Vaccines in pregnancy in Canada

What is recommended in every pregnancy

Canada's national recommendations come from the National Advisory Committee on Immunization (NACI) and are collected in the Canadian Immunization Guide, published by the Public Health Agency of Canada. NACI advises; provinces and territories then decide what they fund. That split matters, because a vaccine can be strongly recommended nationally and still cost you money in one province while being free in another.

The principle underneath all of it is simple. Non-live vaccines are considered safe in pregnancy. Live attenuated vaccines are generally avoided because of a theoretical risk to the fetus. Most transplacental antibody transfer happens in the third trimester, which is why the timing windows sit where they do.

Tdap (whooping cough) — ideally 27 to 32 weeks, every pregnancy

All pregnant people should be given tetanus toxoid, diphtheria toxoid and acellular pertussis vaccine during every pregnancy, irrespective of their Tdap history. The ideal window is 27 to 32 weeks.

Immunization between 13 and 26 weeks may be considered where there is an increased risk of preterm delivery. Ideally the vaccine goes in at least four weeks before birth to allow optimal antibody transfer, but if that has not happened it should still be given at any point up to delivery, both for partial protection of the newborn and to stop you catching pertussis and passing it on.

Influenza — any stage of pregnancy

All pregnant people should receive a non-live influenza vaccine at any stage of pregnancy. If a pregnancy spans two influenza seasons, two doses may be given, one in each season. Influenza in pregnancy carries an increased risk of hospitalization and of adverse neonatal outcomes including late pregnancy loss and stillbirth, and vaccination also protects the infant for the first few months of life.

If the season passes without you being vaccinated, it should be given as early as possible after the birth, preferably before you are discharged from hospital.

COVID-19 — pregnancy is a listed high-risk group

NACI's guidance on the use of COVID-19 vaccines starting fall 2026, released in June 2026, continues to strongly recommend immunization programmes for people at increased risk, and pregnant women and pregnant individuals are named in that list. Most people in the recommended groups are advised to receive one dose per year; the twice-yearly recommendation applies to older adults, long-term care residents and people who are moderately to severely immunocompromised rather than to pregnancy on its own.

The Canadian Immunization Guide's reasoning is that COVID-19 infection in pregnancy carries an increased risk of hospitalization and ICU admission compared with non-pregnant people, and an increased risk of preterm birth, low birth weight and NICU admission for the baby. Provinces and territories decide who receives a publicly funded dose; where you are not covered, vaccines may be available for purchase through pharmacies.

RSV: Canada does this differently from the UK and Australia

This is the recommendation most likely to surprise you if you have read advice from elsewhere. Canada's default route to protecting a baby from RSV is a monoclonal antibody given to the infant, not a vaccine given to the mother.

In its 10 April 2026 update, NACI strongly recommended universal seasonal RSV immunization programmes for infants and set out two acceptable programme designs. One is an infant monoclonal antibody programme offering nirsevimab (Beyfortus) or clesrovimab (Enflonsia) to all infants in their first RSV season. The other is a combined programme offering the RSVpreF vaccine (Abrysvo) during pregnancy to protect infants born during the RSV season, with monoclonal antibodies still given to infants at increased risk.

Where a maternal vaccine is offered, the timing is:

• NACI recommends RSVpreF can be given from 28 to 36 weeks gestation.
• The vaccine is authorized in Canada at 32 to 36 weeks. The broader 28-week recommendation is an explicit off-label recommendation from NACI, supported by safety and efficacy data and aligned with World Health Organization advice.
• If your baby is born less than two weeks after you were vaccinated, they should still receive a monoclonal antibody.
• NACI currently has no recommendation for repeat RSVpreF dosing in subsequent pregnancies. For a later baby, monoclonal antibodies should be considered instead.

The Immunization Guide is also candid that some studies found an increase in preterm births among RSVpreF recipients and that data are insufficient to definitively exclude a causal relationship, which is precisely why the timing window sits late in pregnancy. Ask your provider which programme your province runs before you assume a vaccine will be offered.

Other vaccines that may be indicated

All pregnant people should be tested for hepatitis B surface antigen in each pregnancy, so the newborn can be given prophylaxis if needed. If you are not immune and at ongoing risk, a full hepatitis B vaccine course can be started during pregnancy.

Hepatitis A, meningococcal, pneumococcal, Hib, inactivated polio and rabies vaccines can all be given in pregnancy when there is an indication such as exposure, travel or a medical condition. The nonavalent HPV vaccine can be offered in pregnancy. Rabies post-exposure prophylaxis should never be withheld because someone is pregnant — rabies is invariably fatal.

Vaccines to avoid, and what to do before you conceive

Live attenuated vaccines — MMR, varicella, live typhoid, yellow fever, BCG — are generally contraindicated in pregnancy, though vaccination may be considered where the benefits clearly outweigh the theoretical risk, such as during a rubella outbreak. Live vaccines can be given during reproductive planning, with advice to avoid pregnancy for at least 28 days afterwards.

If your immunization status is uncertain, a pre-conception review is the right moment to correct it. Once you are pregnant, non-immunity to rubella or varicella is normally managed by vaccinating after the birth.

Where to get help

The Public Health Agency of Canada is the governing authority, and the Canadian Immunization Guide chapter on immunization in pregnancy and breastfeeding is the source clinicians work from. It carries a notice listing NACI statements published since the last chapter revision, so check that notice before relying on the chapter text alone for RSV or COVID-19. Your provincial or territorial public health website will tell you what is publicly funded where you live, and your midwife, family doctor or pharmacist can administer most of these. The Society of Obstetricians and Gynaecologists of Canada publishes plain-language material on vaccination in pregnancy at pregnancyinfo.ca.