Is the flu vaccine safe for breastfeeding mothers?

Influenza Vaccination During Breastfeeding: Safety and Recommendations

The influenza vaccine is safe for breastfeeding mothers and is strongly recommended by the American Academy of Pediatrics and CDC guidelines. 1, 2

Safety of Influenza Vaccination During Breastfeeding

Influenza vaccination during breastfeeding is not only safe but beneficial for both mothers and their infants:

• The inactivated influenza vaccine (IIV) poses no risk to breastfeeding mothers or their infants 1
• Vaccination during breastfeeding helps protect infants who cannot receive the vaccine themselves until 6 months of age 2
• Breastfeeding after vaccination activates innate antiviral mechanisms in infants, specifically type 1 interferons 1
• Human milk from vaccinated mothers contains higher levels of influenza-specific immunoglobulin A, providing additional protection 1
• Greater exclusivity of breastfeeding in the first 6 months decreases episodes of respiratory illness with fever in infants of vaccinated mothers 1

Types of Influenza Vaccines for Breastfeeding Women

Not all influenza vaccines are equally recommended for breastfeeding women:

• Inactivated influenza vaccine (IIV) is the preferred option for breastfeeding mothers 2, 3
• While live attenuated influenza vaccine (LAIV) is not contraindicated during breastfeeding, research shows that IIV produces superior breast milk antibody responses 3
• A randomized trial comparing LAIV and IIV in breastfeeding women found that IIV generated significantly higher breast milk IgG and IgA responses 3
• There is a small risk (1%) of transmission of LAIV virus from mother to infant 3

Benefits Beyond Individual Protection

Vaccination of breastfeeding mothers provides multiple benefits:

• Protects the mother from influenza illness and related complications
• Provides passive immunity to the infant through breast milk antibodies
• Reduces the risk of the mother becoming infected and potentially transmitting influenza to her vulnerable infant
• Creates a protective "cocoon" around the infant who cannot be vaccinated until 6 months of age

Common Concerns and Misconceptions

Despite strong safety evidence, concerns persist among some breastfeeding women:

• Research shows that women with concerns about vaccination while breastfeeding are less likely to get vaccinated 4
• Educational interventions targeting both the public and healthcare workers are necessary to increase protection of breastfeeding women and their infants 5
• Healthcare providers should proactively discuss the benefits and safety of influenza vaccination with breastfeeding mothers 2, 4

Recommendations for Breastfeeding During Influenza Illness

If a breastfeeding mother or infant develops influenza:

• Breastfeeding should continue even if the mother or infant has influenza 1
• If direct breastfeeding is not possible due to illness, mothers should pump and feed expressed breast milk 1
• For mothers requiring antiviral treatment, oral oseltamivir is preferred 1
• Breastfeeding is encouraged for infants born to mothers with confirmed influenza at delivery 1

Conclusion

The evidence strongly supports the safety and benefits of influenza vaccination for breastfeeding mothers. Healthcare providers should recommend influenza vaccination to all breastfeeding women, with a preference for the inactivated influenza vaccine over the live attenuated version.