Last update: April 8, 2021
Decreased level of risk
New scientific evidences have driven the Apilam staff to update the level of risk associated to this product.
Former level of risk, which was Low Risk, is now set to Very Low Risk.
Level of risk reviewed on Jan. 29, 2021
Minimal risk for breastfeeding and infant.
"The vaccine (COVID-19) can be offered to a breastfeeding woman who is part of a group recommended for vaccination (e.g. health workers); discontinuing breastfeeding after vaccination is currently not recommended" (WHO 2021/01/25).
Several types of vaccines are currently in development against COVID-19, among those in production there are (WHO 2021/01/26):
• Messenger ribonucleic acid vaccines (mRNA): BNT162b2, Tozinameran-Comirnaty (Pfizer-BioNTech), MRNA-1273 (Moderna & NIH) and CVnCoV (Cure Vac). This type of vaccine uses portions of mRNA replicated from coronavirus n-19 to induce the synthesis and production of coronavirus n-19 surface proteins from muscle cells located at the site of injection that then act as triggers for the production of antibodies against the COVID-19 virus by the immune system.
• Viral vector-based vaccines: Vaxzevria Oxford-AstraZeneca vaccine (Covishield in India), Gam-COVID-Vac (Gamaleya-Sputnik V), Cansino vaccine and Janssen COVID-19 Vaccine (Johnson & Johnson). These vaccines use a non-pathogenic strain of human adenovirus that has been modified to contain genetic material that resembling a portion of coronavirus 2019-nCoV that can induce the immune system to react in a way similar to what was previously described with mRNA vaccines.
• Inactivated virus vaccines: Coronavac from Sinovac, Covaxin (BBV152-Bharat Biotech) and Sinopharm vaccines.These vaccines are manufactured with dead viruses that do not have the capacity to reproduce or infect. These vaccines cause our immune system to react and start the production of specific antibodies against the COVID-19 virus.
At the time this last update was completed, we did not find published data regarding the excretion of this substance through breast milk and of the impact that could have on lactation or the breastfeeding child. Currently breastfeeding women have been excluded from all clinical trials (Palacios 2020, Costantine 2020, CDC 2020/12/15, ABM 2020/12/14).
It is highly improbable that any of the components that are part of the vaccines produced against COVID-19 could be excreted through human breastmilk, and even in this could happen, they would all be digested in the gastrointestinal tract of the breastfeeding child (InfantRisk 2020/12/18).
It would seem reasonable to deduct that if the disease (COVID-19) is compatible with lactation then the vaccine developed against it would be even more so, since it does not carry the live virus within its components.
Neither of the types of vaccines currently in development against COVID-19 contain live viruses within their components and therefore cannot provoke the disease or cause any alterations to the genetic material of their host (CDC 2020/12/18 y 2020/12/13).
Except for three live attenuated virus vaccines (small pox, yellow fever and oral polio-Sabin) that are known to rarely bring about negative effects on breastfeeding children, all vaccines are to be regarded as safe for use during lactation and therefore can be prescribed to breastfeeding women (CDC 2020/02/04).
Similar to what happens when vaccinating against other viruses, the use of a vaccine against COVID-19 would trigger the production of antibodies and the excretion through breastmilk of mainly the IgA type, which would likely help protect the breastfeeding child from COVID-19. (Baird 2021/02/23, InfantRisk 2020/12/18, ABM 2020/12/14).
Breastfeeding women are not considered to be a high-risk group for COVID-19, specially since they tend to be young and usually healthy and therefore until now there are no specific reasons that would warrant the use of the vaccine in this group.
Several Health institutions, medical societies and also expert consensus have suggested that the vaccine should be prescribed for breastfeeding women if they would also belong to a high-risk group such as healthcare workers or people afflicted by a chronic disease or condition known to be a risk factor (Mayo 2021/03/16, Davanzo 2021/02/27, Saus 2021/02/12, Chervenak 2021/02/01, WHO 2021/01/25, Sax 2021, IHAN 2021, AELAMA 2021, NHS 2021, HIFN 2020, MS España 2020/12/30, ACOG 2020/12/13, CDC 2020/12/15 y 2020/12/13).
Vaccinating against COVID-19 should not be an impediment to begin lactation nor a cause for its interruption (Davanzo 2021/02/27, Chervenak 2021/02/01, ACOG 2020/12/13).
At the end of the year 2020; AstraZeneca, Moderna and Pfizer withdrew from their respective drug leaflets the previous recommendation of not administering their vaccines to lactating mothers (Moderna 2021, AstraZeneca2021, Pfizer 2020).
As it may happen with other vaccinations, after the COVID-19 vaccination, palpable axillary lymph nodes may appear on the same side of the vaccine injection. A clinical follow-up of the nodes would be enough to rule out a presumed malignancy at the level of the breast. Costly and unnecessary complementary examinations should be avoided (Edmonds 2021, Mehta 2021).This is a transitory side effect that usually does not disrupt the continuity of breastfeeding.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.
Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.
Thank you for helping to protect and promote breastfeeding.
e-lactancia is a resource recommended by Academy of Breastfeeding Medicine - 2012 from United States of America
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM