Td / tetanus-containing vaccine
India’s UIP provides Td during pregnancy. Review previous Td/TT doses and use the current national schedule rather than automatically repeating doses.
Maternal & Fetal Health
Maternal & Fetal Vaccination
A practical, guideline-informed vaccination guide for pregnancy, covering routine maternal immunization, vaccines that can protect the fetus/newborn through maternal antibodies, India’s pregnancy Td schedule, seasonal and risk-based vaccines, vaccines generally avoided during pregnancy, and the baby’s routine immunization pathway.
Key principle: vaccination decisions should be individualized
according to the current national immunization programme, vaccine product,
gestational age, previous doses, medical conditions, season/outbreak situation
and exposure risk.
Vaccination across the pregnancy journey
Think of immunization as a continuum: prepare before conception, protect during pregnancy, then continue the infant’s own vaccination schedule after birth.
1
Before pregnancy
Review records and complete indicated pre-pregnancy vaccines, particularly vaccines that are not routinely given during pregnancy.
2
During pregnancy
Give routine, seasonal and risk-based vaccines according to national guidance and the individual clinical situation.
3
At birth
Prepare for the newborn’s birth-dose vaccines and ensure maternal vaccine documentation is transferred to the infant record.
4
Infancy & childhood
Maternal antibodies are temporary. The child must receive the complete national age-appropriate vaccination schedule.
Maternal vaccines: complete pregnancy overview
Not every vaccine is required for every pregnant woman. The categories below distinguish routine Indian programme vaccination from vaccines recommended or considered according to international guidance, availability, season or risk.
| Vaccine | When / timing | Why it matters | Programme status |
|---|---|---|---|
| Td / tetanus-containing vaccine | India: as early as possible in pregnancy according to the National Immunization Schedule and previous vaccination history. | Protects the pregnant woman against tetanus and contributes to prevention of maternal and neonatal tetanus. | Routine in India under UIP |
| Influenza vaccine | During pregnancy when seasonal influenza vaccination is recommended/available; timing follows local programme and seasonal guidance. | Pregnancy increases the risk of severe influenza. Maternal vaccination also transfers antibodies to the infant. | Recommended according to national/seasonal guidance |
| Pertussis-containing vaccine (Tdap) | A dose during pregnancy is recommended in many national programmes, with timing chosen to maximize protection of the newborn. Follow local policy and product guidance. | Maternal antibodies can protect the newborn during the first months of life, before the infant completes the primary pertussis series. | Policy-dependent; widely recommended internationally |
| COVID-19 vaccine | Follow the current national programme and product guidance. WHO’s 2026 SAGE advice recommends one dose during each pregnancy for pregnant women, at any stage, ideally in the second trimester. | Reduces the risk of severe COVID-19 in pregnancy and can provide antibody protection to the infant. | Current WHO recommendation for pregnancy; implementation is country-specific |
| Maternal RSV vaccine | Where licensed and included in the national programme, timing is generally linked to the local RSV season and gestational-age window specified by the product/programme. | Can provide passive antibody protection to the infant against severe RSV disease during early infancy. | Availability and programme policy vary |
| Hepatitis B vaccine | May be given during pregnancy when indicated, especially if the woman is unvaccinated and at ongoing risk of hepatitis B exposure. | Prevents maternal infection and reduces risk of transmission around pregnancy and birth. | Risk-based |
| Rabies vaccine after exposure | After a credible exposure, post-exposure prophylaxis should not be withheld because of pregnancy; urgent clinical assessment is required. | Rabies is almost universally fatal after symptoms begin. Exposure management is an emergency priority. | Exposure-based emergency prevention |
| Travel / outbreak vaccines | Only after individualized assessment of destination, outbreak risk, vaccine type, pregnancy stage and alternatives. | Some diseases create greater pregnancy risk than vaccination, while some vaccines are unsuitable during pregnancy. | Specialist / travel-risk decision |
Why “complete” does not mean “every vaccine for everyone”
A complete vaccination assessment is individualized. Some vaccines are universal in a national programme, some are seasonal or pregnancy-specific, some are for medical or exposure risk, and some are normally given before pregnancy or after delivery. A clinician should reconcile the woman’s record with the current national schedule and vaccine-specific guidance.
