Vaccines are always topical when it comes to children, but what about when it comes to ourselves? Vaccines are right at the forefront of conversation right now and not just for traveling. Science has moved at lightning speed to produce numerous vaccines against COVID-19. And just like buses, the vaccines arrived all at once.
Every country has different policies on who gets COVID-19 vaccines in which order. Safe to say, there are quite a few nursing mothers who may have been offered a vaccine and are feeling conflicted about what to do. Are vaccinations safe for mothers and infants during breastfeeding? Never mind the statements by drug companies or whoever, many of us in the age of information want to know the actual evidence found in the first place.
Breastfeeding is such a precious but fragile time for parents and infants. What’s best for you and your family with regards to vaccines can be charged with emotion, but it’s also very individual to your situation.
No article can replace a careful discussion with your healthcare provider about any potential risks and benefits of vaccination according to your circumstances. There isn’t a one size fits all answer here, but here’s a quick look at common vaccinations during breastfeeding, focusing on COVID-19 vaccines.
Please note that vaccines in pregnancy are a different topic altogether.
COVID vaccine and breastfeeding
Numerous professional bodies and governmental health authorities have endorsed vaccinations against COVID-19 in breastfeeding women, while some advise on postponing until further notice. Here’s a quick tour around the statements:
1. The World Health Organization (WHO)
If a breastfeeding woman is a part of a group (e.g., health workers) recommended for vaccination, vaccination can be offered. WHO does not recommend discontinuing breastfeeding after immunization.
2. The US Center for Communicable Disease Control (CDC)
The mRNA vaccines are not considered a risk to the breastfeeding infant. The US Food and Drug Administration (FDA) then issued an Emergency Use Authorization (EUA) for 3 vaccines:
- Two dose Pfizer/BioNTech vaccine: It uses mRNA technology.
- Two dose Moderna vaccine: It uses mRNA.
- One dose Johnson & Johnson vaccine: It uses a harmless, modified form of the common cold virus in humans called an adenovirus.
3. The American College of Obstetricians and Gynecologists (ACOG)
COVID-19 vaccines should be offered similarly to lactating and non-lactating women.
4. The UK Joint Committee on Vaccination and Immunization (JCVI)
Lactating women may be offered vaccination with the Pfizer, Moderna, and AstraZeneca vaccines. There’s a 2 dose vaccine schedule for Pfizer-BioNTech and AstraZeneca vaccines.
The UK government had previously recommended that lactating women should wait before taking the vaccines “until additional evidence is available to support the use of this vaccine in pregnancy and breastfeeding.” But they have since updated the recommendations.
5. New Zealand’s Unite Against COVID-19
The 2 dose Pfizer/BioNTech (Comirnaty) vaccine has been approved to use in New Zealand for people 16 years and older. However, if you’re lactating, you speak with a health professional first
6. India’s Ministry of Health and Government Welfare
Two vaccines that have been granted EUA by the Central Drugs Standard Control Organization (CDSCO) are the 2 dose Covishield (AstraZeneca’s vaccine) and Covaxin. A vaccine dose for nursing moms would require additional evidence and testing to mark it completely safe hence lactating women should not receive the COVID-19 vaccine at this time.
7. Federal Health Department, Australia
Comirnaty (Pfizer Australia) vaccine has not yet been tested in breastfeeding women, but there are no concerns about its safety in breastfeeding women or their babies. The federal health department issued a decision guide to help breastfeeding women assess whether the Pfizer vaccine benefits outweigh the risks.
8. National Health’s Commission of the People’s Republic of China
All COVID-19 vaccines approved for use are effective at preventing the disease. The vaccines given to priority groups in China are inactivated vaccines. However, lactating women should delay getting the COVID-19 vaccine.
9. Ministry of Health of the Russian Federation
The Sputnik V vaccine isn’t given to lactating mothers.
10. South Africa’s Department of Health
The 3 phase mass rollout, which prioritizes health workers, excludes lactating mothers. There’s not enough data found to support, delay, or bar use. But according to the South African government news agency, the Johnson & Johnson vaccine can be safely used in breastfeeding women.
11. Dubai Health Authority (DHA)
Mothers who are breastfeeding babies above six months of age can take the Sinopharm vaccine according to its guideline, while other types of vaccines exclude all breastfeeding women in their guidelines. The other types of vaccine currently available in Dubai include the Pfizer-BioNTech and the Oxford AstraZeneca. DHA mentions, “Should a sufficient amount of research show that the vaccine is safe for pregnant women, breastfeeding women and children, the concerned authorities will study the inclusion of these categories.” DHA advises breastfeeding women to consult the doctor on whether to breastfeed directly, pump milk or postpone breastfeeding if taking Sinopharm.
Some of these pronouncements accompany unhelpful statements such as, “Women should be informed of the absence of safety data in breastfeeding.” Let’s try to unpack what that means.
Clinical trials for COVID-19 vaccines
All vaccines have to go through extensive, rigorous clinical trials before approval. Barriers to ethical approval mean that these rarely, if ever, include large numbers of breastfeeding women.
