Measles-Mumps-Rubella-Varicella Vaccine

Drug Levels and Effects:




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 measles, mumps, rubella and varicellavirusvaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Although rubella vaccinevirusmight be excreted into milk, thevirususually does not infect the infant. If an infection does occur, it is well tolerated because thevirusesare attenuated.[1][2][3] No clear evidence exists of live attenuated measles or mumps vaccinevirusexcretion into breastmilk.[4]


Drug Levels:


Maternal Levels.

No studies have evaluated the effects of the combined measles, mumps, rubella and varicella (MMRV) vaccine during breastfeeding. A study of mothers vaccinated with the Cendehill strain of live, attenuated rubellavirusfound no transmission of the livevirusto their breastfed infants.[5] However, rubella vaccineviruscan appear in breastmilk and result in infections in some infants.[6][7][8][9]

See

"Reported Side Effects In Breastfed Infants" below.

Infant Levels.

Relevant published information was not found as of the revision date. Two postpartum women immunized with varicella vaccine provided preimmunization and serial postimmunization breastmilk samples (number not specified). One sample of colostrum contained detectable viral DNA and B-actin by polymerase chain reaction, but all other samples were negative for these species. No varicella gene sequences were found in any of the samples.[10]

One study of 12 women vaccinated with live, attenuated varicella vaccine found no evidence of varicellavirusexcretion into breastmilk.[11]

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][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 vaccinevirusisolated from a throat swab after maternal immunization. The infant did not demonstrate seroconversion or adverse reactions.[6]

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 had a decreased response to rubella vaccine administered to the infant at 15 to 18 months of age.[7]

After immunization of their mothers with rubella vaccine, 25% of breastfed infants in one study showed transient seroconversion to rubellavirusbut without any clinical disease.[8]


Possible Effects on Lactation:


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


References:


1. Gruslin A, Steben M, Halperin S et al. Immunization in pregnancy: No. 220, December 2008. Int J Gynaecol Obstet. 2009;105:187-91. PMID:19367691
2. Anon.Humanmilk. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009.
3. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60 (RR-2):1-64. PMID:21293327
4. Alain S, Dommergues MA, Jacquard AC et al. State of the art: Could nursing mothers be vaccinated with attenuated livevirusvaccine? Vaccine. 2012;30:4921-6. PMID:22659446
5. Farquhar JD. Follow-up on rubella vaccinations and experience with subclinical reinfection. J Pediatr. 1972;81:460-5. PMID:5065683
6. Buimovici-Klein E, Hite RL, Byrne T et al. Isolation of rubellavirusin milk after pospartum immunization. J Pediatr. 1977;91:939-41. PMID:925824
7. Krogh V, Duffy LC, Wong D et al. Postpartum immunization with rubellavirusvaccine and antibody response in breast-feeding infants. J Lab Clin Med. 1989;113(6):695-9. PMID:2732617
8. Losonsky GA, Fishaut JM, Strussenberg J. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. J Infect Dis. 1982;145:661-6. PMID:7077090
9. Losonsky GA, Fishaut JM, Strussenberg J, Ogra PL. 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. PMID:7077089
10. Dolbear GL, Moffat J, Falkner C, Wojtowycz M. A pilot study: is attenuated varicellaviruspresent in breast milk after postpartum immunization? Obstet Gynecol . 2003;101 (4 Suppl):47s. Abstract.
11. Bohlke K, Galil K, Jackson LA et al. Postpartum varicella vaccination: is the vaccinevirusexcreted in breast milk? Obstet Gynecol. 2003;102:970-7. PMID:14672472
12. Pabst HF. Immunomodulation by breast-feeding. Pediatr Infect Dis J. 1997;16:991-5. PMID:9380478
13. Landes RD, Bass JW, Millunchick EW et al. Neonatal rubella following postpartum maternal immunization. J Pediatr. 1980;97:465-7. PMID:7191002
14. Lerman SJ. Neonatal rubella following maternal immunization. J Pediatr. 1981;98:668-9. Letter. PMID:7205504



Substance Identification:




Substance Name:

Measles-Mumps-Rubella-Varicella Vaccine

Drug Class:


  • Vaccines


  • Administrative Information:




    LactMed Record Number:


    783


    Last Revision Date:


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