Pneumococcal Vaccines and 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 pneumococcal vaccine. Immunization of the mother during the third trimester of pregnancy markedly increases the amount of pneumococcal antibodies in breastmilk.[1] Breastfed infants should be vaccinated according to the routine recommended schedules.[2-4]

Drug levels in milk and infant serum

Maternal Levels. A study followed mothers who received the 23-valent pneumococcal polysaccharide vaccine. It found that mothers who received the vaccination during pregnancy or within 72 hours postpartum had sIgA and IgG in their breastmilk that persisted for at least 7 months postpartum.[5] 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.[2,3,6,7] Immunization of pregnant women with pneumococcal vaccine increased the specific secretory IgA content of milk and colostrum.[8-13] These antibodies in colostrum help inhibit epithelial adhesion of pneumococci to pharyngeal epithelial cells.[8] Some evidence of decreased pneumococcal disease has been found among breastfed infants of vaccinated mothers.[13] Infants breastfed for longer than 90 days have a better antibody response to some pneumococcal strains in the vaccine at 13 months of age than those breastfed less than 90 days.[14]

Effects on lactation and breastmilk

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

References

1. Maertens K, De Schutter S, Braeckman T, et al. Breastfeeding after maternal immunisation during pregnancy: Providing immunological protection to the newborn: A review. Vaccine 2014;32:1786-92.24530929 PubMed
2. Kroger A, Bahta L, Long S, et al. CDC. General Best Practices for Immunization. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
3. 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.
4. 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
5. Martinovich KM, Seppanen EJ, Bleakley AS, et al. Evidence of maternal transfer of antigen-specific antibodies in serum and breast milk to infants at high-risk of S. pneumoniae and H. influenzae disease. Front Immunol 2022;13:1005344.36211411 PubMed
6. Pabst HF. Immunomodulation by breast-feeding. Pediatr Infect Dis J 1997;16:991-5.9380478 PubMed
7. Binks MJ, Moberley SA, Balloch A, et al. Pneumum: Impact from a randomised controlled trial of maternal 23-valent pneumococcal polysaccharide vaccination on middle ear disease amongst indigenous infants, Northern Territory, Australia. Vaccine 2015;33:6579-87.26529076 PubMed
8. Deubzer HE, Obaro SK, Newman VO, et al. Colostrum obtained from women vaccinated with pneumococcal vaccine during pregnancy inhibits epithelial adhesion of Streptococcus pneumoniae. J Infect Dis 2004;190:1758-61.15499530 PubMed
9. Finn A, Zhang Q, Seymour L, et al. Induction of functional secretory IgA responses in breast milk, by pneumococcal capsular polysaccharides. J Infect Dis 2002;186:1422-9.12404157 PubMed
10. Muñoz FM, Englund JA, Cheesman CC, et al. Maternal immunization with pneumococcal polysaccharide vaccine in the third trimester of gestation. Vaccine 2001;20:826-37.11738746 PubMed
11. Obaro SK, Deubzer HE, Newman VO, et al. Serotype-specific pneumococcal antibodies in breast milk of Gambian women immunized with a pneumococcal polysaccharide vaccine during pregnancy. Pediatr Infect Dis J 2004;23:1023-9.15545857 PubMed
12. Shahid NS, Steinhoff MC, Hoque SS, et al. Serum, breast milk, and infant antibody after maternal immunisation with pneumococcal vaccine. Lancet 1995;346:1252-7.7475716 PubMed
13. Lehmann D, Pomat WS, Riley ID, et al. Studies of maternal immunisation with pneumococcal polysaccharide vaccine in Papua New Guinea. Vaccine 2003;21:3446-50.12850357 PubMed
14. 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