
- ^ safe in pregnancy (theconversation.com)
- ^ not routinely recommended (immunisationhandbook.health.gov.au)
- ^ flu vaccine (www.health.gov.au)
- ^ the whooping cough vaccine from 20 weeks (immunisationhandbook.health.gov.au)
- ^ from 28 weeks (immunisationhandbook.health.gov.au)
- ^ the same clinic visit (www.health.gov.au)
- ^ Olga Rolenko/Shutterstock (www.shutterstock.com)
- ^ variety of groups (theconversation.com)
- ^ recent preprint (www.medrxiv.org)
- ^ midwives (www.sciencedirect.com)
- ^ Sharing Knowledge About Immunisation (skai.org.au)
