Infections and Breast feeding

Infections that should NOT stop breast feeding:

In most cases of infection in the breastfeeding mother, by the time the diagnosis is made, the baby has usually been exposed already. Stopping breastfeeding will therefore only prevent the baby obtaining the immunological benefits. Decisions about breast milk and transmission of infection should balance the potential risk compared with the well documented benefits of breast milk. Breast feeding is rarely contra-indicated (not advisable) because of an infection in the mother.
If you are prescribed an antimicrobial treatment (antibiotic) for your infection, or have bought a product from the chemist, always check with the health professional that it is safe for use in breast feeding mothers.

Continuing breast feeding is safe with the following infections:

Candida (Thrush) mastitis - breast feeding should continue along with antimicrobial treatment. Management of candidal mastitis may necessitate using expressed milk because of pain. Support through this period is vital .

Chlamydia - however you must not breast feed if you are taking antibiotics which are tetracyclines (check with your health professional). Chlamydia cannot be transmitted through breast feeding and there are treatments which can be used with breast feeding.

Cold or flu - if you are taking over the counter remedies check with your chemist that these are safe to use.

E.coli – no evidence of transmission in breast milk.

Group B Streptococcus - no evidence to stop breast feeding.

Hepatitis A – no evidence to stop breast feeding.

Hepatitis B – breast feeding can continue and the baby should be vaccinated.

Hepatitis C - no evidence of transmission in breast milk.

Herpes Simplex (1 & 2) “cold sores” - as long as there are no lesions on the breast then breast feeding is safe. If there is a lesion on the breast it must be covered with a dressing (contact your health professional). If the lesion is on the nipple or areolae then mothers should express milk from that breast until the sore heals and breast feed on the unaffected side. If the pump touches the sore whilst expressing then discard the milk.

Listeriosis – no evidence of transmission in breast milk.

Lyme disease - no evidence of transmission in breast milk.

Parvovirus – no evidence of transmission in breast milk.

Respirarory Syncitial Virus (RSV) – no evidence of transmission in breast milk.

Syphilis – no evidence of transmission in breast milk (if on antimicrobial treatment check with you health professional).

Staph aureus and MRSA - there is no difference in the rate of colonization between breast fed and formula fed babies.

Toxoplasmosis - no evidence of transmission in breast milk.

Infections that MAY stop breast feeding

Chickenpox:
If you have chickenpox, avoid contact with other pregnant women and new babies until at least five days after the rash appears, or until all the blisters have crusted over because if the baby is born within seven days of the mother’s rash appearing – the baby may get severe chickenpox and some babies may die as a result. Breast fed and formula-fed infants are equally at risk of infection if close contact from an infected mother. Therefore mother and baby should be separated from each other and cared for by another individual during the mother’s period of infectivity. Your baby will be offered varicella-zoster immunoglobulin (VZIG) and possibly acyclovir. Expressed breast milk can be given to the baby if no skin lesions involve the breasts or as soon as VZIG has been given to the baby.

Active tuberculosis (TB):
Treatment for TB can last for a few months. Breastfeeding is safe when an infected mother who is undergoing treatment has been told by her health professional that she is no longer contagious. Until this happens the mother and her baby should be separated. Whilst she is “infectious” then she should express and discard her milk. However if it is safe for mother and baby to be together then it is safe to breast feed.

Recommendations can be different in developing countries, where the risk of infant mortality (death) may be greater if the baby does not breast feed because of the risks of contaminated water in making up formula feeds.
Three viruses frequently cause infection or disease as a result of breast-milk transmission.

These are:

Cytomegalovirus (CMV), -- This virus may go unnoticed but can cause fever and general malaise. It is not routinely screened for. If it is picked up in pregnancy or very rarely around delivery you need to discuss this with you health professional.

Human T Lymphocyte Virus 1 and 2 (HTLV-I & 2) - Acute HTLV infection is rarely seen or diagnosed.

HTLV1 affects the nervous system and occurs only in certain areas in the world eg SW Japan, the Carribean, South America and sub-Saharan Africa.

HTLV-2 causes forms of inco-ordination. The predominant routes of transmission are intravenous drug use, infected blood and blood products, and breastfeeding.

Human Immune virus (HIV) - Guidelines for the Management of HIV infection in Pregnant Women and the Prevention of Mother-to-Child Transmission of HIV recommend exclusive formula-feeding to all HIV positive mothers.

“Breastfeeding is an important route of transmission. In the UK, where safe infant feeding alternatives are available, HIV-infected women are advised to refrain from breast feeding. If she is taking antiretroviral medication (ART) it should be explained that currently there is no evidence that this will protect the infant. Although ART is likely to reduce free virus in the plasma its effect on free and cell- associated virus in the milk is not known.” www.bhiva.org