Abstract
The May issue of Breastfeeding Medicine could not be more timely, important, and newsworthy. Dr. Anderson's monthly LactMed column presents a most balanced and comprehensive summary on the subject of maternal vaccination of the nursing mother, surely a subject of much potential public health concern. His bottom line is that there are no routine vaccines that are contraindicated in such mothers. The exceptions are smallpox and yellow fever in special circumstances.
Most importantly, given the thrust of the antivaccination movement against the use of standard measles immunization vaccines, he confirmed the safety of vaccinating mothers against measles while they are nursing their infants. Simply put, there is no evidence that this attenuated live measles virus is excreted in the breast milk and thus there is no risk to the infant. As such, there should be no hesitation in vaccinating breastfeeding women against measles as part of any public health campaign to minimize the spread of the virus while contributing to herd immunity. Even more so, it is clear that immunization with inactivated viruses such as papilloma virus or hepatitis A, or inactivated bacteria such as meningococcus, is of no medical concern.
Beyond the invalid concerns for these nonexistent risks, Dr. Anderson emphasized that there are also benefits to vaccinating mothers, for both the mothers themselves and the breastfeeding infants. The most well-documented benefit is that not only does influenza immunization reduce the frequency and severity of maternal respiratory disease, but, that there is also a significant reduction in respiratory symptoms and laboratory confirmed influenza disease in the infants. The substantial beneficial effect results from the transfer to the infant of maternal antibodies that are secreted into breast milk and thus effectively providing passive immunization to the infants. This protective effect also occurs after maternal immunization with diphtheria and tetanus.
No less is Dr. Anderson's reminder to us that there is no concern that higher titers of immunoglobulins in breast milk after maternal vaccinations might theoretically reduce the efficacy of infant vaccination per se. Current data actually indicate quite the opposite, not only is there no reduction in the efficacy of the vaccination of the infant, but, on the contrary, there is also an enhancement in the infant's antibody response and less vaccine-related fever. Thus, breastfeeding is the preferred feeding regimen for infants who are candidates for routine infant vaccination as opposed to the feeding of breast milk substitutes, and the standard immunization schedule should be adhered to.
The World Health Organization (WHO) has recently proclaimed 1 what they term “vaccine hesitancy”—the reluctance or refusal to vaccinate despite the availability of vaccines—as one on the “top ten threats to global health.” Per the WHO, vaccination is one of the most cost-effective ways of avoiding disease—it currently prevents 2–3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved. Thus, any interference or disruption of such basic public health measures is an unwarranted risk of mega proportion to the public at large.
To many, the antivaccination movement can be defined as a loosely organized “conspiracy theorist' subculture that attributes and blames the medical practice of vaccinations for a wide range of health problems.2,3 The movement is based largely on spuriously alleged short- and long-term side effects of vaccinations. In reality, the results of the various antivaccination activities have been an increase in the incidence of infectious diseases, especially measles, with its real associated morbidity and even mortality. Hopefully, what Dr. Anderson's presented in his up-to-date review should support and reinforce responsible medical practitioners' conclusions regarding the value, efficacy, and safety of current immunization material and implementation public policy. It is clear that vaccination should be offered to the widest public, including nursing mothers as necessary, both for the benefit of the maternal–infant dyad and, in turn, for the wider public.