In reference to the question concerning rubella and varicella vaccines, I
would like to insert another view.

First almost all live viruses transfer in human milk to the infant.  Whether
they induce a clinical syndrome in the breastfed infant depends largely on
the immune status of the infant.  We know with certainty that HIV does.

Rubella vaccine has been found in at least four studies to transfer to human
infants, and is culturable from the oropharynx for some weeks.  In only one
infant, was it found to produce a mild rash, typical of the rubella
syndrome.  It is generally recommended that all women who have minimal
rubella titers, receive rubella vaccine immediately postpartum.  Thus far we
have no data that this has been detrimental to any infants.

The AAP Red book suggests that there is no evidence of significant and
documented risk to a breastfed infant from either rubella or varicella
vaccines and I agree. For a normal infant this is certainly true.

On the other hand, I do not believe it would be advisable for a mom to
receive either of these 'live' vaccines and breastfeed, if her infant is
extremely fragile, very very low birth weight, and particularly if the
infant is immunocompromized. In these instances, even an attenuated virus
can be dangerous.  Just remember how sick your normal kids can get with
these immunizations at 1 year.

I believe there are always exceptions to the rule and a weakened infant
would not need the added burden of a live virus (even if it is attenuated)
thrown into this already dangerous situation.

I agree that breastmilk is certainly beneficial to these infants and perhaps
a donor could be briefly arranged for this specific situation.  But I do not
believe that we should always throw "caution to the wind" just so that we
can support breastfeeding an infant.

Sorry to be a naysayer !!

Tom Hale, Ph.D.










Date:    Wed, 3 Dec 1997 21:29:06 -0800
 From:    Kathy Warmbier <[log in to unmask]>
Subject: vaccinations:Hale or Newman

Help:Dr. Hale or Dr. Newman
Baby born 11-7  at 38 weeks, wt. 4lb 4oz
on 11\17 5lb 10oz
Mother was given both varicela and rubella vaccines on 11-26 and told not
to breastfeed for 1mo.
mother is frantic because baby is not tolerating the formula well. Is 1 mo
necessary because of babys age or size?
TIA
Kathy