Breastfeeding and the risk of shedding from live viral vaccinations:
Case report: probable transmission of vaccine strain of yellow fever virus to an infant via breast milk.
Effect of immunization against rubella on lactation products. I. Development and characterization of specific immunologic reactivity in breast milk.
“Over 69% of the women shed virus in milk after immunization.”
Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions.
” Infectious rubella virus or virus antigen was observed in the breast milk of 11 (68%) of the 16 vaccinated, breast-feeding women studied. After maternal immunization, infectious rubella virus or virus antigen was recovered from the nasopharynx and throat of 56% of the breast-fed infants and from none of the non-breast-fed infants.”
? Infant meningoencephalitis caused by yellow fever vaccine virus transmitted via breastmilk.
“In 2009, the first case was confirmed of meningoencephalitis caused by the yellow fever vaccine virus transmitted via breastmilk. We describe a second case in which the vaccine virus was possibly the etiologic agent of meningoencephalitis.”
Isolation of rubella virus in milk after postpartum immunization.
No abstract available
Postpartum live virus vaccination: lessons from veterinary medicine.
“Pregnant rubella-susceptible women are often revaccinated during the postpartum period with the Measles, Mumps, and Rubella vaccine (MMR). It is known that the rubella virus from vaccine is secreted in breast milk and persists in the nose and throat for up to 28 days but it is not known whether the measles and mumps viruses are similarly secreted. It is probable the measles virus from vaccine is.”
Postpartum rubella immunization: association with development of prolonged arthritis, neurological sequelae, and chronic rubella viremia.
“Six women developed chronic long-term arthropathy after postpartum immunization against rubella. All individuals developed acute polyarticular arthritis within 12 days to three weeks postimmunization and have had continuing chronic or recurrent arthralgia or arthritis for two to seven years after vaccination. Acute neurological manifestations, consisting of carpal tunnel syndrome or multiple paresthesiae, developed postvaccination in three women. Two have developed continuing active or chronic recurrent episodes of blurred vision, paresthesiae, and painful limb syndromes together with recurrent joint symptoms. Chronic rubella viremia has been detected in peripheral blood mononuclear cell (MNC) populations in five of the six women up to six years after vaccination. In addition rubella virus was isolated from breast milk MNCs in one individual at nine months postvaccination and from peripheral blood MNCs in two of four breast-fed infants studied at 12-18 months of age. Immune responses to rubella virus studied at sequential intervals after vaccination correlated with development of rheumatologic and neurological manifestations.”
Secondary and Tertiary Transfer of Vaccinia Virus Among U.S. Military Personnel — United States and Worldwide, 2002–2004
“Case 1. In early May 2003, a service member received his primary smallpox vaccination. Approximately 6–8 days after vaccination, he experienced a major reaction (i.e., an event that indicates a successful take; is characterized by a papule, vesicle, ulcer, or crusted lesion, surrounded by an area of induration; and usually results in a scar) (4). The vaccinee reported no substantial pruritus. He slept in the same bed as his wife and kept the vaccination site covered with bandages. After bathing, he reportedly dried the vaccination site with tissue, which he discarded into a trash receptacle. He also used separate towels to dry himself, rolled them so the area that dried his arm was inside, and placed them in a laundry container. His wife handled bed linen, soiled clothing, and towels; she reported that she did not see any obvious drainage on clothing or linen and had no direct contact with the vaccination site.
In mid-May, the wife had vesicular skin lesions on each breast near the areola but continued to breastfeed. Approximately 2 weeks later, she was examined at a local hospital, treated for mastitis, and continued to breastfeed. The same day, the infant had a vesicular lesion on the upper lip, followed by another lesion on the left cheek (5). Three days later, the infant was examined by a pediatrician, when another lesion was noted on her tongue. Because of possible early atopic dermatitis lesions on the infant’s cheeks, contact vaccinia infection with increased risk for eczema vaccinatum was considered. The infant was transferred to a military referral medical center for further evaluation. On examination, the infant had seborrheic dermatitis and no ocular involvement. Skin lesion specimens from the mother and infant tested positive for vaccinia by viral culture and PCR at the Alaska Health Department Laboratory and at Madigan Army Medical Center. Because both patients were stable clinically and the lesions were healing without risk for more serious complications, vaccinia immune globulin was not administered. Neither patient had systemic complications from the infection.
Case 2. In July 2003, a service member who had been vaccinated was wrestling with an unvaccinated service member at a military recreational function when the bandages covering the vaccination site fell off. The unvaccinated service member subsequently wrestled with another unvaccinated service member. Six days later, both unvaccinated service members had lesions on their forearms, neck, and face. Skin lesion specimens from both men tested positive for vaccinia virus by PCR and viral culture at Tripler Army Medical Center’s microbiology laboratory.”
? [Should yellow fever vaccination be recommended during pregnancy or breastfeeding?]. 2010.
“Regarding breastfeeding, the risk was recently confirmed by a report describing vaccine-induced encephalitis occurring in an infant 8 days after primary vaccination of the mother.”
State of the art: Could nursing mothers be vaccinated with attenuated live virus vaccine?
“Recently two cases of vaccine-associated neurologic disease have been reported in breastfed infants whose mothers had received live attenuated yellow fever vaccine.”
Tertiary contact vaccinia in a breastfeeding infant. 2004.
“The vaccinee reported observing all of the standard precautions to avoid household spread. In mid May, his breastfeeding wife developed vesicles on both areolas. On May 29, their infant daughter developed a papule on her philtrum. Contact vaccinia was confirmed by positive polymerase chain reaction and culture for vaccinia of both the maternal and infant lesions. This is the first documented case of inadvertent contact vaccinia transmission from a mother to her infant through direct skin-to-skin and skin-to-mucous membrane contact while breastfeeding. The mechanism of transfer from the vaccinee to the spouse is uncertain. This report demonstrates that breastfeeding infants living in close contact with smallpox vaccinees are at potential risk for contact vaccinia, even if the vaccinee is not the breastfeeding mother, and highlights the need for special precautions to prevent secondary transfer to breastfeeding mothers.”
Transmission of yellow fever vaccine virus through breast-feeding – Brazil, 2009.
“The infant, who was exclusively breast-fed, was hospitalized at age 23 days with seizures requiring continuous infusion of intravenous anticonvulsants. The infant received antimicrobial and antiviral treatment for meningoencephalitis. The presence of 17DD yellow fever virus was detected by reverse transcription–polymerase chain reaction (RT-PCR) in the infant’s cerebrospinal fluid (CSF); yellow fever–specific immunoglobulin M (IgM) antibodies also were present in serum and CSF.”