Postpartum varicella vaccination: is the vaccine virus excreted in breast milk?
ABSTRACT To evaluate whether the varicella vaccine virus is detected in breast milk after vaccination of breast-feeding women and whether there is serologic evidence of exposure of the infant to varicella virus after maternal vaccination.
We enrolled women identified as varicella seronegative during routine prenatal screening at Group Health Cooperative. Participants received the first dose of varicella vaccine at least 6 weeks postpartum and the second dose at least 4 weeks later. They collected ten breast milk samples after each vaccine dose. Breast milk samples were tested for varicella zoster virus by polymerase chain reaction (PCR). Serum specimens were collected from the mothers 1 month after each vaccine dose, and peripheral blood from their infants was collected onto filter spots 1 month after the mother's second dose. These samples were tested for varicella immunoglobulin (Ig) G by whole-virus enzyme-linked immunosorbent assay (ELISA), or by the more sensitive glycoprotein ELISA. When possible, filter spots from the infants were also tested by PCR for the presence of varicella zoster virus deoxyribonucleic acid (DNA).
Twelve women were enrolled; all seroconverted after the first vaccine dose. Varicella DNA was not detected by PCR in any of the 217 postvaccination breast milk specimens. None of the infants was seropositive. Samples from six infants were tested for varicella zoster virus DNA by PCR, and all were negative.
We found no evidence of varicella vaccine virus excretion in breast milk. These findings suggest that postpartum vaccination of varicella-susceptible women need not be delayed because of breast-feeding.
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ABSTRACT: A 30-year-old pregnant woman had skin lesions at 38 weeks of gestation. She was diagnosed as primary varicella zoster infection. Her clinical symptoms were high fever and generalized vesicles eruption. No serious maternal complication was found. The patient delivered a male baby 4 days after she developed skin lesions. The neonatal blood IgM against varicella zoster was negative. The baby was given Varicella zoster immunoglobulin within 24 hours and isolated in a neonatal care unit. The baby developed skin lesions on day 11th post delivery. Intravenous acyclovir was administered for 7 days. Finally, the baby was found to be free of severe neonatal varicella infection.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2008; 91(1):110-6.