Article

Postpartum varicella vaccination: Is the vaccine virus excreted in breast milk?

Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 12/2003; 102(5 Pt 1):970-7. DOI: 10.1016/S0029-7844(03)00860-3
Source: PubMed

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.

0 Bookmarks
 · 
102 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of varicella is low in pregnant women, and estimated around 1/1000 pregnancies. Vaccination is the cornerstone of prevention, but is contraindicated during pregnancy. Varicella is more severe in pregnant women. The risk of viral pneumonia is not increased, but VZV-associated pneumonia is usually more severe in pregnant women. Infection between 0-20 WG is associated with a 2 % risk of congenital varicella syndrome. Infection between D-5 and D+2 of delivery is associated with high risk of severe neonatal infection. Non-immune pregnant women with significant exposure to VZV require post-exposure prophylaxis with specific anti-VZV immunoglobulins that should be administered ideally within 4 days post-exposure and maximum within 10 days of exposure. Anti-VZV immunoglobulins are available in France in the context of an approved expanded access to an investigational new drug. Pregnant women with varicella should receive within 24hours antiviral treatment based either on valaciclovir or, in case of severe infection, intravenous aciclovir. Both drugs were shown safe during pregnancy, even during the first trimester. Neonates born from mothers who developed varicella between D-5 and D+2 of delivery should also receive as soon as possible specific anti-VZV immunoglobulins.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of varicella is low in pregnant women, and estimated around 1/1000 pregnancies. Vaccination is the cornerstone of prevention, but is contraindicated during pregnancy. Varicella is more severe in pregnant women. The risk of viral pneumonia is not increased, but VZV-associated pneumonia is usually more severe in pregnant women. Infection between 0–20 WG is associated with a 2 % risk of congenital varicella syndrome. Infection between D-5 and D + 2 of delivery is associated with high risk of severe neonatal infection. Non-immune pregnant women with significant exposure to VZV require post-exposure prophylaxis with specific anti-VZV immunoglobulins that should be administered ideally within 4 days post-exposure and maximum within 10 days of exposure. Anti-VZV immunoglobulins are available in France in the context of an approved expanded access to an investigational new drug. Pregnant women with varicella should receive within 24 hours antiviral treatment based either on valaciclovir or, in case of severe infection, intravenous aciclovir. Both drugs were shown safe during pregnancy, even during the first trimester. Neonates born from mothers who developed varicella between D-5 and D +2 of delivery should also receive as soon as possible specific anti-VZV immunoglobulins.
    La Presse Médicale 06/2014; DOI:10.1016/j.lpm.2014.04.001 · 1.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Los efectos de los medicamentos sobre la lactancia materna y el niño lactante es un tema que preocupa cada vez más, pero no es fácil dar respuestas porque los datos disponibles suelen ser escasos y parciales. En este sentido, hay pocos medicamentos cuya concentración en la leche materna (o mejor todavía, en la sangre de los niños amamantados) sea conocida. Tampoco se dispone de datos suficientes sobre niños amamantados por madres en tratamiento farmacológico. Si en la leche está presente un medicamento, el niño amamantado lo recibe por vía oral y las posibles consecuencias dependerán del paso del medicamento a la circulación mayor del niño tras la ingestión. Después de dar algunos conceptos generales sobre los medicamentos y la lactancia, se presentarán datos sobre las moléculas principales de las clases terapéuticas que más usan las mujeres en edad de tener niños, así como las conductas prácticas durante la lactancia, privilegiando las moléculas compatibles con ésta. Sin embargo, muchos medicamentos no están suficientemente evaluados en relación con una enfermedad determinada y, además, a menudo es posible dar con un tratamiento adecuado y compatible con la lactancia materna.
    06/2014; 18(2):1–12. DOI:10.1016/S1636-5410(14)67527-9