I’m pregnant. Should I get the RSV vaccine?

Woman getting vaccine from person in lab coat — The RSV vaccine Abrysvo is shown to reduce RSV-related hospitalization of newborns for up to six months if the mother is vaccinated at 32-36 weeks of pregnancy.

Since COVID-19 social distancing ceased, we have seen surges of various respiratory viruses, including respiratory syncytial virus (RSV). Staying apart helped curb the circulation of COVID-19 but also lowered population immunity for other respiratory viruses.

For toddlers through middle-aged adults, RSV infection typically causes symptoms that resemble a common cold. But for those with low immunity – including infants less than 6 months old, people with chronic illnesses, and seniors 75 and older – RSV can cause serious conditions such as bronchitis and pneumonia that may require hospitalization. RSV is very contagious, and when other seasonal viruses such as influenza are circulating, the risk of severe illness increases. According to the Centers for Disease Control and Prevention (CDC), RSV is the leading cause of hospitalization for babies in the U.S.

Newborns cannot be vaccinated for RSV. However, their mothers can.

In 2023, the Food and Drug Administration (FDA) approved Abrysvo, an RSV vaccine developed by Pfizer for women who are pregnant. This vaccine is proven to be safe and effective in reducing severe RSV infection and hospitalization in newborns for up to six months after birth.

Timing is key with the RSV vaccine.

Abrysvo is available for women between 32 and 36 weeks of pregnancy and only during September through January – the approximate RSV season. When a woman who is pregnant gets the RSV vaccine during this specific recommended time frame, antibodies pass through the placenta to help provide protection after birth, when the baby’s immune system is not yet strong enough to make protective antibodies if the baby is exposed to RSV.

There are differences from other vaccine recommendations in pregnancy.

RSV timing recommendations are slightly different from the recommendations for third trimester Tdap vaccination, for example, which is given during each pregnancy throughout the year to protect against pertussis, also known as whooping cough. Pertussis is not a seasonal virus in the U.S. like RSV is. Additionally, unlike the flu and COVID-19 vaccines, which are annual injections, Abrysvo is currently a one-time injection because experts are waiting to review evidence on how long the protection lasts after the first dose. In the future, recommendations may change for women to get the vaccine in each pregnancy.

This is only the second year that Abrysvo has been available for women who are pregnant and recommended by the American College of Obstetricians and Gynecologists (ACOG) and the CDC. So, let’s address some common questions about RSV, the vaccine, and what to do if your newborn is at risk of getting sick.

baby crying — Toddlers with RSV often have mild symptoms, such as coughing, sneezing, stuffy or runny nose, or a low fever.

How does RSV spread?

RSV is a very contagious virus that spreads through close contact with someone who is infected. This can be through droplets sprayed by a sneeze or cough or by touching an infected hard surface and then touching your face.

In toddlers through middle-aged adults, symptoms are typically mild and can include coughing, sneezing, stuffy or runny nose, low fever, sore throat, or headache. Seniors, people who are immunocompromised, and newborns are more vulnerable to severe RSV infection, which can cause symptoms such as:

Rapid, labored breathing
Wheezing
High fever

Extreme fatigue
Bluish tint to the lips, nails, and skin

pregnant woman getting vaccine — Health officials recommend women who are pregnant get the RSV vaccine between the 32nd and 36th week of pregnancy.

How does the RSV vaccine work?

Abrysvo is shown to increase RSV antibody levels in pregnant women. Antibodies are passed to the baby in pregnancy through the placenta and to the newborn through breast milk, helping to protect them for up to six months after birth.

ACOG and CDC recommend that women get the RSV vaccine if they will be in weeks 32-36 of pregnancy in September through January.

These months are key because those babies will be born in the prime season for respiratory viruses to spread.

The 32- to 36-week time frame gives the fetus time to get the full benefit of antibodies from the mother from the placenta before delivery.

Research shows that among babies whose mothers were vaccinated between 32 and 36 weeks of pregnancy, the vaccine reduced the risk of severe lower respiratory tract disease by 91.1% through 90 days (three months) after delivery and 76.5% through 180 days (six months).

If you get Abrysvo in one pregnancy, you don’t have to get it again in your next pregnancy (so far). For babies born to women who did not get the RSV vaccine and who need protection, your child’s pediatrician may administer a dose of nirsevimab, a monoclonal antibody medication approved by the FDA in 2023. Nirsevimab is not a vaccine. Instead, it uses lab-created antibodies to help protect against RSV for up to five months.

It is safe to get the RSV vaccine in combination with flu and COVID-19 vaccinations if the timing lines up for your pregnancy. However, the Tdap vaccine for whooping cough is typically given as early as 27 weeks of pregnancy. While it is safe to get the two vaccines in a single visit, the timing may not work.

Who else in my family should get vaccinated?

Like a cocoon that protects a caterpillar as it grows into a butterfly, vaccinated family members insulate a newborn’s developing immune system. This is called the “cocoon effect.” That’s why the CDC recommends that seniors get the RSV vaccine: for their own health and to reduce the risk of spreading the virus to others.

Your pediatrician may recommend that other children in the home ages 8-19 months get a dose of nirsevimab depending on risk. Talk with your pediatrician about ways to reduce your baby's risk of RSV infection, such as frequent handwashing, limiting visitors and crowd exposure, and disinfecting older siblings’ toys.

What if my newborn is at high risk for RSV?

Babies may be at increased risk of severe illness from an RSV infection if they are born prematurely (before 37 weeks of pregnancy), are of American Indian or Alaska Native ancestry, have a heart, lung, or immunocompromising condition such as cystic fibrosis or HIV, or did not have adequate antibodies during pregnancy.

If your baby is at high risk for RSV, your pediatrician may recommend nirsevimab, which can help protect the baby for about five months. Nirsevimab is shown to be 77% effective at preventing RSV-related emergency room visits and 98% effective at preventing RSV-associated hospitalization in babies. However, most babies 8 months or younger whose mothers got an RSV vaccination will not need nirsevimab.

What if my newborn gets RSV?

Call your pediatrician right away if you think your baby has RSV. It’s better to check in rather than wait for severe symptoms to start. About 2% of babies younger than 6 months who have RSV need to be hospitalized to get breathing support, fever management, and IV fluids.

This year, there are several recommended vaccines for pregnant patients. If you have questions or concerns, talk with your prenatal care provider. We’re here to give you the information you need to make an informed choice about your pregnancy and your newborn’s health.

To talk with an expert about RSV and vaccination, call 214-645-8300 or request an appointment online.