Travel Vaccines

[tapper42nd]

Hello, I am a US resident and will be traveling to Kenya in mid-April. My toddler will be 20 months old; her last weight was 21lbs 10oz on 3/6. We nurse 2x/day for maybe 5-10 minutes each time for comfort. I've been directed to receive the following vaccines approx 10-14 days before my trip: yellow fever, typhoid, hepatitis A, and maybe a meningococcal booster.

Do I need to avoid nursing after receiving any of these vaccines for any length of time?

Thank you!

[tapper42nd]

So to update a little - all of the above seem fine except possibly yellow fever vaccine. The info I’ve seen says a hard no if you’re breastfeeding a child younger than 9 months old, as there were 3 cases of exclusively breastfed 1 month olds who got encephalitis. Based on this I’ve seen folks say the vaccine is contraindicated for breastfeeding.

But my 20mo infant only nurses a little bit and the vaccine would be safe enough to give directly (it’s indicated for ages 9mo and older). Obviously “safe enough” is a cost-benefit, and she is not traveling with me, so she is not at any risk per se (besides prematurely weaning).

Would love your thoughts Dr. Hale as I make this decision!

[Sandra]

tapper42nd,

"Clinical Recommendation: Yellow fever vaccine is a live, attenuated virus preparation made from the 17D yellow fever virus strain. Being a live attenuated vaccine, there is significant risk to the infant following breastmilk exposure to this vaccine. There are at present, two reported cases of transmission of yellow fever vaccine virus to the infant through breastmilk. According to CDC recommendations, all persons aged >9 months, traveling to, or living in areas of high yellow fever transmission should be vaccinated. For infants between 6-8 months of age, travel should preferably be avoided or postponed. But if travel is unavoidable, then a risk vs benefit assessment has to be made and the infant be vaccinated accordingly. Yellow fever vaccine is absolutely contra-indicated in infants 1-5 months of age. According to CDC, immunization of lactating mothers with infants <9 months of age, should preferably be avoided. However, if travel of a lactating mother to an endemic area cannot be avoided or postponed, or in situations where exposure to the yellow fever virus is high, then the potential benefits of the vaccine out weigh the potential risks, and immunization in such a situation should be considered.

Studies have found that in up to 80-100% of cases, the 17D vaccine virus is no longer present in maternal serum 10-13 days following vaccination. This would suggest that the risk to a breastfed infant 10-13 days after immunization is low to nil. Therefore, brief interruption of breastfeeding of upto 13 days maybe advisable, especially in those who get inadvertently vaccinated during lactation." (Medications and Mothers' Milk database, Dr Thomas Hale PhD)

Sandra Lovato R.N.
InfantRisk Center