VACCINE, RUBELLA

Breast Feeding Summary

Vaccination of susceptible women with rubella vaccine in the immediate postpartum period is recommended by the American College of Obstetricians and Gynecologists and the CDC (1,9). A large number of these women will breast-feed their newborns. Although two studies failed to find evidence of the attenuated virus in milk, subsequent reports have demonstrated transfer (12,13,14,15 and 16).

In one case, the mother noted rash and adenopathy 12 days after vaccination with the HPV-77 vaccine on the 1st postpartum day (13). Rubella virus was isolated from her breast milk and from the infant's throat (14). A significant level of rubella-specific cell-mediated immunity was found in the infant, but there was no detectable serologic response as measured by rubella hemagglutination inhibition antibody titers (14). No adverse effects were noted in the infant. In a second case report, a 13-day-old breast-fed infant developed rubella about 11 days after maternal vaccination with HPV-77 (17). It could not be determined whether the infant was infected by virus transmission via the milk (18,19). Nine (69%) of 13 lactating women given either HPV-77 or RA 27/3 vaccine in the immediate postpartum period shed virus in their milk (15). In another report by these same researchers, 11 (68%) of 16 vaccinated women shed rubella virus or virus antigen in their milk (16). No adverse effects or symptoms of clinical disease were observed in the infants.

References

1. American College of Obstetricians and Gynecologists. Immunization during pregnancy. Technical Bulletin. No. 160, October 1991.
2. Product information. Meruvax. Merck, 2001.
3. CDC. Rubella vaccination during pregnancy—United States, 1971–1982. MMWR 1983;32:429–32.
4. Burgess MA. Rubella reinfection—what risk to the fetus? Med J Aust 1992;156:824–5.
5. Condon R, Bower, C. Congenital rubella after previous maternal vaccination. Med J Aust 1992;156:882.
6. CDC. Rubella vaccination during pregnancy—United States, 1971–1988. MMWR 1989;38:289–93.
7. Preblud SR, Williams NM. Fetal risk associated with rubella vaccine: implications for vaccination of susceptible women. Obstet Gynecol 1985;66:121–3.
8. Hofmann J, Kortung M, Pustowoit B, Faber R, Piskazeck U, Liebert UG. Persistent fetal rubella vaccine virus infection following inadvertent vaccination during early pregnancy. J Med Virol 2000;61:155–8.
9. CDC. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8):1–57.
10. Burgess MA. Rubella vaccination just before or during pregnancy. Med J Aust 1990;152:507–8.
11. Linder N, Ohel G. In utero vaccination. Clin Perinatol 1994;21:663–74.
12. Isacson P, Kehrer AF, Wilson H, Williams S. Comparative study of live, attenuated rubella virus vaccines during the immediate puerperium. Obstet Gynecol 1971;37:332–7.
13. Grillner L, Hedstrom CE, Bergstrom H, Forssman L, Rigner A, Lycke E. Vaccination against rubella of newly delivered women. Scand J Infect Dis 1973;5:237–41.
14. Buimovici-Klein E, Hite RL, Byrne T, Cooper LZ. Isolation of rubella virus in milk after postpartum immunization. J Pediatr 1977;91:939–41.
15. 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.
16. Losonsky GA, Fishaut JM, Strussenberg J, Ogra PL. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. J Infect Dis 1982;145:661–6.
17. Landes RD, Bass JW, Millunchick EW, Oetgen WJ. Neonatal rubella following postpartum maternal immunization. J Pediatr 1980;97:465–7.
18. Lerman SJ. Neonatal rubella following maternal immunization. J Pediatr 1981;98:668.
19. Bass JW, Landes RD. Neonatal rubella following maternal immunization (reply). J Pediatr 1981;98:668–9.