Overview

Vaccines can be a complex and controversial topic, especially for new parents. In this episode, we answer a listener’s question about whether family members and visitors should be vaccinated before being around a newborn. We review the official vaccine recommendations and explore key considerations for your specific situation. Plus, we provide guidance on how to approach this conversation and handle any disagreements if you do request that close friends or family get vaccinated. Like any parenting decision, there is no one-size-fits-all answer. Tune in to get the information you need to make an informed and confident decision for you and your baby.

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Transcript and Resources

In the episode on the Tdap vaccine, you mentioned that it is recommended that everyone who will be around your baby get vaccinated. We have family planning to visit soon after our baby is born. Should I ask them to get vaccinated, and what vaccines do they need? If they should have vaccines and do not want to get them do you have any advice on how to handle that?

-Stephanie

Vaccines are a complex and often polarizing topic. While medical organizations advocate for vaccines based on public health as a whole, individual perspectives on this topic vary widely. It’s one thing to decide if you want a vaccine and another to recommend or require that others get vaccinated. It’s important to recognize that some people have deeply held concerns or personal reasons for avoiding vaccines. Others may feel strongly that they are safe and effective and that everyone should get them. My goal is to provide you with evidence-based information so you can make confident decisions.

Why Newborns Are Vulnerable

Newborns are born with underdeveloped immune systems, making them more susceptible to illnesses. Many vaccines are recommended for infants during their first year, but very few are given immediately after birth. This creates a window of vulnerability, during which your baby could be exposed to illnesses before they can receive their own vaccinations and produce antibodies to fight off infections.

Vaccines During Pregnancy

Vaccination during pregnancy is primarily aimed at providing passive immunity to your baby before birth. There are four vaccines recommended during pregnancy:

1. COVID-19: Recommended as soon as possible during any trimester.
2. Flu: Recommended during flu season (October to May) in any trimester.
3. RSV: Recommended between 32 and 36 weeks of pregnancy, from September through January.
4. Tdap: Recommended in the third trimester to protect against pertussis (whooping cough).

COVID-19, flu, RSV, and pertussis (which is included in the Tdap vaccine) are all contagious respiratory illnesses. The virus or bacteria that cause these illnesses are spread through close contact with someone infected. For more in-depth information, you can check out the episodes covering the flu vaccine and Tdap, with upcoming episodes on RSV and COVID-19.

General Vaccine Recommendations

The vaccine for pertussis (DTaP for young children) is a five dose series from two months to six years old. Older children and adults should get the Tdap vaccine, recommended at age 11 or 12, with boosters every 10 years or during pregnancy. The flu and COVID-19 vaccines are updated seasonally and recommended for everyone older than six months. The RSV vaccine is recommended for adults over 60. For infants, protection can come through maternal vaccination during pregnancy or preventive antibodies shortly after birth. (We will examine these options in depth in an upcoming episode on the RSV vaccine.)

Should Family and Visitors Be Required to Get Vaccinated?

The American College of Obstetricians and Gynecologists recommends adolescent family members or caregivers should get the Tdap vaccine at age 11 to 12. If adult family members or caregivers have never had the Tdap vaccine, they should get it at least two weeks before having contact with your baby. This makes a safety “cocoon” of vaccinated caregivers around your baby. The American College of Nurse-Midwives also advises that adults in families who will be around newborns, such as partners, grandparents, older siblings, and babysitters, be vaccinated against pertussis.

According to the CDC, anyone who is around babies should be up to date on all routine vaccines, including the whooping cough vaccine (DTaP for children and Tdap for preteens, teens, and adults) and the flu vaccine during flu season. The CDC and ACOG are very clear in their recommendation that everyone older than six months should stay up to date on the COVID-19 vaccine. Up to date would mean receiving the most recent 2024–2025 COVID-19 vaccine. Both organizations also recommend the RSV vaccine if you are between 32 and 36 weeks of pregnancy from September through January. I did not find a specific recommendation that family members who will be around a newborn should be vaccinated against COVID-19 or RSV.

