title: Compliance of mothers following recommendations to breastfeed or withhold breast milk during rotavirus vaccination in North India: a randomized clinical trial.
abstract: BACKGROUND
  Neutralizing antibodies in breast milk may adversely influence the immune response to live oral vaccines. Withholding breastfeeding around the time of vaccine administration has been suggested for improving vaccine performance. However, we do not know whether mothers find withholding breastfeeding around the time of vaccination acceptable and how they perceive this recommendation.
  
  
  METHODS
  In a clinical study designed to examine predictors of poor immune response to rotavirus vaccine in infants in India, Rotarix® was administered to infants at 6 and 10 weeks with other childhood vaccines. For the study, 400 mother-infant pairs were randomized into two groups in a 1:1 ratio. Mothers were either recommended to withhold breastfeeding or were encouraged to breastfeed half an hour before and after administration of Rotarix®. The mother-infant pairs were observed and the breastfeeding intervals were recorded during this period. Mothers were administered a questionnaire about their perception of the intervention after the infants received the second dose of Rotarix®.
  
  
  RESULTS
  Almost 98% (391/400) of the infants received both doses of Rotarix®. Adherence to the recommendations was high in both groups. All mothers in the group who were asked to withhold breastfeeding did so, except one who breastfed her infant before the recommended time after the first dose of Rotarix®. Of the mothers, 4% (7/195) reported that the recommendation to withhold breastfeeding was difficult to follow. All mothers in this group reported that they would withhold breastfeeding at the time of vaccination if they were asked to by a health-care provider. Only one mother responded that withholding breastfeeding would be a reason for not giving rotavirus vaccine to her infant.
  
  
  CONCLUSIONS
  Withholding breastfeeding half an hour before and after vaccination appears to be acceptable to mothers in this setting. If withholding breastfeeding produces an improvement in the performance of the vaccine, it could be used to increase the public health impact of rotavirus immunization.
  
  
  BACKGROUND
  Clinical Trial Registry, India (CTRI/2012/10/003057), Clinicaltrials.gov (NCT01700127).Date of Registration: Clinical Trial Registry, India: 28 September 2012, Clinicaltrials.gov: 3 October 2012.
authors: Temsunaro
authors: T
authors: Rongsen-Chandola
authors: Brita Askeland
authors: BA
authors: Winje
authors: Nidhi
authors: N
authors: Goyal
authors: Sudeep Singh
authors: SS
authors: Rathore
authors: Madhu
authors: M
authors: Mahesh
authors: Rajat
authors: R
authors: Ranjan
authors: Alok
authors: A
authors: Arya
authors: Farhana Afzal
authors: FA
authors: Rafiqi
authors: Nita
authors: N
authors: Bhandari
authors: Innlandet Hospital Trust, Lillehammer, Norway and Centre for International Health, University of Bergen, Bergen, Norway. tors@me.com.
authors: Tor A
authors: TA
authors: Strand
mesh_terms: D000328:Adult; D057134:Antibodies, Neutralizing / Q000032:analysis; D001942:Breast Feeding / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D008895:Milk, Human / Q000276:immunology*; D009035:Mothers / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D012400:Rotavirus Infections / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology; D055815:Young Adult
chemical_list: D057134:Antibodies, Neutralizing; C492457:RIX4414 vaccine; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated