Breastfeeding and immunisations

MVEC is supportive of breastfeeding at the time of childhood immunisations as well as the immunisation of breastfeeding mothers when vaccines are indicated.

In this reference page, we detail the different types of vaccines recommended for breastfeeding women and describe when a more detailed discussion with your healthcare provider is warranted.

Immunising breastfeeding mothers will not impact their ability to produce breastmilk. Inactivated (e.g. seasonal influenza and whooping cough) and live-attenuated vaccines (e.g. measles-mumps-rubella) are generally safe to administer to women who are breastfeeding.

In some instances, antibodies created by the mother in response to a vaccine can be passed onto the infant via breastmilk (passive immunity) to be absorbed orally and provide short term protection. Any maternal antibodies passed onto a baby via breastmilk does not interfere with a baby’s immune response to their own vaccines.

In addition, there are no concerns for a breastfeeding mother to have contact with someone who has recently received either a live-attenuated or an inactivated vaccine.

Influenza

Annual influenza immunisation is safe and recommended for breastfeeding mothers. Babies less than 6-months of age are at greatest risk from disease yet cannot receive influenza vaccines until they are 6-months of age. Maternal immunisation will provide protection for mothers as well as providing some passive protection for babies through the secretion of antibodies until they are old enough to receive their own influenza vaccine [refer to MVEC: Influenza vaccine recommendations].

Measles-mumps-rubella (MMR)

The MMR vaccine is a live-attenuated vaccine and therefore immunisation should be avoided in the 28 days prior to a pregnancy and is contraindicated during pregnancy. However, it is safe for immunisation to occur at any time following delivery including whilst breastfeeding with no concerns for the mother or the breastfed infant.

COVID-19 vaccines

Women who are breastfeeding can receive COVID-19 vaccines. They do not need to stop breastfeeding before or after being vaccinated. Antibodies have been detected in breastmilk and therefore this may also offer some protection to the infant via passive immunity.

Hepatitis B

It is safe for mothers who are positive for the hepatitis B virus to breastfeed their baby as long as the infant receives a dose of hepatitis B immunoglobulin (HBIG) at birth as well as all scheduled doses of hepatitis B vaccine commencing with the birth dose.

Yellow fever vaccines

The live-attenuated yellow fever vaccination should be avoided in breastfeeding mothers. Anyone travelling to a yellow fever endemic area should have a specialist travel consultation to provide individual travel advice and discuss immunisation recommendations. There is some evidence to suggest that yellow fever vaccine virus can be transmitted to infants via breastmilk. Infants are not recommended to receive the yellow fever vaccine until a minimum of 9 months of age due to its side effects profile [refer to Australian Immunisation Handbook: Yellow fever].

Resources

There are a lot of excellent resources that review the evidence and support the administration of routine vaccines to breastfeeding mothers.

Authors: Dr Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (MVEC Education Nurse Coordinator) and Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)

Date: July 2021

Materials in this section are updated as new information becomes available. The Melbourne Vaccine Education Centre (MVEC) staff regularly review materials for accuaracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


BCG vaccine

Background

Tuberculosis (TB) is a disease caused by the bacteria called Mycobacterium tuberculosis. It is spread via droplets through coughing and sneezing. It primarily affects the lungs, however it can spread to the lymph nodes, the brain, kidneys, or spine. Common symptoms of pulmonary TB include fever, cough, chest pain and night sweats.

TB infection can be categorised as having active disease (displaying symptoms and being infectious) or latent TB infection (the bacteria is dormant, there are no symptoms, and the patient is not infectious). Latent TB can become active if an infected person’s immune system becomes weakened.

Australia has one of the lowest rates of TB disease in the world, but it remains very common in some countries, including places Australians frequently travel to visit friends and relatives (VFR).

About BCG vaccine

The BCG vaccine is a live-attenuated vaccine. It was developed from a bacteria similar to TB called Mycobacterium bovis and is weakened so that it will not cause disease in healthy humans.

The BCG vaccine does not prevent someone being infected with the bacteria that causes TB, but it can prevent the development of serious disease. It is specifically designed to prevent TB in children and can be given from birth onwards.  The World Health Organization (WHO) currently recommends a single lifetime dose.

How to administer BCG

The BCG is given intradermally as a single dose of vaccine and can only be administered by a medical or nursing professional who is trained in BCG vaccination working within a recognised BCG clinic [see resources].

The recommended site of vaccination is on the left arm over where the deltoid muscle inserts into the humerus. Administration at this site will minimise the risk of keloid scarring.

If active eczema, dermatitis or psoriasis is present at the site of injection, vaccination should be deferred until the skin can be treated and is clear of symptoms.

Who should be immunised?

In Australia, the BCG vaccine is recommended for specific groups:

When travelling to endemic countries BCG should be administered at least 4-6 weeks prior to departure, to ensure vaccine effectiveness prior to exposure.

Tuberculin skin testing (TST/Mantoux)

Tuberculin skin testing (TST) or Mantoux testing, involves the intradermal injection of a tuberculin purified protein derivative (PPD). Everyone ≥ 6 months of age should have a TST performed prior to BCG vaccination to identify if a person already has a level of immunity to TB. In people who have previously received a BCG or have previously had TB exposure, a hypersensitivity reaction can be recognised 48-72 hours later.

It is important to note that TST results may be unreliable for 4-6 weeks following a measles infection or receiving a measles-containing vaccine.

What to expect following BCG vaccine

BCG, like all vaccines, has a list of common and expected side effects and a list of rare side effects that may occur in the weeks following [refer to What to expect following the BCG vaccination- RCH parent handout for more information].

Common/expected reactions:

  1. a small red papule will appear at the injection site in the weeks following the vaccine
  2. an ulcer (open sore) may develop 2-3 weeks later (usually less than 1 cm in diameter) and last from a few weeks to months
  3. the majority of infants will develop a flat scar at the site once the ulcer heals.

Rare of more serious side effects:

  1. axillary lymphadenopathy (swelling of the lymph nodes under the left arm)
  2. persisting ulcer lasting longer than a few months
  3. a large abscess (collection of pus) at the injection site
  4. keloid scarring at the site.

If you suspect a rare or serious side effect, it is strongly recommended to seek medical advice either from a GP or the medical clinic where the BCG was administered.

For specialist immunisation advice or to report an adverse event following immunisation (AEFI), please contact SAEFVIC.

Refer to the useful resources and links below to find out more about the BCG vaccine.

Resources

BCG Clinics in Victoria

Useful links

Authors: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute) and Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute) and Francesca Machingaifa (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: July 15, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.