pertussis, titers, breastfeeding

[Barbrae]

In that same post she did state relying on breastfeeding alone is not a good idea...

AHHHHH, I know, that had nothing to do with my question. I repeat - never was there a question about relying on breastfeeding alone. Can anyone hear me??? AM I talking to myself?? The question to Rolfe was specifically to elaborate on if breastfeeding alters vaccine immunity, apparently it does with live vaccines. The question was answered.

I think you are thinking I am debating something I am not.

 

[Rolfe]

The question to Rolfe was specifically to elaborate on if breastfeeding alters vaccine immunity, apparently it does with live vaccines. The question was answered.

The question as I read it was

Also, Rolfe had mentioned a long time ago somthing to the effect that breastfeeding and vaccination don't mix.

I read that as an implication that breastfeeding somehow rendered vaccination harmful, though I see there was a subsequent sentence that made that less of an obvious implication.

Look, it's not "breastfeeding" as such. It's consumption of colostrum, during the time when the gut mucosa is open enough to allow antibody molecules to be absorbed. This is all very very early indeed in the infant's life, and it does not carry on no matter how long one breastfeeds for. If I didn't make that clear before, then I hope I have now.

Passive maternal immunity is an extremely well understood phenomenon, as are its potential effects on the efficacy of vaccines. If it isn't much addressed in human medicine, this is because it's not much of an issue - as I said, I think partly because the time-scale involved is such a small part of a baby's infancy (compared to quite a chunk of a puppy's infancy), and partly because trans-placental immunity is such a big deal in man that I suspect colostrally-derived immunity is an even smaller deal.

If paediatricians aren't making much of a deal about maternal immunity for babies, you can be sure that it's because it isn't much of a deal. It's a dead cert that human vaccination schedules are carefully worked out to avoid any possible problem with maternal immunity - if the veterinary profession can do it, so can the medical. It's just that it seems to be less of an issue in human medicine due to accidents of timing.

Don't think that you know more about this than your paediatrician, because you don't. Don't think that you've spotted a potential pitfall in the usual vaccination schedules, because you haven't. Don't think you've found a spiffy way to get protection without having vaccines, because you haven't.

And don't think you're doing any of your children any favours by missing recommended vaccines, because you aren't.

Rolfe.

 

[Capsid]

Okay, every site I have come across states colostrum can help protect babies from disease, but they don't state for how long or why.


Some sites just say breastmilk does.

This really isn't helping. The more informative sites are on animals. Sheesh. Why is it so hard to get good information on humans.

Help, please

Well this could be a nice review article

I can get you the pdf file of it tomorrow when I return to work, if you wish.

In humans, in whom gut closure occurs precociously, breast milk antibodies do not enter neonatal/infant circulation. A large part of immunoglobulins excreted in milk are IgA that protect mainly against enteric infections

 

[Eos of the Eons]

AHHHHH, I know, that had nothing to do with my question. I repeat - never was there a question about relying on breastfeeding alone. Can anyone hear me??? AM I talking to myself?? The question to Rolfe was specifically to elaborate on if breastfeeding alters vaccine immunity, apparently it does with live vaccines. The question was answered.

I think you are thinking I am debating something I am not.

I'm not debating. I'm only saying your question was answered already to a certain degree. If we'd gotten the source of your information in the first place, then it would have made things easier. Now we can concentrate on specifics. these can be found in the posts between yours and mine here.

Thanks Rolfe and Capsid

 

[Badly Shaved Monkey]

AHHHHH, I know, that had nothing to do with my question. I repeat - never was there a question about relying on breastfeeding alone. Can anyone hear me??? AM I talking to myself?? The question to Rolfe was specifically to elaborate on if breastfeeding alters vaccine immunity, apparently it does with live vaccines. The question was answered.

I think you are thinking I am debating something I am not.

I'm intrigued to know why you think there would be a difference in the principle between live and killed vaccines.

 

[Dr. Imago]

Re: Re: oh brother!

No, don't bother with any education. Capsid, Rolfe, BSM and skepticgirl did a fine job answerign my quesitons.

They have far more patience for silliness than do I.

-TT

 

[Barbrae]

I'm intrigued to know why you think there would be a difference in the principle between live and killed vaccines.

Because that is the info given by Capsisd.

 

[Barbrae]

Don't think that you know more about this than your paediatrician, because you don't. Don't think that you've spotted a potential pitfall in the usual vaccination schedules, because you haven't. Don't think you've found a spiffy way to get protection without having vaccines, because you haven't.

And don't think you're doing any of your children any favours by missing recommended vaccines, because you aren't.

Rolfe.

