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Evidence Library · Staying well

Vaccines in pregnancy, with the actual numbers

Three, with genuinely different strengths of evidence.

Tdap, for whooping cough. In a cohort of 148,981 newborns, maternal Tdap was 91.4% effective at preventing pertussis in the first two months of life and 69.0% effective across the first year. The first two months are the point, because that is before a baby can be vaccinated.

Influenza. In 3,764 infants under six months across 7 US centres, maternal vaccination was 34% effective against flu-related hospital or emergency visits, 53% in infants under three months. Third-trimester vaccination was 52% effective; first or second trimester vaccination showed no significant effect.

RSV. In a randomized trial of 7,358 pregnant women, medically attended severe RSV lower respiratory illness in the first 90 days occurred in 6 infants of vaccinated mothers against 33 of unvaccinated, an efficacy of 81.8%. At 180 days it was 19 against 62, an efficacy of 69.4%. The wider endpoint of any RSV illness did not meet its statistical target.

Reading these honestlyTdap and RSV show large effects on the outcomes that matter most, and the RSV numbers are absolute counts you can check. Influenza vaccine in pregnancy has a more modest effect, concentrated in the youngest infants and in third-trimester vaccination. All three are more useful the closer the baby is to being born.
Where this comes from:
166. Baxter R, Bartlett J, Fireman B, Lewis E, Klein NP. Effectiveness of vaccination during pregnancy to prevent infant pertussis. Pediatrics. 2017;139(5):e20164091.
167. Sahni LC, Olson SM, Halasa NB, Stewart LS, Michaels MG, Williams JV, et al. Maternal vaccine effectiveness against influenza-associated hospitalizations and emergency department visits in infants. JAMA Pediatr. 2024;178(2):176-184.
168. Kampmann B, Madhi SA, Munjal I, Simões EAF, Pahud BA, Llapur C, et al. Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants. N Engl J Med. 2023;388(16):1451-1464.

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