 |
|
|
|
|
|
Question: Since I exclusively breastfeed my newborn baby, does he need to receive the routine childhood vaccines? Answer: You apparently are already aware that exclusive breastfeeding of your baby provides him with far more than just excellent nutrition. Breastmilk also provides maternal antibodies or immunoglobulins as well as proteins that modulate the infant immune system and assist it to kill bacteria, viruses, and other harmful microorganisms. Breastmilk also provides live cells that assist the immunoglobulins in this killing process. The newborn infant receives the bulk of his IgG antibody (the main infection fighting antibody) from the mother via the placenta during the third trimester of pregnancy. The full term infant receives much more antibody than the premature infant for this reason. IgG is the only antibody transferred to the infant. This is a variety of specific antibodies directed against the infectious agents which the mother has experienced or been vaccinated against. Other antibodies (mainly IgA and IgM) must be generated by the infant's immune system or received in breastmilk. Together, these antibodies provide the bulk of the protection against infection the infant has at birth.
Hopefully the infant will be put to the breast very shortly after birth and thus will begin to receive colostrum which is very rich in IgA and other proteins to enhance the infant's immune system. IgA is a special protein which migrates to the lining of the respiratory system (nasal and sinus membranes, and the lungs) and the digestive system (mouth, Eustachian tubes to the ears, throat, stomach, and intestines), to link up with other IgA molecules to form a very large antibody referred to as Secretory IgA, which is an extremely effective barrier to bacteria and viruses which try to get into the body. All of these immunoactive agents result in the significantly lower rate of infection in the breastfed infant. The infections that do occur are generally milder and resolve more quickly than those in the infant who is not breastfed. However, infections do occur in all infants and can be serious. Until the infant actively produces his own antibody, this passively received antibody is the main protection the infant has against a world of infectious agents. The higher the mother's antibody level and the greater amount of breastmilk received, the greater the amount of protection delivered to the infant. Thus it is important to ensure that the mother's vaccination status is up to date. Tetanus-Diphtheria (Td) vaccine can be given during pregnancy. Rubella vaccine can be given immediately postpartum since this weak virus does not cause infant illness. Other live vaccines are generally deferred during lactation but may be given if the risk of disease exposure is very high (determined on a case by case basis). |
|
The initial amount of IgG antibody received before birth gradually declines and reaches a level which is just barely protective against some diseases by about 4-6 months of age, making the amount of antibody received from the mother of critical importance. Since the current recommendations are for vaccines against the most common serious infectious diseases of infancy (Tetanus, Diphtheria, Pertussis or Whooping Cough, Polio, Hemophilus Iinfluenza B, Pneumococcus) to be given not earlier than 6 weeks of age (except for Hepatitis B vaccine which may be given at birth), adherence to the recommended childhood vaccination schedule is necessary to allow the active production of antibody by the infant to replace the disappearing maternal antibody without a gap in protection. Once the infant does produce this antibody, there is a memory in the immune system for each of these agents. While this memory wanes after some time and booster doses are needed for some vaccines, there is a rapid production of antibodies on exposure to the infectious agent providing even greater protection than breastmilk alone. In summary, early and continued breastfeeding significantly improves the ability of the infant to prevent infectious agents from entering the body and to kill infectious agents that do enter resulting in fewer and milder infections than would occur without breastfeeding. However, only vaccination (or infection) allows the infant to actively produce his own antibody and to enhance and sustain this protection indefinitely. Think of breastfeeding as your baby's first (passive) vaccination. References:1. Goldman, A.S. Host response to infection,
Ped in Review; 21(10), Oct 2000, pp342-349.
2. Fleisher, T.A. Immune Function, Ped in Review,
18(10), Oct 1997, pp351-356.
3. Slusser, Wendelin, M.S., Powers, N.G.
Breastfeeding Update 1: Immunology, Nutrition and
Advocacy, Ped in Review, 18(4), Apr 1997, pp111-119.
|
|
James G. Murphy, MD, trained in general pediatrics at the Naval Medical Center, San Diego, had the honor of serving as a Naval Medical Officer for 25 yrs retiring in 1995, and continues to serve as a General Pediatrician and Level 1&2 Nursery Attending at NMC San Diego. Dr Murphy maintains a special interest in immunization science and practice and promotion of breastfeeding, as a board member of the SDCBC.
| The printing of this newsletter was graciously sponsored by the Regional Perinatal System of San Diego and Imperial Counties. |
