Tools/Vaccination Guide
PHAC, NACI & Manitoba Health Protocols

Pregnancy & Household Immunization Reference

Evidence-based immunization schedule to maximize transplacental IgG transfer to the infant before birth, paired with household cocooning strategies for partners and grandparents.

Bordetella pertussis (Whooping cough)Timing: 27 to 32 weeks gestation (during EACH pregnancy)

Tdap (Tetanus, Diphtheria, Acellular Pertussis)

Recommended routinely

Maximizes maternal anti-pertussis IgG production and transplacental transfer via neonatal Fc receptors, providing high circulating antibody levels in the newborn before their first primary vaccine at 2 months of age.

Manitoba & Public Health Guidance:

Manitoba Health publicly funds Tdap for all pregnant individuals in the province at 27-32 weeks.

Partner & Household “Cocooning”:

Cocooning strategy: Partners, grandparents, and household contacts should ensure they have received a pertussis booster within the last 10 years at least 2 weeks prior to newborn contact.

Influenza A & BTiming: Any trimester during influenza season (October to April)

Inactivated Influenza Vaccine (Flu Shot)

Recommended routinely

Pregnancy-induced altered cell-mediated immunity and cardiopulmonary strain markedly increase risks of maternal ICU admission, pneumonia, and preterm delivery from influenza. Transplacental antibodies protect infant for first 6 months.

Manitoba & Public Health Guidance:

Manitoba Health universal seasonal influenza immunization program provides free vaccination through clinics, pharmacies, and public health units.

Partner & Household “Cocooning”:

Partners and household contacts must receive annual seasonal flu vaccine to reduce household viral introduction.

SARS-CoV-2Timing: Any trimester (per current seasonal campaign)

COVID-19 mRNA Vaccine

Recommended routinely

Pregnant women with symptomatic COVID-19 have significantly increased rates of ICU admission, mechanical ventilation, preeclampsia, and stillbirth compared to non-pregnant age-matched controls.

Manitoba & Public Health Guidance:

Available free of charge across Manitoba through public health and primary care providers.

Partner & Household “Cocooning”:

Partners and family members should stay up-to-date with current seasonal formulations.

Respiratory Syncytial Virus (RSV) BronchiolitisTiming: Maternal Abrysvo at 32 to 36 weeks gestation OR Infant Nirsevimab at birth

RSV Vaccine (Abrysvo) vs Monoclonal (Beyfortus / Nirsevimab)

Recommended routinely

RSV is the leading cause of hospitalization in Canadian infants under 1 year. Maternal bivalent protein subunit vaccine (Abrysvo) stimulates protective IgG antibodies transferred across the placenta.

Manitoba & Public Health Guidance:

Manitoba Health RSV infant prevention program provides seasonal guidance and hospital nursery access for high-risk and newborn populations.

Partner & Household “Cocooning”:

Strict hand hygiene, avoidance of symptomatic visitors during the winter viral season.

Rubella (CRS) & Varicella zosterTiming: PRECONCEPTION or IMMEDIATE POSTPARTUM (Strictly avoid during pregnancy)

MMR (Measles, Mumps, Rubella) & Varicella

Contraindicated (Live)

Live-attenuated vaccines carry a theoretical risk of fetal viral infection and congenital rubella syndrome.

Manitoba & Public Health Guidance:

Manitoba public health and postpartum hospital wards administer MMR/Varicella prior to postpartum discharge for non-immune mothers.

Partner & Household “Cocooning”:

Verify partner and older children are fully immunized against measles and varicella to maintain household herd immunity.

Hepatitis B Virus (HBV) chronic carriage and liver diseaseTiming: Infant birth dose if maternal HBsAg positive; routine Manitoba pediatric series

Hepatitis B Vaccine & Neonatal Post-Exposure Prophylaxis

Recommended if high risk

Inactivated recombinant subunit vaccine contains HBsAg. Safe during pregnancy for individuals at elevated risk of HBV exposure. For infants of HBsAg-positive mothers, administration of Hepatitis B Immune Globulin (HBIG) PLUS Hepatitis B vaccine within 12 hours of birth is 95% effective at preventing perinatal chronic vertical transmission.

