Can a pregnant patient receive RSV (Respiratory Syncytial Virus) and COVID (Coronavirus Disease) vaccinations together?

Can Pregnant Patients Receive RSV and COVID-19 Vaccines Together?

Yes, pregnant patients can and should receive RSV and COVID-19 vaccines simultaneously at different anatomic sites on the same day. 1

Clear CDC Guidance on Simultaneous Administration

The CDC's Advisory Committee on Immunization Practices explicitly states that maternal RSV vaccine can be administered to pregnant persons with other recommended vaccines, including COVID-19 vaccines, without regard to timing. 1 This follows CDC's General Best Practices Guidelines for Immunization, which permits simultaneous vaccination at different anatomic sites. 1, 2

Optimal Timing for Both Vaccines

RSV Vaccine Timing:

• Administer between 32 weeks 0 days and 36 weeks 6 days of gestation 3, 4
• In most of the continental United States, give during September through January 1, 2
• This timing minimizes potential preterm birth risk while maximizing infant protection during RSV season 3

COVID-19 Vaccine Timing:

• Can be given at any gestational age when indicated 1
• No specific gestational age restrictions exist for COVID-19 vaccination 5, 6

Practical Implementation Algorithm

When both vaccines are indicated:

1. Confirm gestational age is 32-36 weeks for RSV vaccine eligibility 1, 2
2. Verify it is September-January in most continental U.S. locations 1
3. Administer RSV vaccine in one arm and COVID-19 vaccine in the opposite arm 1
4. Can also include Tdap and influenza vaccines on the same visit if due 1, 2

Safety Considerations

RSV Vaccine Safety Profile:

• No statistically significant differences in preterm birth (4.2% vaccine vs 3.7% placebo at approved 32-36 week interval) 1, 3
• No statistically significant differences in low birthweight or neonatal jaundice 1
• FDA determined benefits outweigh risks when given at 32-36 weeks 3

COVID-19 Vaccine Safety:

• mRNA COVID-19 vaccines show no clear harm in pregnancy 6
• Most common adverse reactions are transient: injection site pain, fatigue, and headache 6
• Strong maternal and fetal antibody responses documented 6

Important Clinical Caveats

Do not give both maternal RSV vaccine and infant nirsevimab to the same infant in most circumstances, as either strategy provides adequate protection. 1, 2 However, nirsevimab is still recommended for:

• All infants born at <34 weeks gestation regardless of maternal vaccination 1, 2
• Infants born <14 days after maternal RSV vaccination 1, 2
• Infants whose mothers did not receive RSV vaccine or vaccination status is unknown 1, 2

Regional Variations: In Alaska, southern Florida, Guam, Hawaii, Puerto Rico, U.S.-affiliated Pacific Islands, and U.S. Virgin Islands, follow local guidance on RSV vaccine timing due to different RSV seasonality patterns. 1, 2