= = references = External links = = * Official website

The example from Lower Saxony is not an isolated case. A woman reports on Twitter that breastfeeding women are not vaccinated in Baden-Württemberg either. Another mother from Bavaria writes: Three doctors had advised her against vaccination while breastfeeding, she would stop breastfeeding.

May breastfeeding women be vaccinated?

In the Bavarian vaccination centers, "vaccination is only possible (...) if there is a recommendation for vaccination from a family doctor or specialist," writes the Bavarian Ministry of Health Request from the #fact fox. This recommendation "must then be brought to the vaccination appointment". When registering for the vaccination centers in Bavaria, you can currently state that this recommendation is available.

Other women are asking on Twitter: "should I just lie to get a vaccine?" Jasmin Wintjen also says: "If I can put myself on the waiting list for the state vaccination center, then it would actually be the case that I wouldn't say that I'm breastfeeding, because then I would be worried that I wouldn't be vaccinated."

StiKo does not generally recommend vaccination for breastfeeding women

There is a simple reason why women who are breastfeeding are not vaccinated without restrictions: the Standing Vaccination Commission (StiKo) does not currently recommend this. And vaccination centers and doctors usually follow the recommendations of the StiKo.

"When deciding whether to vaccinate, physicians naturally follow these recommendations," says Professor Regina Ensenauer, paediatrician and chairwoman of the National Breastfeeding Commission (NSK) in Germany, in an interview with #Faktenfuchs.

The StiKo hesitates because, in their opinion, there are too few studies. The Munich gynecologist Marianne Röbl-Mathieu, who is also a member of the StiKo, says in a StiKo YouTube video: "There is insufficient data on the use of the vaccination during breastfeeding. And therefore the vaccination for breastfeeding women is not generally recommended." The StiKo does not recommend a general vaccination for pregnant women either, the data situation is also not sufficient here.

At the same time, Röbl-Mathieu emphasizes: "However, the StiKo considers it unlikely that the vaccination of the breastfeeding woman poses a risk for the breastfed infant. There are also no biologically plausible mechanisms for this." There is currently no evidence of harmful effects in pregnant women who have been vaccinated.

Breastfeeding women were excluded from the pivotal trials

In practice, this leads to the confusion that breastfeeding women describe. In some cases they receive a vaccine, in others they don't. The chair of the National Breastfeeding Commission, Ensenauer, says: Doctors would interpret these recommendations differently. One observes more the missing data, the other more the possible benefit of the vaccination.

The database on breastfeeding women is poorer because they were excluded from the clinical studies for the approval of the corona vaccines. Regina Ensenauer says: “People in sensitive phases of life, such as pregnant or breastfeeding women, are not generally part of every study. This procedure would also be used for other drug studies and has nothing to do with the vaccine." Ensenauer expects that in six months to a year there will be more reports on vaccination in breastfeeding women.

Professional societies are already demanding vaccinations for breastfeeding women

The German specialist societies and professional associations for gynecology and obstetrics do not want to wait that long. They are already calling for the vaccine to be released for breastfeeding women. Eleven organizations announced on May 3rd: "Covid-19 vaccination of breastfeeding women with mRNA-based vaccines has an equivalent antibody formation and a similarly low side effect profile as in pregnant and non-pregnant women. It is recommended to breastfeeding women to offer and enable an mRNA-based vaccination (editor's note: Biontech/Pfizer and Moderna) against COVID-19."

Professor Christoph Scholz, chief physician at the gynecological clinics in Neuperlach and Harlaching at the municipal Munich clinic, is of the opinion that the StiKo should recommend vaccination for breastfeeding women: "Of course, there isn't that much data, because it's always in the studies the pregnancy and breastfeeding periods are primarily taken out. But there are now also data, secondary analyzes that definitely prove safety - at a very good level for this collective."

First studies show no difference between breastfeeding and non-breastfeeding

Scholz refers, for example, to an Israeli study that was published in April in the "Journal of the American Medical Association". 84 breastfeeding women were examined. These were all fully vaccinated with the Biontech/Pfizer vaccine. There were no serious health problems in any of the women or the infants.