Manitoba & Public Health Guidance:

Manitoba Health universal prenatal testing protocol ensures prompt hospital notification; Cadham Provincial Lab flags HBsAg-positive results directly to delivering obstetric units and pediatric nursery.

Partner & Household “Cocooning”:

If maternal HBsAg is positive, partner and all household contacts must undergo serologic testing (HBsAg and anti-HBs) and receive the 3-dose vaccine series if non-immune.

Streptococcus pneumoniae (Invasive pneumococcal disease, bacteremia, meningitis, otitis media)Timing: Infant primary series at 2, 4, and 12 months of age

Pneumococcal Conjugate Vaccine (Pneu-C-15 / Pneu-C-20)

Safe / Preconception for high-risk maternal medical conditions

Streptococcus pneumoniae is a leading cause of severe bacteremia, pneumonia, and acute otitis media in young infants. Conjugate polysaccharides coupled to CRM197 carrier protein induce robust T-dependent immune memory.

Manitoba & Public Health Guidance:

Part of the publicly funded Manitoba Routine Childhood Immunization Schedule, administered at 2, 4, and 12 months at primary care clinics and public health access centres.

Partner & Household “Cocooning”:

Ensure older siblings are up to date on pneumococcal immunizations prior to baby's arrival to prevent pneumococcal shedding in household droplets.

Rotavirus Gastroenteritis (Severe dehydrating diarrhea and vomiting)Timing: Infant oral doses at 2 and 4 months (must complete by 8 months of age)

Rotavirus Oral Vaccine (Rotarix / RotaTeq)

Pediatric only (Strictly infant oral administration)

Live-attenuated oral vaccine replicating in the gut mucosal epithelium to confer IgA local and systemic neutralizing immunity against circulating rotavirus serotypes. Historically rotavirus was the number one cause of infant hospitalization for dehydration in Canada.

Manitoba & Public Health Guidance:

Funded universally by Manitoba Health. Administered orally at 2 and 4 months infant checkups (sweet-tasting oral liquid drops; baby swallows willingly).

Partner & Household “Cocooning”:

Practice thorough hand hygiene following diaper changes for 10-14 days post-vaccination, as small amounts of live-attenuated vaccine virus can shed transiently in infant stool.

Neisseria meningitidis (Meningococcemia, purpura fulminans, bacterial meningitis)Timing: Infant 12-month dose (Men-C-ACYW) and adolescent booster (Grade 6/9)

Meningococcal Conjugate Vaccine (Men-C-ACYW / Men-B)

Safe if clinically indicated for outbreak or anatomical asplenia

Meningococcal disease progresses with terrifying velocity (death can occur within 12 hours of petechial rash onset). Conjugate vaccines provide bactericidal antibody protection against outer capsular polysaccharides.

Manitoba & Public Health Guidance:

Universal infant Men-C-ACYW administered at 12-month well-baby visit across all regional health authorities in Manitoba.

Partner & Household “Cocooning”:

Verify partner has received adolescent/young adult meningococcal boosters, especially if living in communal or high-density housing.

HPV Types 6, 11, 16, 18, 31, 33, 45, 52, 58 (Cervical, anogenital cancers & genital warts)Timing: Postpartum completion (Defer during active pregnancy)

Human Papillomavirus 9-Valent Vaccine (Gardasil-9)

Defer until postpartum (Compatible with breastfeeding)

Recombinant L1 virus-like particle (VLP) vaccine. While accidental exposure during pregnancy has shown no increased risk of congenital anomalies or miscarriage in registry data, NACI recommends deferring remaining doses until postpartum as a precautionary measure. Fully compatible with lactation.

Manitoba & Public Health Guidance:

Available through primary care clinics and pharmacies. Women up to age 26 who missed the school-based Grade 6 program may be eligible for public or private coverage.

Partner & Household “Cocooning”:

Partners up to age 45 who have not completed the 9-valent HPV series should consider vaccination to reduce HPV transmission, oropharyngeal, and penile cancer risks.