India: pregnancy vaccination under the National Immunization Schedule
India’s current Universal Immunization Programme uses tetanus-diphtheria (Td) vaccination for pregnant women. The Ministry of Health and Family Welfare schedule specifies Td-1 early in pregnancy, Td-2 four weeks later, and a Td booster in specified circumstances based on previous vaccination history.
| Vaccine | Timing | Clinical note |
|---|---|---|
| Td-1 | As early as possible during pregnancy / first antenatal contact | Use the current UIP/NIS schedule and check previous Td/TT history. |
| Td-2 | 4 weeks after Td-1 | Give according to the national schedule and minimum interval requirements. |
| Td booster | When indicated by previous documented Td/TT doses and programme rules | A booster may be used instead of repeating the two-dose sequence when previous protection is adequate. |
Do not confuse historical TT wording with the current Td programme
Older Indian immunization materials may use TT (tetanus toxoid). Current UIP materials use Td (tetanus-diphtheria) for pregnant women. Use the latest Ministry of Health and Family Welfare / UIP schedule available at the time of care.
Need personalized vaccination dates and reminders?
Use the vaccination planner to enter relevant dates and vaccination history, review suggested due dates, and keep your pregnancy vaccination follow-up organized.
Before pregnancy: vaccination planning
Preconception care is the ideal time to close vaccine gaps that are difficult to address during pregnancy.
- Review the vaccine record: Check previous doses, documented immunity where relevant, missing primary series and any occupational, travel or outbreak risks.
- Complete live-vaccine protection before conception: When indicated, vaccines such as MMR or varicella should generally be administered before pregnancy rather than during pregnancy. Follow product-specific guidance on timing before conception.
- Plan seasonal vaccines: Discuss influenza and other vaccines that may be indicated before or during pregnancy, depending on season and local recommendations.
- Assess chronic conditions and exposure: Hepatitis B, rabies, travel and occupational vaccines may need individualized planning.
Key vaccines in pregnancy — what to discuss
The following explanations are designed for antenatal counselling and should be interpreted with the current local programme.
Influenza
Pregnancy increases the risk of severe influenza. WHO identifies pregnant women as a high-priority group for seasonal influenza vaccination where programmes provide it. Use an inactivated vaccine during pregnancy.
Pertussis / Tdap
Maternal pertussis vaccination is used in many programmes to transfer antibodies to the newborn. Timing and product selection should follow local guidance.
COVID-19
WHO’s March 2026 SAGE recommendation is one COVID-19 vaccine dose during each pregnancy, at any stage, ideally in the second trimester, with implementation determined nationally.
Maternal RSV vaccine
Where licensed and offered, maternal RSV vaccination can provide antibody protection to the infant. Seasonal timing and eligibility are programme/product dependent.
Risk-based vaccines
Hepatitis B, rabies post-exposure prophylaxis and selected travel/outbreak vaccines require individualized risk assessment. Do not delay urgent post-exposure care because of pregnancy.
How maternal vaccination can protect the fetus and newborn
Maternal immunization can create a bridge of temporary passive immunity while the newborn is too young to receive some vaccines or complete primary vaccination.
Maternal antibodies
Vaccination during pregnancy can generate antibodies that cross the placenta and may protect the newborn during the early months of life.
Breastfeeding
Breastfeeding can provide additional immune protection, although it does not replace recommended infant vaccination.
Infant immunization
The baby still needs the full age-appropriate national immunization schedule. Maternal vaccination does not replace routine infant vaccines.
Birth-dose planning
Where included in the national schedule, arrange birth-dose vaccines such as hepatitis B promptly after delivery.
Maternal vaccination is not a substitute for infant immunization
Passive antibody protection fades. The infant must still receive all vaccines due under the current national immunization programme.
