Measles-Mumps-Rubella-Varicella Vaccine use while Breastfeeding
Measles-Mumps-Rubella-Varicella Vaccine Levels and Effects while Breastfeeding
Summary of Use during Lactation
The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to measles, mumps, rubella and varicella virus vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Although rubella vaccine virus might be excreted into milk, the virus usually does not infect the infant. If an infection does occur, it is well tolerated because the viruses are attenuated. No clear evidence exists of live attenuated measles or mumps vaccine virus excretion into breastmilk.
Maternal Levels. No studies have evaluated the effects of the combined measles, mumps, rubella and varicella (MMRV) vaccine during breastfeeding. A study of mothers vaccinated with the Cendehill strain of live, attenuated rubella virus found no transmission of the live virus to their breastfed infants. However, rubella vaccine virus can appear in breastmilk and result in infections in some infants. See "Reported Side Effects In Breastfed Infants" below.
In a prospective study, 169 mothers with low titers or either measles or rubella were given MR vaccine (Schwarz FF-8 strain/TO-336 strain; Takeda Pharmaceutical Co. Ltd, Osaka, Japan) at their 1-month postnatal checkup. Mothers provided 5 mL of breastmilk 2 weeks later. Rubella virus antigen was not detected in the breastmilk of any mothers. Measles virus RNA was isolated from the breastmilk of 2 vaccinated mothers.
Infant Levels. Relevant published information was not found as of the revision date. Two postpartum women immunized with varicella vaccine provided preimmunization and serial postimmunization breastmilk samples (number not specified). One sample of colostrum contained detectable viral DNA and B-actin by polymerase chain reaction, but all other samples were negative for these species. No varicella gene sequences were found in any of the samples.
One study of 12 women vaccinated with live, attenuated varicella vaccine found no evidence of varicella virus excretion into breastmilk.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
Limited data indicate that breastfeeding can enhance the response of the infant to certain vaccine antigens.
One 12-day-old breastfed infant developed a rubella infection 11 days after maternal vaccination with live rubella vaccine. However, it is questionable if maternal vaccination was the cause of the infant's infection.
Another breastfed infant had live rubella vaccine virus isolated from a throat swab after maternal immunization. The infant did not demonstrate seroconversion or adverse reactions.
Some breastfed infants acquire passive immunity to rubella after maternal vaccination as do infants of mothers with natural rubella immunity. However, neither group of infants had a decreased response to rubella vaccine administered to the infant at 15 to 18 months of age.
After immunization of their mothers with rubella vaccine, 25% of breastfed infants in one study showed transient seroconversion to rubella virus but without any clinical disease.
In a prospective study of mothers given MR vaccine (Schwarz FF-8 strain/TO-336 strain; Takeda Pharmaceutical Co. Ltd, Osaka, Japan) at their 1-month postnatal checkup, measles virus RNA was isolated from the breastmilk of 2 vaccinated mothers. Neither of their breastfed infants had any clinical disease.
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
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2. American Academy of Pediatrics Committee on Infectious Diseases, Kimberlin DW, Brady MT et al. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics. 2015.
3. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60 (RR-2):1-64. PMID: 21293327
4. Alain S, Dommergues MA, Jacquard AC et al. State of the art: Could nursing mothers be vaccinated with attenuated live virus vaccine? Vaccine. 2012;30:4921-6. PMID: 22659446
5. Farquhar JD. Follow-up on rubella vaccinations and experience with subclinical reinfection. J Pediatr. 1972;81:460-5. PMID: 5065683
6. Buimovici-Klein E, Hite RL, Byrne T et al. Isolation of rubella virus in milk after pospartum immunization. J Pediatr. 1977;91:939-41. PMID: 925824
7. Krogh V, Duffy LC, Wong D et al. Postpartum immunization with rubella virus vaccine and antibody response in breast-feeding infants. J Lab Clin Med. 1989;113(6):695-9. PMID: 2732617
8. Losonsky GA, Fishaut JM, Strussenberg J. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. J Infect Dis. 1982;145:661-6. PMID: 7077090
9. Losonsky GA, Fishaut JM, Strussenberg J, Ogra PL. Effect of immunization against rubella on lactation products. I. Development and characterization of specific immunologic reactivity in breast milk. J Infect Dis. 1982;145:654-60. PMID: 7077089
10. Hisano M, Kato T, Inoue E et al. Evaluation of measles-rubella vaccination for mothers in early puerperal phase. Vaccine. 2016;34:1208-14. PMID: 26801065
11. Dolbear GL, Moffat J, Falkner C, Wojtowycz M. A pilot study: Is attenuated varicella virus present in breast milk after postpartum immunization? Obstet Gynecol. 2003;101 (4 Suppl):47s. Abstract.
12. Bohlke K, Galil K, Jackson LA et al. Postpartum varicella vaccination: is the vaccine virus excreted in breast milk? Obstet Gynecol. 2003;102:970-7. PMID: 14672472
13. Pabst HF. Immunomodulation by breast-feeding. Pediatr Infect Dis J. 1997;16:991-5. PMID: 9380478
14. Landes RD, Bass JW, Millunchick EW et al. Neonatal rubella following postpartum maternal immunization. J Pediatr. 1980;97:465-7. PMID: 7191002
15. Lerman SJ. Neonatal rubella following maternal immunization. J Pediatr. 1981;98:668-9. Letter. PMID: 7205504
Measles-Mumps-Rubella-Varicella Vaccine Identification
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