Updated Canadian guidance on influenza vaccine during pregnancy

The National Advisory Committee on Immunization (NACI) has released updated guidance on the use of influenza vaccine during pregnancy.1 The new statement is intended to supplement recommendations for influenza vaccination found in NACI’s statement on seasonal influenza vaccine for 2023–2024.2The supplemental statement describes the disproportionate risk of morbidity and mortality for pregnant individuals and infants under six months of age who acquire influenza compared to the general population. It also reviews the available evidence on the efficacy, effectiveness and safety of influenza vaccination during pregnancy. Overall, the supplemental statement reaffirms the safety and importance of influenza vaccination during pregnancy.Pregnant individuals should be prioritized to receive influenza vaccines because of their higher risk for severe influenza disease and related complications such as pneumonia, hospitalization and death. However, influenza vaccine uptake remains suboptimal during pregnancy, particularly among individuals who are pregnant and racialized, Indigenous, younger, and/or have lower household income.1Individuals at any stage of pregnancy should receive an age-appropriate inactivated unadjuvanted or recombinant influenza vaccine each influenza season. Influenza vaccine may be given at the same time as, or at any time before or after administration of another vaccine, including COVID-19 or pertussis vaccine. Concomitant administration has the potential to increase local and systemic vaccine adverse reactions, including fever.1Influenza vaccination during pregnancy is safe, based on numerous studies, and reduces the morbidity and mortality associated with influenza infection. Vaccination of a pregnant person also helps protect the fetus, as influenza infection during pregnancy increases the risk of late-stage pregnancy loss, still birth, low birth weight and preterm birth. In addition, the passive transfer of antibodies from vaccination during pregnancy protects newborns during their first months of life, when they are at high risk of complications from influenza infection, yet too young to be immunized.1 The statement includes detailed evidence summaries on the safety and effectiveness of influenza vaccination during pregnancy, as well as the benefits and risks to the developing fetus and infants under six months of age.1Summary of NACI Recommendations1. Influenza vaccine should be offered to pregnant individuals. Recommended products include: standard-dose inactivated influenza vaccine, cell-culture based inactivated influenza vaccine, and recombinant influenza vaccine. (Strong NACI Recommendation)12. Influenza vaccination should be offered at any stage of pregnancy (i.e., in any trimester). (Strong NACI recommendation)Note that if an individual’s pregnancy extends over two influenza seasons, that person may receive two doses of influenza vaccine (i.e., one dose in each season, during the course of the pregnancy).13. All pregnant individuals, at any stage of pregnancy, are particularly recommended to receive influenza vaccination. (Strong NACI recommendation)14. Influenza vaccine may be given at the same time as, or at any time before or after administration of another vaccine, including COVID-19 or pertussis vaccine. (Strong NACI recommendation)Administration of multiple vaccines at the same visit is a strategy for increasing immunization uptake.1BreastfeedingThe supplemental statement does not examine the safety and effectiveness of influenza vaccination during breastfeeding. However, annual influenza vaccination is recommended during breastfeeding, and either non-live influenza vaccines or live attenuated influenza vaccine can be administered to breastfeeding individuals. No safety signals have been identified for influenza vaccination in breastfeeding.1,2 References1. National Advisory Committee on Immunization (NACI). Updated guidance on influenza vaccination during pregnancy. December 2023. (accessed December 27, 2023).2. National Advisory Committee on Immunization (NACI). An Advisory Committee Statement (ACS). Statement on seasonal influenza vaccine for 2023-2024. (accessed December 27, 2023).

Updated Canadian guidance on influenza vaccine during pregnancy

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