The Australian Immunisation Handbook 10th Edition 2013

Contact between pregnant women and persons who have recently received live vaccines
Household contacts of pregnant women should be age-appropriately vaccinated.
It is safe to administer measles-, mumps-, rubella- and varicella-containing
vaccines, zoster vaccine and rotavirus vaccine to the contacts of pregnant
women. There is no risk of transmission of measles, mumps or rubella vaccine
viruses from vaccinated household contacts. There is an almost negligible risk
of transmission of varicella-zoster vaccine virus (from persons vaccinated with
varicella or zoster vaccines); however, vaccine recipients with a varicella-like
rash should be advised to cover the rash if in contact with a pregnant woman.
Although there is a very small possibility of transmission of the rotavirus vaccine
viruses to pregnant contacts, the benefit of immunising infants to protect against
rotavirus disease and, in turn, reduce the risk of rotavirus in household contacts,
far outweighs any theoretical risk (see 4.17 Rotavirus).
Use of immunosuppressive therapy during pregnancy
Certain immunosuppressive medications given for management of a medical
condition in a woman during pregnancy (e.g. biological disease modifying
anti-rheumatic drugs [bDMARDs]) may cross the placenta and be detectable
in the infant, particularly if given during the third trimester. 46-48 In this setting,
administration of live attenuated vaccines in the first few months of the infant’s
life, particularly BCG vaccine, is not recommended. 49 (See also 4.20 Tuberculosis.)
This is because of the risk that the infant’s immune response to vaccination may
be reduced and potentially associated with increased vaccine virus/bacteria
replication and related adverse effects. Although no specific time intervals
are indicated, withholding BCG vaccine until the infant is 6 months of age is
prudent. 50 Although there is some theoretical concern that a risk also applies
to the administration of rotavirus vaccines, there are currently no data to
substantiate this.
Inactivated vaccines should be administered to these infants according to the
recommended schedule. However, immune responses may be suboptimal.
Additional inactivated vaccine doses may be required; expert advice should be
sought regarding this.
Breastfeeding and vaccination
Vaccination is rarely contraindicated in breastfeeding women. The rubella
vaccine virus may be secreted in human breast milk and there has been
documented transmission to breastfed infants. However, where infection has
occurred in an infant, the symptoms have been absent or mild. 51-53 Infants born
to mothers who are hepatitis B surface antigen (HBsAg)-positive can also be
breastfed, provided the infant is appropriately immunised at birth. Although
studies have indicated the presence of hepatitis B virus (HBV) in the breast
milk of mothers with HBV infection, breastfeeding poses no additional risk of
virus transmission, compared with formula feeding, in vaccinated infants. 54
Administration of yellow fever vaccine to breastfeeding women should be
142 The Australian Immunisation Handbook 10th edition