Oh my god - Have I lost my mind???? Are you trying to gaslight me? did I not make it perfectly and abundantly clear that I was asking about the period before a child is fully vaccinated according to a regular schedule? How many times have I said that? Please, please show me where the question of vacinating ever came up - I feel like I am losing my mind. Or is it just that you think I must have some strange motive for asking? Even when I came right out and explained my reasons which had nothing to do with trying to find a way out of vaccinating. Seriously, did you read my posts? Why do you folks keep repeating this concept as if I ever EVER EVER had debated it, mentioned it, hinted at it, etc..

 

[Barbrae]

Re: Re: Re: oh brother!

They have far more patience for silliness than do I.

-TT

AH, but you have plenty of patience for mudslinging I see.

 

[Suezoled]

Re: Re: Re: Re: oh brother!

AH, but you have plenty of patience for mudslinging I see.

As do you.

Certainly as someone who is seeing that a homeopath is picking and choosing, and misundertanding the basic concept of conferred immunity through colostrum, one would reason that it's a bit of a public service giving more information than is required (you may have started this thread, but others read it beside yourself, so please, do recall it may be your question but it's not all about you). This is especially so when there are young people involved who rely soley on the parental figures to make informed, safe choices.

Homeopaths are not safe, but the purists are predictable. Homeopaths who pick and choose between "allopathy" and "homeopathy" (thus creating the situation where if the conditions worsens, it's the fault of the mainstream med, but if it's the other way, the homeopathy certainly seemed to the agent of healing) are unpredictable.

So what if you're getting more information than you ask for?

 

[Dr. Imago]

Re: Re: Re: Re: oh brother!

AH, but you have plenty of patience for mudslinging I see.

No, Barb. I asked you a legitimate question, and you called me a "complete jerk" - at that point, all bets were off.

-TT

 

[Skeptic Ginger]

I'd like to stay out of the fray here but I do want to say Barb did ask about breastfeeding AND vaccinating on schedule. It was easy to miss and I had to read it twice before I realized that's what she posted, but that is what she posted.

On the other side though I haven't felt Eos' posts were particularly rants or anything. Perhaps because I am in complete agreement with them they didn't come across as accusations anti-vaxers were evil baby killers. There are preventable deaths when vaccines are not given. You can't exactly over look that fact.

 

[Chris Haynes]

Re: Re: Re: Re: Re: pertussis, titers, breastfeeding

...allopathy ...

The label "allopath" was considered highly derisive by regular medicine. A 1902 book intended for new medical graduates reveals just how vehemently Medical Doctors once opposed and resented the label

From http://www.ncahf.org/articles/a-b/allopathy.html

 

[Badly Shaved Monkey]

Because that is the info given by Capsisd.

I think we need Capsid to clarify then.

The problem is that there are several different concepts that are muddled in your enquiry about "breastfeeding" and vaccination and these have stayed muddled.

1. There are maternal antiodies transferred in utero. These are in the blood, but decline over months.

2. There are maternal antiodies transferred in colostrum. These are in the blood, but decline over months.

3. There are maternal antiodies present in milk. These are not in the blood and are only maintained if breastfeeding is maintained.

4. There are live vaccines and killed vaccines.

5. There are live systemic vaccines and live vaccines working at a body surface.

So, from that menu, can you rephrase your original question to ask what you meant to ask?

 

[Capsid]

I think we need Capsid to clarify then.

The problem is that there are several different concepts that are muddled in your enquiry about "breastfeeding" and vaccination and these have stayed muddled.

1. There are maternal antiodies transferred in utero. These are in the blood, but decline over months.

2. There are maternal antiodies transferred in colostrum. These are in the blood, but decline over months.

3. There are maternal antiodies present in milk. These are not in the blood and are only maintained if breastfeeding is maintained.

4. There are live vaccines and killed vaccines.

5. There are live systemic vaccines and live vaccines working at a body surface.

So, from that menu, can you rephrase your original question to ask what you meant to ask?

I'm not sure what the question is here. Points 2 and 3 are the same. Breastmilk contains colostrum (hindmilk?) which is the antibody (IgA) containing component, but it is only present in the first few months of breastfeeding. Colostrum does not get into the bloodstream in humans because it does not cross the gut wall; human guts in neonates are not leaky like in animals (Rolfe has covered this). So the colostrum will provide some protection against enteric (gut) pathogens only. Systemic protection is provided by antibodies transferred in utero. It's a neat solution to the problem of getting maternal antibodies into the foetal bloodstream in readiness for exposure to the pathogens of the outside world. The human placenta does a marvellous job, but it does expose the mother to paternal/foetal antigens which then can lead to autoimmunities and haemolytic anaemia of the newborn.