Vaccines generally avoided during pregnancy
Live attenuated vaccines are generally avoided during pregnancy. Exceptions and post-exposure/travel decisions require expert assessment.
| Vaccine | Pregnancy approach |
|---|---|
| MMR | Live attenuated vaccine; routinely avoided during pregnancy. If given inadvertently, it is not by itself an indication to terminate a pregnancy; seek clinical advice. |
| Varicella vaccine | Live attenuated vaccine; routinely avoided during pregnancy. Postpartum vaccination can be considered when indicated. |
| Live attenuated influenza vaccine (nasal spray) | Live vaccine and not recommended during pregnancy; an inactivated influenza vaccine is used when influenza vaccination is indicated. |
| Other live vaccines | Use only after specialist assessment when there is a compelling exposure/travel indication and no safer alternative. |
Important if a live vaccine was given before pregnancy was recognized
An inadvertent dose of MMR or varicella vaccine is not, by itself, an indication for termination of pregnancy. Document the vaccine and date and arrange appropriate counselling and follow-up.
Special situations and catch-up decisions
Vaccination planning should remain active when the pregnancy is high-risk or when records are incomplete.
Pregnancy discovered after a live vaccine
Do not panic. An inadvertent live-vaccine dose is not by itself an indication for pregnancy termination. Document the vaccine and date and arrange individualized counselling.
Missed Td dose
Do not restart a vaccine series simply because a scheduled interval was missed. Review the documented history and use the current catch-up/interval guidance.
Previous vaccine record unavailable
Use the clinical and programme guidance for uncertain vaccination history. Do not delay urgent indicated vaccination solely because records are incomplete when safe catch-up is appropriate.
Immunocompromised pregnancy
Vaccine selection and timing may require specialist review, especially for live vaccines and selected travel vaccines.
High-risk exposure
For rabies, hepatitis B exposure, measles exposure, travel-related disease or outbreaks, assess urgently rather than waiting for the next routine antenatal visit.
Breastfeeding after vaccination
For most non-live vaccines, breastfeeding can continue. Check specific product and national guidance when a vaccine has special precautions.
Newborn and child vaccination: continue the protection
The table below is a practical overview of India’s National Immunization Schedule for infants and children. Always use the latest official UIP/NIS schedule at the time of vaccination because programme recommendations can be updated.
| Age | Vaccines / programme milestones | Important note |
|---|---|---|
| At birth | BCG, birth-dose OPV where applicable, Hepatitis B birth dose | Follow the current National Immunization Schedule and facility/UIP instructions. |
| 6 weeks | Primary infant vaccines according to NIS/UIP, including OPV, pentavalent, rotavirus, fIPV and PCV where scheduled | Exact programme components can change; use the current national schedule. |
| 10 weeks | Second scheduled doses of relevant primary-series vaccines | Follow the current NIS/UIP schedule. |
| 14 weeks | Third scheduled doses and relevant IPV/PCV/rotavirus doses | Follow the current NIS/UIP schedule. |
| 9–12 months | MR and JE where applicable, plus PCV booster as scheduled | JE vaccination is applicable in endemic/selected areas according to the national programme. |
| 16–24 months | MR-2, DPT booster, OPV booster and JE-2 where applicable | Continue the national schedule and catch-up if doses were missed. |
| 5–6 years | DPT booster-2 | Use the current NIS/UIP schedule. |
| 10 years | Td | Routine adolescent Td under the national programme. |
| 16 years | Td | Routine adolescent Td under the national programme. |
Catch-up vaccination
If a child misses a scheduled dose, contact the immunization provider promptly. Delayed vaccination should be managed using the current catch-up schedule and minimum interval rules; many series do not need to be restarted simply because a dose was delayed.
Practical antenatal vaccination checklist
Use this as a documentation and counselling framework rather than as a replacement for the official vaccine schedule.
1. Review records
Document previous Td/TT, pertussis, influenza, COVID-19, hepatitis B, travel and other relevant vaccines.
2. Establish gestational age
Use the confirmed pregnancy dating to determine the appropriate vaccination window where timing matters.
3. Identify risks
Assess season, outbreaks, occupation, travel, household exposure, chronic disease, immunocompromise and recent exposures.
4. Give and document
Record vaccine name, date, dose, batch/lot when required, site, provider and next due dose according to local documentation rules.
5. Safety-net
Explain expected local reactions and advise the woman when and where to seek urgent assessment for a severe allergic reaction or other concerning symptoms.
6. Plan newborn vaccines
Ensure the infant immunization record is prepared and birth-dose vaccines are not missed.
