Maternal, Newborn, and Child Health
MNCH Immunization Interventions
Maternal, Newborn, and Child Health
MNCH Immunization InterventionsImmunization for Pregnant Women
Protecting Mothers and Babies Through Antenatal Vaccination
Infectious diseases that can be prevented through vaccination pose serious health risks to mothers, newborns, and young infants, contributing to illness and death in these vulnerable populations.
When mothers receive vaccines during pregnancy, this provides multiple layers of protection: it directly shields the mother from vaccine-preventable infections, creates a protective barrier around the developing baby (known as the cocooning effect), and transfers disease-fighting antibodies across the placenta to give the baby immunity before birth.
What Are the Benefits of Immunizing Pregnant Women?
- Direct Maternal Protection: Antenatal vaccines provide immediate protection to pregnant women, who face heightened vulnerability to certain infections due to pregnancy-related changes in their immune system. Vaccines like influenza and COVID-19 prevent serious maternal illness that could lead to hospitalization, pregnancy complications, or even maternal death.
- Prevention of Pregnancy Complications: Maternal infections during pregnancy can trigger serious complications, including preterm labor, premature rupture of membranes, low birth weight, and fetal growth restriction. Antenatal vaccination significantly reduces these risks by preventing the underlying infections that cause such complications.
- Passive Immunity Transfer to Newborns: A critical benefit is the transfer of maternal antibodies to the baby through the placenta. This process, called passive immunization, provides newborns with immediate protection against diseases during their most vulnerable first months of life, before their own immune systems mature enough to respond to vaccines.
- Extended Infant Protection: Maternal antibodies can protect infants for several months after birth, bridging the gap until babies can receive their own vaccinations. For example, maternal pertussis (whooping cough) vaccination provides protection during the critical first 2-3 months when infants are too young to be vaccinated and most vulnerable to severe disease.
- Cocooning Effect: When mothers are vaccinated, they’re less likely to contract and transmit infections to their newborns, creating a protective “cocoon” around the baby. This is particularly important for household transmission of respiratory infections like influenza and pertussis.
- Optimal Antibody Timing: Vaccination during the recommended windows of pregnancy (typically second or third trimester) ensures peak antibody levels are achieved before delivery, maximizing the level of protective antibodies transferred to the baby.
How to Implement
1. Assess Disease Burden
- Assess the disease burden that may be addressed through the introduction of new vaccines and the programmatic feasibility.
2. Develop Age-Appropriate Vaccination Schedules for Women 15–49 Years
- Strengthen antenatal care systems, as women who present late in pregnancy may miss the opportunity for timely vaccination.
3. Train Providers on Vaccination Counseling and Administration
- Leverage existing maternal tetanus elimination program structures as a platform on which to build additional maternal vaccination programs.
4. Embed Policies and Procedures
- Establish policies embedded into guidelines, reminders incorporated into antenatal records, and clearly outlined procedures for vaccine administration.
- Develop national and facility-level clinical protocols that specify which vaccines to give, when to administer them (e.g., influenza anytime during pregnancy, Tdap between 27-36 weeks), contraindications, and counseling requirements.
- Build vaccination prompts directly into antenatal care documentation systems, whether paper-based or electronic. This includes adding vaccine checklists to maternal health cards, creating standardized forms that prompt providers to assess vaccination status at each visit, and establishing reminder systems that flag when vaccines are due.
- Establish clear, step-by-step protocols for vaccine delivery, including patient eligibility screening, informed consent processes, proper vaccine storage and handling, administration techniques, documentation requirements, and post-vaccination monitoring.
5. Build Provider Capacity
- Build healthcare provider capacity through training, as provider recommendation is one of the most important determinants of vaccine uptake.
What’s the Evidence?
- Based on the reviewed data, the WHO’s Global Advisory Committee on Vaccine Safety concluded that there is no evidence of adverse pregnancy outcomes from the vaccination of pregnant women with inactivated virus, bacterial, or toxoid vaccines. Therefore, pregnancy should not preclude women from immunization with the assessed vaccines if medically indicated.
- According to this 2024 Advocacy Brief:
- Inactivated influenza vaccines have been administered to pregnant women for the past 50 years, with no evidence of associated adverse effects in either women or their newborn infants. Live attenuated influenza vaccines are contraindicated during pregnancy.
- Even for individuals previously vaccinated against pertussis, the WHO recommends administration of one dose of tetanus, diphtheria, and acellular pertussis vaccine (Tdap) during pregnancy, in the 2nd or 3rd trimester, and preferably at least 15 days before delivery.
- Pregnant women are at higher risk of developing severe disease and complications from influenza infection during pregnancy and up to 2 weeks postpartum. For women pregnant during flu season, influenza vaccination provides safe and effective prevention against infection. Maternal immunity is also transferred to the infant, offering protection during the first weeks of life.
- COVID-19 infection during pregnancy poses an increased risk of severe maternal illness and preterm birth. COVID-19 vaccines are safe and provide robust protection against these severe outcomes. COVID-19 vaccines do not contain live virus and therefore cannot cause infection in the mother or fetus.
Key Indicators
- Percentage of pregnant women receiving recommended vaccines (e.g., tetanus toxoid, influenza, Tdap) during pregnancy.
- Timeliness of vaccination (percentage receiving vaccines within optimal gestational age windows).
- Percentage of facilities offering vaccination services on-site.
- Healthcare provider recommendation rates for maternal vaccination.
- Percentage of providers trained in maternal immunization protocols.
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Tips
- Present Vaccination as Routine Care: Having institutional support with policies embedded into guidelines, reminders incorporated into antenatal records, and a clearly outlined procedure for how women should receive vaccination all help to embed vaccination within workplace culture.
- Provide Vaccines On-Site During Visits: Studies show that immunization rates are higher when a health care provider can offer and administer the vaccine during the same visit, as opposed to recommending vaccination and referring the patient elsewhere.
Challenges
- Late Presentation and Incomplete Vaccination Series: Strengthen preconception care services to reach women earlier, implement catch-up vaccination protocols during early pregnancy when safe, and prioritize single-dose vaccines or accelerated schedules where appropriate.
- Limited Provider Knowledge and Service Coordination: Develop comprehensive training programs on maternal immunization for all reproductive health staff, establish integrated service delivery models, and create standardized protocols that clearly define roles and responsibilities across services.
- Infrastructure and Supply Chain Challenges: Strengthen health system infrastructure through targeted investments, advocate for inclusion of maternal vaccines in national immunization programs, and work with global partners to improve vaccine affordability and supply security.
Key Resources
- Maternal and neonatal tetanus elimination strategies. WHO
- Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development. Frontiers in Immunology 2020
- How to implement influenza vaccination of pregnant women. WHO 2016
- Immunization in Practice modules. WHO 2015
- Maternal Immunization Safety Monitoring in Low- and Middle-Income Countries. GAPPS 2017
- Pertussis vaccines position paper. WHO 2015
- Tetanus vaccines position paper. WHO 2017
- Vaccines against influenza position paper. WHO 2022
- Questions and Answers: COVID-19 vaccines and pregnancy. WHO 2022
