Haemophilus Vaccines and Breastfeeding

Summary of use during lactation

Although there is some conflicting information on the effect of breastfeeding on infants' antibody response to Haemophilus influenzae type b vaccines, there is no evidence that breastfeeding reduces protection against the disease. 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 the Haemophilus influenzae vaccine.[1-3] Breastfeeding alone appears to increase antibodies against Haemophilus influenzae and reduce the incidence of Haemophilus influenzae type b meningitis.[4-6] Breastfeeding also appears to reduce infant side effects associated with routine childhood immunization. Breastfed infants should be vaccinated according to the routine recommended schedules.

Drug levels in milk and infant serum

Maternal Levels. A study compared colostrum and milk antibody levels following maternal immunization with Haemophilus influenzae type b polysaccharide vaccine at 3 time periods. Women who were immunized at 24 to 26 weeks of pregnancy had higher antibody levels in colostrum (average 21 mg/L) and in breastmilk at 3 or 6 months after delivery (average 3.1 mg/L) than women who were immunized 1 to 8 months before pregnancy (average 0.13 mg/L at 3 or 6 months postpartum) or those who had not been immunized (average 0.91 mg/L in colostrum, and 0.09 mg/L at 3 or 6 months postpartum).[7] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Breastfed infants are less likely to have fever and may be less likely to experience anorexia and reduced energy intake after routine childhood immunization than those who are not breastfed.[8,9] In 2 studies, breastfed infants had higher antibody titers against Haemophilus influenzae type b than formula-fed infants at 7 and 12 months of age after vaccination with a Haemophilus influenzae type b conjugate vaccine.[1,10] In another study, infants breastfed for longer than 90 days had a better antibody response to the vaccine at 13 months of age than those breastfed less than 90 days.[11] In a study of 408 infants immunized with Haemophilus influenzae type b polysaccharide-tetanus toxoid conjugate vaccine, no difference in antibody titer was observed at 7 months between infants breastfed for less than 4 weeks and those who were breastfed for 24 weeks or more. Likewise, no difference in antibody response was found when infants were grouped by breastfeeding less than 1 month or greater than 1 month.[12] Another study of 252 infants who each received one of 4 Haemophilus influenzae type b vaccines found no difference in antibody titers among those who were breastfed and those who were not.[13] Among 272 infants who were vaccinated with Hib PRP-OMP vaccine at 2 and 4 months postpartum, 101 were breastfed and 171 were formula fed. Of the breastfed infants, 79% were breastfed at least 80% at 7 weeks and 59% at 7 months of age. Breastfed infants had lower IgG titers than formula-fed infants at both 7 weeks and 7 months of age. Although the difference was statistically significant after adjustment for confounding variables, no invasive Haemophilus influenzae type b infections occurred in any of the infants in the study.[14] A study in Sweden compared the IgG response to Haemophilus b (Hib) vaccine in infants who were either breastfed or randomized to one of 3 different formulas. In a secondary analysis of the results, breastfed infants had significantly lower IgG levels against Hib at 4, 6, and 12 months than formula-fed infants. A significantly higher proportion of the formula-fed infants showed Hib IgG concentrations above the protective levels at 4, 6, and 12 months. The authors could not explain the differences, but felt that the clinical relevance of different IgG responses is most likely limited.[15]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Kroger A, Bahta L, Long S, et al. CDC. General Best Practices for Immunization. 2024. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
2. Kimberlin DW, Brady MT, Jackson MA, et al. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics. 2018.
3. Gruslin A, Steben M, Halperin S, et al. Immunization in pregnancy: No. 220, December 2008. Int J Gynaecol Obstet 2009;105:187-91.19367691 PubMed
4. Silfverdal SA, Bodin L, Hugosson S, et al. Protective effect of breastfeeding on invasive Haemophilus influenzae infection: A case-control study in Swedish preschool children. Int J Epidemiol 1997;26:443-50.9169183 PubMed
5. Silfverdal SA, Bodin L, Olcen P. Protective effect of breastfeeding: An ecologic study of Haemophilus influenzae meningitis and breastfeeding in a Swedish population. Int J Epidemiol 1999;28:152-6.10195681 PubMed
6. Silfverdal SA, Bodin L, Ulanova M, et al. Expression of idiotypic antibodies-1 and -2 and breastfeeding in relation to antibody levels against Haemophilus influenzae type b in children. Scand J Immunol 2006;63:371-5.16640661 PubMed
7. Insel RA, Amstey M, Pichichero ME. Postimmunization antibody to the Haemophilus influenzae type b capsule in breast milk. J Infect Dis 1985;152:407-8.3875665 PubMed
8. Pisacane A, Continisio P, Palma O, et al. Breastfeeding and risk for fever after immunization. Pediatrics 2010;125:e1448-52.20478932 PubMed
9. López-Alarcón M, Garza C, Habicht JP, et al. Breastfeeding attenuates reductions in energy intake induced by a mild immunologic stimulus represented by DPTH immunization: possible roles of interleukin-1beta, tumor necrosis factor-alpha and leptin. J Nutr 2002;132:1293-8.12042449 PubMed
10. Pabst HF, Spady DW. Effect of breast-feeding on antibody response to conjugate vaccine. Lancet 1990;336:269-70.1973970 PubMed
11. Silfverdal SA, Ekholm L, Bodin L. Breastfeeding enhances the antibody response to Hib and pneumococcal serotype 6B and 14 after vaccination with conjugate vaccines. Vaccine 2007;25:1497-502.17097198 PubMed
12. Scheifele D, Bjornson GJ, Guasparini R, et al. Breastfeeding and antibody responses to routine vaccination in infants. Lancet 1992;340:1406.1360102 PubMed
13. Decker MD, Edwards KM, Bradley R, et al. Comparative trial in infants of four conjugate haemophilus influenzae type b vaccines. J Pediatr 1992;120:184-9.1735812 PubMed
14. Hawkes JS, Makrides M, Roberton DM, et al. Responses to immunisation with Hib conjugate vaccine in Australian breastfed and formula-fed infants. J Paediatr Child Health 2007;43:597-600.17688643 PubMed
15. Björmsjö M, Ekström N, Silfverdal SA, et al. Vaccine response was higher in formula-fed infants compared to breastfed but not affected by lactoferrin or iron in a randomised controlled trial. Acta Paediatr 2024;113:2266-74.38934330 PubMed