Vaccines During Breastfeeding
by Anne Eglash MD, IBCLC, FABM
The National Library of Medicine’s Lactmed database for medications during breastfeeding has comprehensive information on vaccines during lactation, whether they are routine vaccines or special for travel. Each vaccine should be searched separately in the database. Some vaccines are live attenuated (weakened), and others are not live. Nearly all vaccines, including the live attenuated vaccines, are safe during lactation, and appropriate vaccination should not be delayed. For example, MMR and chickenpox vaccines are live attenuated, but if the breastfeeding mother is not immune to these diseases, it is much safer for her to receive the vaccines during lactation, than to wait and take the risk of contracting these illnesses. Contracting these illnesses puts her infant at very high risk of morbidity and even mortality.
The smallpox vaccine is the only one that is contraindicated during lactation. Anyone who receives the smallpox vaccine should not handle an infant for 3-4 weeks, until the vaccination scab has healed.
- The yellow fever vaccine should be used with caution in breastfeeding mothers because cases of yellow fever infection in nursing infants have been documented after maternal immunization.
- Breastfeeding reduces infant side effects from vaccines.
- Breastfeeding women should wait until after weaning to receive a MMR booster.
- A mother should not breastfeed her infant within 1 hour after the infant receives the oral rotavirus vaccine, to prevent breastmilk from destroying the rotavirus bacteria in the infant gut.
- Breastmilk antibodies to influenza are higher if the breastfeeding mother receives the flu shot rather than the nasal flumist.
- Breastfed infants as compared to formula fed infants appear to develop stronger immunity to some vaccines.
- If a breastfeeding mother receives the smallpox vaccine she will need to pump and dump her milk until the vaccine site has healed.
- Breastfeeding mothers may receive the oral typhoid vaccine but they need to pump and dump for 2 weeks after the vaccine.
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There has not been a recent literature review of vaccines during lactation that includes vaccines not typically given routinely in the USA, such as those for travel. The Center for Disease Control has a phone app and a website on routine vaccines, but does not include a ‘special travel need’ category for breastfeeding like they do for pregnancy and other conditions. Lactmed thru the National Library of Medicine has more up to date information on vaccines during lactation.
Breastfeeding infants have fewer side effects of vaccinations, such as fever and fussiness, likely because breastmilk has factors that moderate inflammation. In addition, breastfeeding infants appear to demonstrate a stronger immune response to vaccines, as measured by their antibody levels. Breastfeeding immediately after an oral rotavirus vaccine does not reduce the infant’s immune response. Pregnant mothers who receive the tetanus/diphtheria/pertussis vaccine show higher levels of pertussis in their breastmilk, which means that breastfed newborns are less likely to contract whooping cough.
The typhoid vaccine, although live, attenuated, is safe during breastfeeding and mothers do not pass the virus to their breastfeeding infants.
In addition to not holding their infants for 3-4 weeks, mothers who receive the smallpox vaccine need to pump and dump their milk during that time, to avoid the risk of spreading smallpox to their infants.