Is Rotavirus Vaccines Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Rotavirus Vaccines? Is Rotavirus Vaccines safe for nursing mother and child? Does Rotavirus Vaccines extracts into breast milk? Does Rotavirus Vaccines has any long term or short term side effects on infants? Can Rotavirus Vaccines influence milk supply or can Rotavirus Vaccines decrease milk supply in lactating mothers?

Rotavirus vaccines are used only in infants and are not indicated for use in women of childbearing age. Breastfeeding protects infants against acute gastroenteritis caused by rotavirus.[1][2] However, breastfeeding can reduce the immune response of an infant to rotavirus vaccines in developing countries.[3][4][5][6][7] Lactadherin, a milk glycoprotein, may be a cause.[8] Breastfeeding might also reduce viral shedding in the stool by the vaccinated infants.[6] The extent of the effect depends on the maternal anti-rotavirus antibody titer in breastmilk with higher titers found in less developed areas.[9][10][11][12] Withholding breastfeeding for up to 2 hours before and after vaccine administration has been recommended to minimize the interference.[9][13] However, some studies found that withholding breastfeeding for either one hour before and after immunization,[14][15] or for 30 minutes before vaccination had no effect on seroconversion.[16] A review concluded that withholding of breastfeeding at the time of vaccination had no effect on seroconversion of infants.[17] A European study found no difference in rotavirus infection rates during the first season between infants who were breastfed and formula-fed when they received rotavirus vaccination. In the second season, protection against infection was slightly less in breastfed infants.[4] A German study found that exclusive or partial breastfeeding increased the risk of breakthrough infection fourfold.[5] A study in Indonesia found that rotavirus vaccine was cost-effective for the health system, even with improved breastfeeding rates.[18]

A subset of 300 infants in a multicenter European rotavirus efficacy trial had antirotavirus IgA titers measured 1 to 2 months after the second rotavirus dose (Rotarix - GSK). Breast-fed infants had an 85.5 % conversion rate compared with 89.2 % rate in exclusively formula-fed infants, which was not statistically different. The serum antirotavirus IgA concentrations were 185.8 units/mL and 231.5 units/mL in the breastfed and exclusively formula-fed infants, respectively.[4] Two hundred fifty breastfed infants were randomized to receive their routine rotavirus vaccination (Rotarix) with either unrestricted breastfeeding or withholding breastfeeding from 1 hour before to 1 hour after the vaccination. No difference were found in the rate of seroconversion between the two groups of infants.[14] Four hundred infants in India were randomized to either be breastfed before receiving rotavirus vaccine (Rotarix) or to not be breastfed within 30 minutes of their vaccination. Vaccinations were given at 6 to 7 weeks and at 10 to 14 weeks of age. Of the 388 infants with evaluable information, no difference was found in the seroconversion rate between the two groups.[16] Among 45 breastfed (at least 4 times daily) Nicaraguan infants who were given a rotavirus vaccination (Rotateq-MSD), 31 infants seroconverted and 14 infants did not. The seroconversion failures were mostly in infants who had high preimmunization IgA levels and whose mothers had high serum IgG antibody levels against rotavirus. No correlation was found between breastmilk IgA or neutralizing antibodies and seroconversion, although the sample size was small.[19]