March 6, 2025 — Carolyn Figurelle was in Las Vegas getting ready for her sister-in-law’s wedding when her 6-month-old son’s breathing became shallow. Carolyn, in the emergency room in wedding hair and makeup, told her husband to go to the ceremony without her.
“I was thinking, ‘It’s fine, we will be out of here for the reception,’” she said.
They stayed for 12 days.
At the time, fall of 2022, she didn’t know much about respiratory syncytial virus — just “another version of the cold,” she figured — but learned fast in the hospital, surrounded by other RSV-infected babies. During one “terrifying” night, her son was rushed to the pediatric intensive care unit with dangerously low oxygen levels. Figurelle also remembers struggling to pump breast milk around the clock so that her son could be fed through a tube, “tiny bits at a time.”
“There were definitely moments during the experience where I thought, ‘What if he’s not coming home?’” said Figurelle, who lives in Williamsburg, Virginia.
The FDA approved a monoclonal antibody to prevent RSV in babies and toddlers in July 2023, followed by the first RSV vaccine for pregnant people in August 2023. Now pregnant with her second, Figurelle made sure to get the RSV vaccine. Her son, almost 3 years old, has received the antibody treatment.
“Pregnancy is the most amazing venue for first vaccination,” said Natali Aziz, MD, director of pregnancy infectious diseases at Stanford Children’s Health and a clinical associate professor of obstetrics & gynecology at Stanford School of Medicine.
That’s because getting vaccinated during pregnancy can protect not just the mom-to-be but also the baby during those first critical months of life. The American College of Obstetricians and Gynecologists advises pregnant people to get flu, Tdap (tetanus, diphtheria, and acellular pertussis), COVID-19, and RSV vaccines. Pregnancy weakens the immune system, raising the risk of serious infections like the flu.
But uptake has plummeted since 2019 and 2020, when 61.2% of pregnant people got the flu vaccine and more than 70% got the COVID vaccine. According to a 2024 CDC survey of pregnant people, 47.7% had a flu vaccine, 30.9% had an updated COVID vaccine, and 59.6% had a Tdap vaccine. As of Feb. 15, 2025, according to the CDC’s weekly tally, 37.5% of pregnant people had a flu vaccination.
“These are not optimal numbers,” Aziz said. “[We] should be aiming for 100%.”
How Maternal Vaccination Impacts Infants
When a pregnant person gets vaccinated, antibodies travel through the placenta and are passed to the fetus. Antibodies can also transfer to infants through breast milk. Vaccines recommended during pregnancy don’t contain live virus, so they cause “an immune response” in pregnant people, but “not a true infection,” Aziz said. The baby is then better equipped to fight severe infections.
COVID vaccination during pregnancy, for example, cuts hospitalization risk by 52% among infants under 6 months. Maternal influenza vaccination is 91.5% effective in preventing hospitalization of infants for flu during their first six months.
“Sometimes babies start with a viral infection, like influenza, and then get a bacterial infection on top of [that],” said Cynthia Rand, MD, MPH, professor of pediatrics and division chief of general pediatrics at the University of Rochester Medical Center.
Pertussis, also known as whooping cough, is a growing concern among pediatricians like Rand. Cases have been on the rise following a pandemic-era dip, according to the CDC. There were six times as many reported cases in December 2024 as in 2023, representing an increase from pre-pandemic rates in 2019. Most cases and deaths are among infants ages 3 months and younger.
“What’s really scary is they just stop breathing,” Rand said.
Infants can’t get vaccinated against pertussis until they’re about 8 weeks old, so maternal Tdap vaccination is crucial. It protects infants younger than 2 months from getting sick with pertussis, and protects 9 in 10 infants against pertussis hospitalization.
Depending on the timing of their pregnancy, pregnant people can either get the RSV vaccine or their baby can get the monoclonal antibody nirsevimab (Beyfortus). Nirsevimab protects against RSV for at least five months, and in a phase III clinical trial reduced RSV infections needing medical care and hospitalizations among healthy full- and near-full term infants by about 76%.
The antibody treatment “is dramatically changing the landscape of RSV infection,” Rand said. “However, a lot of parents haven’t vaccinated their child or vaccinated themselves [for RSV], and that is a shame.”
How to Boost Immunization Rates
Rand pointed out that RSV vaccine uptake among pregnant people has been strong, especially considering how new it is. As of January 2025, 60.6% of infants born since April 1, 2024, were reportedly protected against RSV, with 14% protected through maternal immunization and 46.6% having received nirsevimab, according to the CDC.
There are lower rates of vaccination in Black and Latino populations, as well as among uninsured pregnant people. Vaccine skepticism is also on the rise. Among pregnant people, flu vaccine hesitancy increased from 17% to 25% while Tdap vaccine hesitancy grew from 15% to 20% in 2023 to 2024, compared to 2022 to 2023.
“Unfortunately, there is more vaccine hesitancy than there was in my practice five to eight years ago,” Rand said. “That’s nerve-racking to me.”
Rand’s forthcoming research shows that flu vaccination rates improved when providers strongly recommended the vaccine. Tdap rates also improved when providers repeatedly offered vaccination, discussed the effect on newborns, and stocked the vaccine in their office.
Still, obstetricians and pediatricians are pressed for time, many online sources are rife with misinformation, and simply debunking vaccine myths doesn’t work.
“We’re not all drawing from the same well of the same facts,” said Karen Ernst, program director for Voices for Vaccines, an advocacy and education organization. “With someone with hesitancy, we shouldn’t close out the conversation. After you give them information, you ask, ‘What are your thoughts now?’” Ernst said.
For her part, Figurelle has been speaking out on social media. She’s often one of the first to comment when pregnant people seek opinions on specific vaccines, sometimes sharing “a condensed version” of what happened to her family.
“I basically say I would rather do everything I can to prevent that,” she said. “I don’t know if that changes anyone’s mind.”
