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Flu and covid vaccine in autumn booster programme

Many women who are breastfeeding will be offered flu vaccine, and maybe also covid boosters, shortly as the NHS expect yet another difficult season ahead.

You can have both flu and covid-19 vaccines when breastfeeding as the molecules are too large to pass into breastmilk. Your nursling will however receive antibodies, which you make to the vaccine, which will help to protect them as well.

There are now numerous studies on the compatibility of the vaccines in breastfeeding which I have linked to on my facebook pages over the months.

MHRA Guidance Sept 2022 https://www.gov.uk/government/publications/covid-19-vaccination-women-of-childbearing-age-currently-pregnant-planning-a-pregnancy-or-breastfeeding/covid-19-vaccination-a-guide-for-women-of-childbearing-age-pregnant-planning-a-pregnancy-or-breastfeeding#:~:text=Getting%20pregnant,-There%20is%20no&text=There%20is%20no%20evidence%20that,your%20chances%20of%20becoming%20pregnant.

Sources of information used

Flu Vaccines

The Green Book: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1102862/Influenza-green-book-chapter-19-2September22.pdf)

A UK study of co-administration of AstraZeneca and Pfizer BioNTech COVID-19 vaccines with inactivated influenza vaccines confirmed acceptable immunogenicity and reactogenicity (Lazarus et al, 2021). Where co-administration does occur, patients should be informed about the likely timing of potential adverse events relating to each vaccine. If the vaccines are not given together, they can be administered at any interval, although separating the vaccines by a day or 2 will avoid confusion over systemic side effects.

NHS (https://www.nhs.uk/pregnancy/keeping-well/flu-jab/)

It’s safe for women who are breastfeeding to have a flu vaccine if they’re eligible (for example, because of a long-term health condition).

Hale Medications and Mother’s Milk

The influenza vaccine is prepared from inactivated, non-viable influenza viruses and infection of the neonate via milk would not be expected. There are no reported side effects, nor published contraindications for using influenza virus vaccine during lactation.[1,2] Influenza vaccine is now indicated for breastfeeding mothers and their infants by the American Academy of Pediatrics.

LactMed (https://www.ncbi.nlm.nih.gov/books/NBK500990/)

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 either the live, attenuated (i.e., inhaled) or inactivated (i.e., injected) influenza vaccine, including H1N1 (swine) influenza vaccine. Immunization of the mother during pregnancy increases the amount of influenza antibodies and influenza-specific CD8 T cells in breastmilk and may offer added protection of their breastfed infants against influenza.[1-3] Breastmilk antibody responses are higher with the inactivated influenza vaccine than with the live oral vaccine.[4] Breastfed infants should be vaccinated according to the routine recommended schedules

COVID 19 Vaccines

The Green Book: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1102459/Greenbook-chapter-14a-4September22.pdf)

NHS (https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/pregnancy-breastfeeding-fertility-and-coronavirus-covid-19-vaccination/)

If you’re breastfeeding, It’s safe to get the COVID-19 vaccine if you are breastfeeding. You cannot catch COVID-19 from the vaccines and cannot pass it to your baby through your breast milk.

Hale Medications and Mother’s Milk

With much research now available on COVID-19 vaccines during breastfeeding, there is no evidence of harm to the mother or infant. Offering these vaccines to breastfeeding women is now the universal recommendation by governmental bodies and professional organizations. Compassion and understanding should be shown to moms hesitant to receive the vaccine. Their prime concerns are making the best decision during this vulnerable time and evidence should be provided to assist them in combatting their fears. The risk and benefit of the vaccine should be compared to each mother’s individual risk for getting COVID-19 as well as how well she is expected to tolerate the disease. In general, protection through any FDA authorized COVID-19 vaccination is expected to outweigh the risks associated with the injection.

No COVID-19 vaccines contain live viruses, so none of these vaccines are capable of causing COVID-19 upon administration. Neutralizing antibodies against COVID-19 have been found in the milk of breastfeeding mothers.[1-5] In a survey of 4,455 breastfeeding women, very few notable adverse effects were noted. 98% of respondents reported their vaccination had no impact on lactation. 93% of respondents noticed no impacts on their breastfeeding child. Of the 7% who reported infant adverse events, changes in fussiness or sleep, or diarrhea were the most commonly noted. Mothers also reported impacts on their ability to perform work duties, childcare duties, and household duties, particularly after the second dose.[6] Mothers considering getting these vaccines may consider timing the injection so that they may have additional support as they recover.

LactMed (https://www.ncbi.nlm.nih.gov/books/NBK565969/)

Summary of Use during Lactation: Many studies involving hundreds of women and their infants have been reported in the literature. No evidence suggests that women receiving a vaccine against SARS-CoV-2 is harmful to either the nursing mother or the breastfed infant. Antibodies and T-cells that neutralize the SARS-CoV-2 virus appear in the milk after maternal vaccination.[1-3] Nursing mothers experienced minimal disruption of breastfeeding after vaccination although a few reported to blue or blue-green discoloration of their milk.[4-8] Numerous professional organizations and governmental health authorities recommend that COVID-19 vaccines be offered to those who are breastfeeding because the potential benefits of maternal vaccination during lactation outweigh any theoretical risks.

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