However, there has never been any evidence that inactivated vaccines—those that do not contain a “live” version of the virus—have shown any problems for breastfeeding women. None of the vaccinations available against COVID-19 contain an active virus; hence numerous experts have given the go-ahead for breastfeeding mothers. Remember also that babies worldwide are already receiving multiple vaccinations as part of their primary immunization series every day.
These relevant professional bodies apply caution because vaccine trials initially excluded lactating (and pregnant) women. Until recently, there hadn’t been any clinical data regarding the vaccines’ safety for nursing moms. Hence countries that approved of the vaccines would still advise breastfeeding mothers to consult medical professionals first.
ACOG has conducted a cohort study of the impact of the COVID-19 vaccine on breastfeeding women. Vaccine-generated antibodies were present in all umbilical cord blood and breastmilk samples, which means immune transfer to neonates occurred through the placenta and breastmilk. The COVID-19 mRNA vaccines generated robust humoral immunity in breastfeeding women with similar immunogenicity observed in non-pregnant women. Finally, vaccine-induced immune responses were even greater than the response to natural infection.
Other factors to consider
Policies may vary from place to place. For instance, the ACOG has stated that while discussing the vaccines with a health care professional may be helpful; it shouldn’t be a barrier to a nursing mother receiving a COVID vaccination. ACOG adds that such discussions prior to vaccination may cause unnecessary barriers to access. However, you may want to think about your personal circumstances and individual risk, as you would for any vaccine during breastfeeding.
- Do you have health conditions that put you at increased risk of severe COVID-19?
- Does your occupation put you at increased risk of catching the virus, e.g., healthcare worker?
- What are the virus rates like in your area?
- How much are you able to protect yourself from contracting the virus?
Are you considering finishing breastfeeding very soon? If so, it may be an individual choice to wait until then. Breastfeeding has a whole host of benefits to infants and mothers, so it is definitely not recommended to stop breastfeeding to be vaccinated.
Fever, muscle aches, and fatigue are typical and short-lived after the COVID-19 vaccines. This simply signifies that your immune system is doing its job creating antibodies in response to the vaccine. Acetaminophen (also called paracetamol) is safe in breastfeeding and can bring the fever down. Not all fever is bad, though; it just means the immune system is busy.
Antibodies to COVID-19 will pass in breast milk, so the baby will even receive their own protection in that way.
Busting myths about COVID-19 vaccines
Information overload and misinformation have become the norm in our world today. You probably know of an unreliable website out there. Family and friends can be well meaning, but facts get mixed up down the information chain. Even though you know it might not be correct, things stick in your mind and lead to doubt.
Feeling hesitant and having questions about vaccines is normal. Many patients now schedule a conversation with their care provider before booking vaccine appointments to ask if they can get the vaccine or clear up any concerns.
Here are a couple of common misconceptions that are going around:
1. COVID-19 vaccines cause infertility
There is no evidence of this whatsoever.
2. Isn’t it better to get COVID-19 and let my own immune system protect me?
Vaccinations produce higher antibody levels than any natural immunity. Although most COVID-19 infections cause no or minor illness, this disease’s highly transmissible nature means that the severe after-effects become widespread in an infected community.
You’re already aware of the scenarios in hospitals. Although older persons are most at risk, serious illness can affect anyone of any age. A growing body of evidence suggests that a surprising number of people are COVID long haulers. About 33% of survivors develop long-haul symptoms of COVID.
This poorly understood illness has rendered many folks unable to carry on with their livelihoods due to exhaustion and a constellation of other symptoms. Hospital emergency departments and clinics may be dealing with them for months and months to come. Not what you need when you have young children.
3. No one knows right now how long the vaccines offer protection.
Studies on this are ongoing, so there should be more information soon.
4. Can my baby get COVID-19 from the vaccine?
None of the COVID-19 vaccines are “live,” meaning they don’t contain the actual forms of the virus. Your baby cannot contract COVID-19 from your breastmilk, as explained above.
Which other vaccines can you take when breastfeeding?
Most vaccines are safe. Broadly speaking, “non-live” vaccines are safe. Live vaccines contain an attenuated version of the real pathogen. This downgraded version will still trigger the body to make an immune response without causing the actual disease. “Non-live” vaccines may be called: inactivated, attenuated, recombinant, conjugate, polysaccharide, or toxoid to reflect the technology used.
They include: flu shot (injectable form), typhoid (injectable), rabies, hepatitis A vaccine, hepatitis B vaccine, varicella (chickenpox), DTP (diphtheria, tetanus, and Pertussis), Haemophilus influenzae type b (HiB), and pneumococcal vaccine.
Many live vaccines are also safe to take, including MMR (measles, mumps, and rubella), flu nasal spray vaccine, varicella (chickenpox), and certain forms of typhoid vaccine.
Vaccines to avoid while breastfeeding
There are 2 crucial exceptions.
- Smallpox vaccine: This vaccine is rarely used except in certain lab workers.
- Yellow fever vaccine: It has been associated with infrequent adverse events in breastfeeding women. It would be best if you generally avoided getting vaccinated unless you’re traveling to a location where the risk of yellow fever is high. Without going into more detail, have a careful discussion with your health care provider before you travel.