 

[Rolfe]

As Eos has reminded me, I asked earlier

Would someone mind explaining whether breast milk is a significant source of maternal immunity for human babies? Humans have a haemoendothelial placenta, which allows close enough contact between maternal and foetal circulation for antibodies to cross to the foetus.

The species I deal with rely almost exclusively on colostrum and the permeable gut of the neonate for maternally-derived immunity. (Which at least means that we have much less trouble with foetal/maternal ag/ab incompatibility because the problem doesn't arise until after the infant has been born.) I know that in man there is substantial acquisition of passive immunity trans-placentally. And we hear relatively little about the role of colostrum. I therefore wondered whether it had any significant role at all. (Especially because of the amount of bottle-feeding going on from birth - if you tried to do that with a calf, depriving it entirely of colostrum, it would simply die.)

It seems I now have a useful answer to that, from the review article Capsid quoted.

In humans, in whom gut closure occurs precociously, breast milk antibodies do not enter neonatal/infant circulation. A large part of immunoglobulins excreted in milk are IgA that protect mainly against enteric infections.

This indicates that colostrally-derived immunity really isn't a significant feature at all, in the way it is in animals.

So, any pertussis immunity conferred by a mother on her baby is going to happen trans-placentally, rather than via the milk. The other part of milk-borne immunity, the local IgA part, is only going to give some small protection from ingested pathogens, and as far as I know, Bordetella species are acquired through the respiratory tract.

Actually, BSM explained it all much more succinctly than I did.

1. Passive humoral (that is, in the bloodstream) immunity may be acquired by transfer of antibodies across the placenta, before birth. This only occurs in man.
2. It may also be acquired by transfer of colostral antibody across open gut mucosal junctions. Colostrum secretion and the open mucosal junctions only persist for a few days after birth. This is the sole method of acquisition in animal species, and it appears to be of negligible or no importance in man.
3. Some minor local protection from ingested pathogens is afforded by the presence of antibodies in the milk in the gut of the infant, though these are not absorbed after the first few days of life in any species. This may continue as long as nursing continues.[/list=1]So if you're talking about humoral immunity (as opposed to local gut protection) then it all happens before the infant is a week old, probably actually before birth in man. This immunity may persist for a few months, but you can't add to it after the crucial period for acquiring it has passed.
   
   You may get some pertussis protection this way, but I wouldn't personally want to rely on it. I don't think local IgA would really protect at all against a Bordetella, though I hope Capsid or someone will correct me if I'm wrong.
   
   Capsid, ThirdTwin, somebody - if an expectant mother with a 12-year-old child came to you expressing concern that the 12-year-old might expose the young baby to pertussis, what would you advise? Is there any reason why giving the 12-year-old a booster is not a sensible suggestion?
   
   Rolfe.

 

[Capsid]

Capsid, ThirdTwin, somebody - if an expectant mother with a 12-year-old child came to you expressing concern that the 12-year-old might expose the young baby to pertussis, what would you advise? Is there any reason why giving the 12-year-old a booster is not a sensible suggestion?

Rolfe.

I would ask why she thought her 12 yr old was a risk to her baby. If the 12 yr old is already infected with B pertussis then there is little point in vaccinating. Would there be reason to suspect that the 12 yr old is still not protected? And why would she be a source of the bacterium? Is she exposed to infected individuals? But to my mind and to answer your question specifically then there is no reason not to give the 12 yr old a booster, but it would be in a specific set of circumstances IMHO.

 

[Badly Shaved Monkey]

Colostrum does not get into the bloodstream in humans

OK, that was what I had not known before.

 

[Rolfe]

OK, that was what I had not known before.

I had suspected as much, because the human medics don't make a fetish of colostral consumption the way we have to, and of course there is that haemoendothelial placenta, but this was the first time I'd had definite confirmation.

So really, the contribution of breast milk to passive immunity in human infants seems to be pretty minimal, and it looks as if the stories about it may mainly be people extrapolating from non-human species without real justification.

Rolfe.

 

[Capsid]

So really, the contribution of breast milk to passive immunity in human infants seems to be pretty minimal, and it looks as if the stories about it may mainly be people extrapolating from non-human species without real justification.

Rolfe.

At 1 day after birth there is 1740mg/100mL of IgA in colostrum!!! By day 4 it has declined to just 100mg/100mL which is similar to concentrations found in gastric juice (10-200) and plasma (85-490). That is a very high initial concentration so it must have some role although only for the first few days after birth when the gut is immunologically naive.

Source: Immunochemistry LabFax (Kerr & Thorpe eds) 1994. Bios Scientific Publishers.