Safety, contraindications and urgent assessment
Vaccines are generally well tolerated, but every administration should include a brief contraindication and allergy assessment.
Before vaccination
Confirm the indication, previous serious allergic reaction to a vaccine or component, current acute illness, relevant immunocompromise, pregnancy stage, previous doses and product-specific precautions.
Seek emergency care for suspected anaphylaxis
Breathing difficulty, swelling of the face or throat, widespread hives with systemic symptoms, collapse or other signs of severe allergic reaction require immediate emergency management.
Pregnancy-specific caution
Do not automatically refuse a clinically indicated vaccine simply because the patient is pregnant. First determine whether it is a live vaccine, whether it is recommended in pregnancy, whether the indication is routine or risk-based, and what the current national programme says.
Frequently asked questions
Common counselling questions for pregnant women, families, midwives and students.
Is vaccination safe during pregnancy?
Several vaccines are routinely or conditionally recommended during pregnancy because the benefits to the pregnant person and/or infant outweigh expected risks. Vaccine choice must be based on the specific vaccine, indication, gestational age, local recommendations and medical history.
Which vaccines are routine for pregnant women in India?
India’s Universal Immunization Programme includes tetanus-diphtheria (Td) vaccination for pregnant women, with Td-1, Td-2 or a Td booster selected according to timing and previous vaccination history.
Can I take influenza vaccine during pregnancy?
WHO recommends seasonal influenza vaccination for pregnant women in countries/programmes using it. Inactivated influenza vaccine is used during pregnancy; live attenuated nasal influenza vaccine is not recommended during pregnancy.
Should Tdap be given during pregnancy?
Pertussis-containing vaccination during pregnancy is recommended in many countries to transfer antibodies to the infant. The exact timing and product should follow the current national programme and local clinical guidance.
Can I receive a COVID-19 vaccine while pregnant?
WHO’s March 2026 SAGE advice recommends one COVID-19 vaccine dose during each pregnancy, at any stage, ideally during the second trimester. National implementation and product availability should be checked.
What about the RSV vaccine in pregnancy?
Maternal RSV vaccination is available in some settings and can protect infants through transplacental antibodies. Eligibility, gestational timing and seasonal use depend on the national programme and licensed product.
Can MMR or varicella vaccine be given during pregnancy?
These are live vaccines and are routinely avoided during pregnancy. If vaccination occurred inadvertently, contact the maternity/vaccination team for counselling rather than assuming that pregnancy termination is required.
Does maternal vaccination replace my baby’s vaccines?
No. Maternal vaccination can provide temporary passive protection, but the baby still needs the complete age-appropriate infant and childhood immunization schedule.
Can vaccines be given together?
Some vaccines can be administered at the same visit. The exact combinations, spacing and contraindications depend on the products and national guidance. The vaccination provider should plan the schedule.
What if I miss a vaccine dose?
Contact the vaccination provider and use the current catch-up schedule. Many vaccine series do not need to be restarted after a delay.
Guideline and reference base
The page is designed around current WHO guidance and Indian UIP/NIS material, with country-specific implementation explicitly separated from broader international recommendations.
WHO — Essential Programme on Immunization: WHO EPI
WHO — Vaccination before and during pregnancy: WHO pregnancy vaccination factsheet
WHO — COVID-19 vaccine Q&A, updated 2026: WHO COVID-19 vaccination guidance
WHO — Influenza vaccination of pregnant women: WHO influenza implementation manual
WHO — Tetanus: WHO tetanus guidance
WHO — Routine immunization recommendations, 2025: WHO routine immunization summary
WHO — Maternal health recommendations, 2nd edition, 2025: WHO maternal health recommendations
Government of India — National Immunization Schedule: MoHFW National Immunization Schedule
Government of India — Routine Immunization Manual: MoHFW Routine Immunization Manual
Educational disclaimer
This page provides general health education and is not a personalized vaccination prescription. Vaccine recommendations can change with national policy, product licensing, epidemiology, outbreaks and new evidence. Pregnant women should discuss their vaccination record and individual indications with an appropriately qualified healthcare professional. In an urgent exposure such as a possible rabies exposure, seek immediate medical assessment rather than waiting for a routine antenatal visit.