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 (Measles Mumps Rubella) and chickenpox vaccines are live attenuated. 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.
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 compared to those fed formula, 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. Breastmilk antibodies to influenza are higher if the breastfeeding mother receives the flu shot rather than the nasal flu mist.
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 to 4 weeks, until the vaccination scab has healed. If a breastfeeding mother receives the smallpox vaccine, she will need to pump and dump her milk until the vaccine site has healed to avoid the risk of spreading smallpox to their infants. 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. The typhoid vaccine, although live, attenuated, is safe during breastfeeding and a mother does not pass the virus to her breastfeeding infant.
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.
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.
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Diane Erdmann RN IBCLC has been working with breastfeeding families for over 40 years and promises each mom she will have lots of suggestions to help her overcome any breastfeeding issues she may be dealing with. Diane is able to bill most insurances for lactation consultations so moms rarely pay out of pocket for them. Call today for an appointment at 402-707-1696. If Diane is not able to see you the day you call, she will likely be available the next day.