Key Considerations

The priority of organizations like the American College of Obstetricians and Gynecologists and the CDC is protecting public health as a whole. Vaccinating everyone is the easiest way to reduce contagious illnesses like the flu or whooping cough. That is the goal of these organizations and what is driving their messaging and recommendations. On a national or global scale, the benefits of herd immunity outweigh the small risks of some individual adverse reactions to vaccines. Your decisions should focus on the unique factors relevant to you and your baby. This is a very nuanced topic, and there are many things you may want to consider.

No vaccine is 100% effective. Someone with a flu vaccine could still get the flu and be contagious, particularly if they have a strain of the virus that is not included in the flu vaccine. The flu vaccine is formulated annually to include four strains predicted to be most common for that season.

Respiratory viruses are more common in the fall and winter months. If your baby is due in spring or summer, the risk of flu, COVID-19, RSV, or whooping cough is significantly lower.

You should also consider whether your area has an outbreak of whooping cough. An NPR article published five days ago (10/11/24) had the headline, “Worst U.S. whooping cough outbreak in a decade has infected thousands.” The article opens with, “Whooping cough is spreading nationwide at the highest levels since 2014. There have been more than 16,000 cases this year — more than four times as many compared to the same time last year — and two confirmed deaths. And experts are concerned that the outbreak could worsen in the fall and winter months.” Let’s keep this in perspective: the last time there was a significant whooping cough outbreak was in 2012, with 48,000 cases. This is still significantly lower than the tens of millions of flu cases annually. Additionally, if there is a particularly bad flu or COVID-19 season in the future, you may want to take that into consideration.

Babies born prematurely are more susceptible to illness, and you may want to take additional precautions if your baby was born before 37 weeks.

If You Request Vaccinations

Your choice of whether or not to request vaccinations is likely based on your overall view of each of these vaccines. I encourage you to examine these individually and make an informed decision. I do have some tips if you decide to request close friends or family get vaccines.

Ideally, you give plenty of advance notice that someone needs to get a vaccine. It takes about two weeks to produce antibodies after getting a vaccine. Ideally, vaccines occur at least two weeks before they plan to see your baby.

If someone is hesitant or unwilling to get vaccinated, it may help to explain that you’re simply trying to protect your baby. Frame it as something you’ve carefully researched. You can also take some pressure off yourself and tell them that your pediatrician recommends this.

Should family members refuse vaccination, you may face the difficult decision of whether to allow them to be around your baby. Rather than giving ultimatums, try to have a conversation, listen to their concerns, and work toward a mutual understanding. You can always delay a visit until your newborn is slightly older or until your baby gets vaccinated.

Protecting Your Baby

Regardless of who gets vaccinations, there are some things you can do to protect your baby from illnesses. Anyone around your baby should be healthy and not experiencing any symptoms of a cold, flu, or other illness. While having a sore throat or sniffles can be inconvenient, anyone with signs of being sick or not feeling great should reschedule their visit to when they are healthy. You can request visitors wash their hands upon arrival. You can decide whether or not to allow visitors to hold your baby or even ask that they avoid kissing your baby to reduce the spread of germs.

The best thing you can do to boost your baby’s immune system is to breastfeed. Breast milk contains living cells to inhibit the growth of bacteria and viruses. Your body will produce antibodies in response to germs your baby transfers to your breasts. Then, you pass those antibodies back to your baby through breast milk. If you get vaccinated after you have your baby, you can also pass antibodies from a vaccine in breast milk.

Also, remember that if you choose to get vaccinated during pregnancy, you pass antibodies to your baby, and they will have some protection against these illnesses.

Final Thoughts

There is no one-size-fits-all answer, and the choice comes down to what feels right for you and your baby. Every family’s approach to protecting their baby is different. Some parents will choose to opt into all vaccines and require close contacts also get vaccinated. Others make the choice to opt out of vaccines. There are also many options in between. You can choose some vaccines and not others. You may suggest close contacts get vaccinated without making it a requirement to see your baby. Some parents may not be concerned about vaccination status at all. Whatever you decide, I hope you feel confident in your choices.

If you have questions about vaccinations or illnesses, please discuss them with your doctor, midwife, or pediatrician.

Thank you to the amazing companies that have supported this episode.

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