In 2026, Brazil's Ministry of Health organizes vaccination during pregnancy around three practical moments: review vaccination status as soon as pregnancy is confirmed, ensure Tdap (dTpa) from the 20th week onward, and receive the respiratory syncytial virus (RSV) vaccine from the 28th week onward. The key distinction is that Tdap and RSV vaccination are recommended in every pregnancy, while hepatitis B and dT vaccination need to be adjusted according to the doses already documented in the person's vaccination history.
The table below summarizes what should be checked. It is informational and does not replace assessment during prenatal care or at a vaccination service, especially when there are medical conditions, special clinical circumstances, uncertainty about old doses, or a need for travel-related vaccination.
2026 pregnancy vaccination schedule: what to check at each stage
| Timing | What should be reviewed | What depends on vaccination history |
|---|---|---|
| As soon as pregnancy is known | Hepatitis B, dT, seasonal influenza, COVID-19, and exceptional assessment for yellow fever vaccination | Hepatitis B and dT; yellow fever also requires risk-benefit assessment and review of prior vaccination |
| From the 20th week | 1 dose of Tdap in every pregnancy | Prior vaccines containing diphtheria and tetanus components determine whether dT doses are still missing and help define intervals |
| From the 28th week | 1 dose of RSV vaccine in every pregnancy | The routine schedule does not make this dose conditional on a previous series; timing is based on gestational age |
These recommendations are set out in the Ministry of Health's 2026 National Vaccination Schedule for Pregnant Women and Technical National Vaccination Schedule for Pregnant Women.
When pregnancy is confirmed: bring your records and review what is complete
The first step is not to wait for a specific week. The Ministry of Health recommends reviewing vaccination status from the first prenatal appointment and starting updates for delayed schedules. Bringing a vaccination card or any available vaccination record is therefore useful.
Hepatitis B: complete the series only if it is incomplete
For hepatitis B, the simplified schedule lists three doses according to vaccination history. The technical schedule explains that pregnant people without a complete series should start or complete the three-dose series while observing the recommended intervals. If the series cannot be completed during pregnancy, it may be continued in the postpartum period, preferably within 45 days after delivery.
Someone who has already completed the three-dose series at some point in life should not be revaccinated solely because of pregnancy. This is one reason why previous records matter: they help avoid both missing needed doses and repeating a completed series.
dT: the number of previous doses changes what is still needed
The dT vaccine protects against diphtheria and tetanus and is part of the basic series that should be checked at the start of prenatal care. When doses are overdue, the schedule is updated according to previous doses, while Tdap is included from the 20th week onward.
Influenza and COVID-19 can be addressed during the initial review
Seasonal trivalent influenza vaccine is recommended at any stage of pregnancy, with one dose of the current season's vaccine. For COVID-19, the 2026 recommendation is one dose in each new pregnancy; if a previous dose was received, the technical schedule recommends a minimum interval of six months since the last dose.
Yellow fever vaccination is exceptional during pregnancy
Yellow fever vaccine is not a routine dose for every pregnant person. The schedule allows vaccination in exceptional situations when the person lives in or will travel to an area of epidemiological risk, exposure cannot be postponed, and the health service concludes that the benefit outweighs the risk. Previous vaccination history is also considered.
From the 20th week: Tdap is recommended in every pregnancy
Tdap protects against diphtheria, tetanus and pertussis. In 2026, the central rule is straightforward: one dose from the 20th gestational week onward, in every pregnancy. A complete prior dT or Tdap history does not remove this pregnancy-specific dose.
What the history changes is whether the basic series with diphtheria- and tetanus-containing vaccines still needs to be completed. The Ministry of Health's detailed guidance can be summarized as follows:
| Previous dT/Tdap history | Recommended approach during pregnancy |
|---|---|
| No previous dose | Reach a total of three doses containing diphtheria and tetanus components: two dT doses and one Tdap dose; Tdap is given from the 20th week onward |
| 1 previous dose | Give 1 dT dose and 1 Tdap dose, with Tdap from the 20th week onward |
| 2 previous doses | Give 1 Tdap dose from the 20th week onward |
| 3 doses or a complete basic series | Give 1 Tdap dose from the 20th week onward as the dose recommended for the current pregnancy |
The Ministry of Health uses a recommended interval of 60 days between doses containing diphtheria and tetanus components and a minimum interval of 30 days when the schedule has to be organized. The official Tdap (dTpa) page details these combinations. Because the schedule has to fit the gestational age and the actual dates of previous doses, this part should be confirmed at the vaccination service.
From the 28th week: the RSV vaccine is added
For 2026, the schedule includes one dose of respiratory syncytial virus vaccine from the 28th week onward, in every pregnancy. Its purpose is to protect the infant against RSV-associated lower respiratory tract infections, including bronchiolitis and pneumonia, during the first months of life through antibodies transferred by the pregnant person.
The technical schedule recommends vaccination as early as possible within the indicated window to seek the greatest protection benefit for the baby. Unlike hepatitis B and dT, the routine RSV dose is not determined by the number of doses in an old series; it is determined by the current pregnancy and gestational age.
What actually depends on vaccination history
- Hepatitis B: depends on how many valid doses have already been received; anyone with an incomplete series should start or complete it.
- dT: depends on the number of previous doses containing diphtheria and tetanus components; that determines how many doses remain in the basic series.
- Tdap: is given in every pregnancy from the 20th week onward even with a complete previous series; history is used to organize the remaining series and intervals.
- COVID-19: is recommended in every new pregnancy, but a previous dose affects the recommended minimum interval.
- Yellow fever: is considered only in exceptional situations, with assessment of epidemiological risk, whether exposure can be postponed, and vaccination history.
- RSV: is one dose in every pregnancy from the 28th week onward, without a requirement to complete a previous routine series.
What if prenatal care starts late or a dose is missed?
It is not necessary to assume the opportunity has been lost. The vaccination record should be shown to the health service so the schedule can be reorganized according to gestational age and previous doses. For Tdap, if someone arrives from the 20th week onward with no previous diphtheria and tetanus vaccination, Tdap can be used as the first dose and the series can then be completed with dT. If Tdap is not given during pregnancy, the Ministry of Health allows it in the immediate postpartum period, up to 45 days after delivery.
For hepatitis B, if the series cannot be completed before delivery, the technical schedule also allows completion in the postpartum period, preferably within 45 days. Seasonal influenza vaccine can likewise be administered up to 45 days postpartum if vaccination was not possible during pregnancy.
Checklist for prenatal care or the vaccination clinic
- vaccination card and any digital records or proof available;
- date of the most recent COVID-19 vaccine dose;
- records of hepatitis B, dT and Tdap doses;
- current gestational week;
- information about travel to or residence in a yellow-fever-risk area, if relevant;
- information about a special clinical condition, use of immunobiological products, or previous guidance from a CRIE/RIE reference center.
The Ministry of Health's Vaccination Schedule is the reference for checking updates. People with special clinical conditions should seek guidance from their health service and, when indicated, from the Reference Centers for Special Immunobiologicals. If an old vaccination record conflicts with the current schedule, the decision should be made with the prenatal or vaccination team.