Some of the mothers had vaccine-typical symptoms such as local pain, tiredness or fever. Four of 84 infants developed fever symptoms during the observation period. Three of these infants recovered without treatment, with one requiring treatment with antibiotics. However, it is simply not clear whether this fever in infants is related to the vaccination.

Another study comes from the USA and was published in March in the "American Journal of Obstretics Gynecology". A total of 131 women working in the medical field who had been vaccinated with Biontech/Pfizer or Moderna vaccines were examined. 84 women were pregnant, 31 were breastfeeding and 16 were not pregnant. The result: the amount of Covid-19-specific antibodies that appeared after vaccination was the same in all three groups.

This study was supported by several health institutes including the Bill & Financially supported by the Melinda Gates Foundation. It is one of the largest private foundations in the world, has also invested in the vaccine developer Biontech and regularly supports medical studies, including those on the corona virus.

For the chief physician Christoph Scholz, there is currently no evidence that a breastfeeding woman reacts differently to vaccination than a non-breastfeeding woman: "And so it makes no sense to simply exclude the period in principle. That's just not justified and thus it is a worse position for breastfeeding women and women ultimately." In the regular German monitoring of vaccination side effects, there are also no frequent reports of special side effects for breastfeeding women, says Scholz.

By the way, the StiKo unreservedly recommends all common vaccinations in Germany against diseases other than Covid-19, with the sole exception of yellow fever, for breastfeeding women. Of course, there are decades of experience with these vaccinations.

Covid-19 antibodies detected in breast milk

In the case of other diseases, however, there is a proven "nest protection" when an immunized mother breastfeeds her baby. The mother protects her child from illness by breastfeeding. This nest protection lasts for different lengths of time, with measles, for example, a maximum of six months.

This hypothesis also applies to Covid-19: antibodies in breast milk protect newborns from the disease. Regina Ensenauer from the National Breastfeeding Commission tells #Faktenfuchs: "The assumption is that the infant is passively immunized as a result."

In the aforementioned Israeli study, the breast milk of the vaccinated women was regularly examined. Covid-19-specific IgA and IgG antibodies were found in the milk. These are the same antibodies that build up in the mother's blood after vaccination. Regina Ensenauer says: "These antibodies could possibly be of benefit to the child."

In the USA, women who have already been vaccinated therefore share their breast milk with other infants or give it to older children on their own initiative - as protection against Covid-19 disease. There are even reports of a real market for breast milk from vaccinated people.

There is still insufficient data to prove nest protection

This hypothesis has yet to be confirmed for Covid-19, says Ensenauer: "We cannot yet adequately assess the effect of this transfer of antibodies." Because in order to scientifically prove the effects of such nest protection, more data is needed on the courses in infants.

Passive immunization for infants is a complex field with many gradations. There have also been cases of infants born to vaccinated mothers contracting Covid-19. The number of antibodies ingested through breast milk or the amount of coronavirus ingested could have an impact on the disease.

Conclusion

Since the Standing Vaccination Commission has not yet made a clear recommendation, there is uncertainty in practice as to whether breastfeeding mothers can be vaccinated. In the Bavarian vaccination centers you need a certificate from a doctor.

In the first smaller studies, however, no differences were found between breastfeeding and non-breastfeeding women after a vaccination - and there were also few abnormalities in the infants. However, these studies only include a few women. The data basis is therefore still small and not fully meaningful. However, the German specialist societies for gynecology and obstetrics are currently of the opinion that breastfeeding women should be vaccinated. There are no indications of security risks.

Possibly vaccinated women who breastfeed protect their children against Covid-19 disease with their breast milk. This is indicated by antibodies against Covid-19 in breast milk. However, there is still insufficient evidence for this "nest protection".

May 8th, 2021, 6:35 p.m.: In the conclusion of the text, the paragraph on the significance of the studies mentioned was revised and the small number of test persons and the general data basis were pointed out. In the text section on the two studies, a sentence was added with a reference to German vaccination monitoring. The paragraph on the US study was amended with reference to the support of the study by the Bill & Melinda Gates Foundation added.