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Vaccines and immunoglobulins
4.5.1
Maternal immunization
A woman who has not received all the recommended immunizations before or during pregnancy may be immunized in the postpartum period even though she is breastfeeding. The presence of live viruses in the milk does not present a problem because the viruses have been attenuated. According to the statement of the American Academy of Pediatrics Committee on Infectious Diseases ( ), breastfeeding women may be immunized with both killed and live vaccines. All vaccines and immunoglobulins used for mothers are considered safe for the infant during breastfeeding. Lactating women can be immunized, using standard recommended doses for adults, against measles, mumps, rubella, tetanus, diphtheria, pertussis, influenza, streptococcus pneumoniae, neisseria meningitis, hepatitis A, hepatitis B, and varicella. Often it is the need to travel to endemic countries that raises the issue.
A lactating woman can be given inactivated poliovirus vaccine, for instance, if necessary. The administration of live vaccine (oral vaccine) should be delayed in the mother (or parents) of a young infant until the infant has been vaccinated with killed virus regardless of the feeding mode.
With some vaccines, i.e. against meningococcal or pneumococcal disease ( , ) and cholera, there is discussion on whether the relevant amounts of the maternal antibodies built up as a result of immunization appear in the milk.
4.5.2
Efficacy of immunization in breastfed infants
Many myths have circulated regarding the efficacy of immunization of the infant during breastfeeding. Actually, the immunogenicity of some vaccines is increased by breastfeeding, but long-range enhancement of efficacy has not been studied. In any case the response to vaccines while breastfeeding is not diminished, and the usual vaccination schedules should be followed. The American Academy of Pediatrics recommends that all infants should be vaccinated on the regular schedule regardless of the mode of feeding.
4.5.3
Hepatitis A vaccine
Experience
Hepatitis A vaccine is available in two preparations, which are prepared from cell culture-adapted hepatitis A virus which has in turn been cultured in human fibroblasts and inactivated. It has not been studied in breastfeeding or in children under 2 years of age.
Recommendation
Hepatitis A vaccine is unlikely to present a problem during lactation and is not contraindicated.
4.5.4
Hepatitis B vaccine
Experience
Hepatitis B vaccine is a highly effective and safe vaccine which is produced by recombinant DNA technology. The vaccine is an inactivated non-infectious hepatitis B surface antigen vaccine, and contains between 10 and 40 μg of HB 3 Ag protein per mL with apparently similar rates of seroconversion. Pediatric vaccines contain no thimerosal. The vaccine is given to newborns at birth. Hepatitis B vaccine is also combined with other vaccines, and can be given concurrently with other vaccines but via a separate syringe and at another site. A total of three injections of Hepatitis B vaccine are required in the first 6 months of life.
Recommendation
Hepatitis B vaccines are considered safe during lactation.
4.5.5
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