Vaccination during breastfeeding
Vaccination of breastfeeding women. Per CDC ACIP 2023, WHO 2022, AEP CAV 2024, and SEGO 2023, breastfeeding is not a contraindication to any adult-schedule vaccine. Inactivated vaccines (influenza, COVID, hepatitis B, Tdap, RSV, HPV) are fully compatible. Live attenuated vaccines (MMR, varicella) are also compatible – vaccine viruses are not shed in active form via milk. Exception – yellow fever vaccine, restricted for epidemiologic reasons in infants <9 months.
ICD-10 Z2310 drugs
Also known as: Vaccination while breastfeeding, Vaccines and breastfeeding
Drugs used for this condition
- ACOVID-19 vaccine, mRNA (Moderna)First line · mRNA SARS-CoV-2 vaccineSpikevax during breastfeeding. Fully compatible for the same reasons as Comirnaty. Hale L1.
- ACOVID-19 vaccine, mRNA (Pfizer-BioNTech)First line · mRNA SARS-CoV-2 vaccineComirnaty during breastfeeding. CDC ACIP 2024 and AEP CAV 2024 – fully compatible. mRNA and lipid nanoparticles do not transfer to milk in significant amounts. Spike antibodies pass into milk and provide passive infant protection.
- AHepatitis A vaccine, inactivatedFirst line · Inactivated viral vaccineHepatitis A during breastfeeding. CDC ACIP 2024 and SEGO 2023 – fully compatible. Particularly indicated for travel to endemic regions or exposure contact.
- AHepatitis B vaccine, recombinantFirst line · Recombinant protein vaccineHepatitis B during breastfeeding. Per CDC ACIP 2024 and SEGO 2023, fully compatible. If unvaccinated and in a risk group (healthcare worker, HBV+ partner, HIV+), vaccinate without interrupting breastfeeding.
- AHPV vaccine, nonavalentFirst line · Recombinant protein vaccine, VLPHPV during breastfeeding. CDC ACIP 2024 and SEGO 2023 – fully compatible. If unvaccinated before pregnancy and ≤26 (or ≤45 depending on risk) – vaccinate postpartum.
- AInactivated influenza vaccineFirst line · Inactivated subunit or split influenza vaccineInfluenza vaccine during breastfeeding. CDC ACIP 2024 and AEP CAV 2024 – fully compatible. Inactivated, no replication, anti-flu antibodies protect the infant via milk. Especially recommended if the infant is <6 months and cannot yet be vaccinated. Administer any trimester of pregnancy or immediately postpartum.
- AMMR – measles, mumps, rubella vaccine (live)First line · Combined live attenuated viral vaccineMMR during breastfeeding. CDC ACIP and AEP CAV 2024 – compatible. Although live, the rubella vaccine virus can be shed in breast milk and may transiently, asymptomatically infect the infant, but this is harmless and causes no disease. If unvaccinated before pregnancy and rubella-susceptible – vaccinate immediately postpartum, no breastfeeding interruption.
- APneumococcal conjugate vaccine PCV20First line · Conjugate polysaccharide vaccinePCV20 during breastfeeding. Per CDC ACIP 2024 and SEPAR 2023, recommended for adults ≥50, immunocompromise, chronic heart/lung/liver disease, diabetes. Breastfeeding is not a contraindication.
- ARSV vaccine, recombinant (maternal)First line · Recombinant protein vaccine, stabilized prefusion F proteinAbrysvo during breastfeeding. CDC ACIP 2024 – compatible. Hale L1.
- ATdap – tetanus, diphtheria, acellular pertussis vaccineSecond line · Combined inactivated bacterial vaccine (Td + acellular pertussis)Tdap during breastfeeding. Fully compatible. If missed in pregnancy – vaccinate immediately postpartum. Protection comes from cocooning: a vaccinated mother does not get pertussis and cannot pass it to the infant. The baby still needs its own DTaP series on schedule.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit