Rubella Vaccine 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 rubella 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.[1-3]

Drug levels in milk and infant serum

Maternal Levels. Early studies found no transmission of rubella virus to breastfed infants. None of 18 infants who were breastfed after maternal vaccination with rubella vaccine (various strains) had detectable antibodies in one study.[4] Another study of two strains of rubella vaccine (HPV -77 DE5 and RA 27 /3) given by subcutaneous injection or intranasal inhalation found infectious rubella virus or virus antigen in the breastmilk of 8 of the 13 women.[5] 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.[6] However, rubella vaccine virus can appear in breastmilk and result in infections in some infants.[7-9] 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.[10] 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.[1,2,11] A paper reported on 511 women who received rubella vaccine in the immediate postpartum period. Three strains were studied: Cendehill (n = 210), HPV-77 DE-5 (Meruvax; n = 182) and RA 27/3 (n = 119). Sixty-three infants, 67% of whom were breastfed, were studied at 2 to 8 months of age. None of them had any evidence of side effects or seroconversion from maternal vaccination.[12] One 12-day-old breastfed infant developed a rubella infection 11 days after maternal vaccination with live rubella vaccine.[13] However, it is questionable if maternal vaccination was the cause of the infant's infection.[14] 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.[7] 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 has a decreased response to rubella vaccine administered to the infant at 15 to 18 months of age.[8] After immunization of their mothers with rubella vaccine, 25% of breastfed infants in one study showed transient seroconversion to rubella virus (RA 27/3 strain), but without any clinical disease.[9]

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. 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. Isacson P, Kehrer AF, Wilson H, et al. Comparative study of live, attenuated rubella virus vaccines during immediate puerperium. Obstet Gynecol 1971;37:332-7.5101211 PubMed
5. Losonsky GA, Fishaut JM, Strussenberg J, et al. Effect of immunization against rubella on lactation products. I. Development and characterization of specific immunologic reactivity in breast milk. J Infect Dis 1982;145:654-60.7077089 PubMed
6. Farquhar JD. Follow-up on rubella vaccinations and experience with subclinical reinfection. J Pediatr 1972;81:460-5.5065683 PubMed
7. Buimovici-Klein E, Hite RL, Byrne T, et al. Isolation of rubella virus in milk after pospartum immunization. J Pediatr 1977;91:939-41.925824
8. 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;113:695-9.2732617 PubMed
9. Losonsky GA, Fishaut JM, Strussenberg J, et al. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. J Infect Dis 1982;145:661-6.7077090 PubMed
10. Hisano M, Kato T, Inoue E, et al. Evaluation of measles-rubella vaccination for mothers in early puerperal phase. Vaccine 2016;34:1208-14.26801065 PubMed
11. Pabst HF. Immunomodulation by breast-feeding. Pediatr Infect Dis J 1997;16:991-5.9380478 PubMed
12. Grillner L, Hedstrom CE, Bergstrom H, et al. Vaccination against rubella of newly delivered women. Scand J Infect Dis 1973;5:237-41.4798559 PubMed
13. Landes RD, Bass JW, Millunchick EW, et al. Neonatal rubella following postpartum maternal immunization. J Pediatr 1980;97:465-7.7191002 PubMed
14. Lerman SJ. Neonatal rubella following maternal immunization. J Pediatr 1981;98:668-9.7205504 PubMed