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Breastfeeding—with infectious diseases

The decision to breastfeed or not is a difficult one when a mother has a health issue that may influence that choice. The benefits of breastfeeding are sufficiently important to support a mothers’ choice to breastfeed unless there is substantial evidence of disease transmission.

If you are advised not to breastfeed for intermittent periods, you will be advised about expressing, storing or discarding your breast milk.

It is also important that women who are not breastfeeding are informed of the benefits of skin-to-skin contact with their baby.

Human immunodeficiency virus (HIV)

HIV positive mothers should not breastfeed their baby. Breastfeeding increases the risk of transmission of HIV from mother to infant, particularly during the first six months. The risk increases with the duration of breastfeeding.

Replacing breastfeeding with formula milk is a safe practice in Australia, where clean water and good quality infant formula are readily available.

Hepatitis C

There is no evidence that breastfeeding increases the risk of transmission of hepatitis C from mother to infant. However, if your breast milk may be contaminated with your blood i.e. your nipples are cracked, grazed or visibly bleeding; you should express and discard the milk, from the affected breast, until your nipples are healed.

Relevant information regarding hepatitis C includes the following:

• The virus does appear in breast milk. • The risk of transmission appears to be small; however, a HIV co-infection can increase the hepatitis C viral load. • Transmission may depend on the viral load. • Transmission is blood borne.

Hepatitis B

There is no evidence that breastfeeding increases the risk of transmission of hepatitis B from mother to infant. To protect against transmission it is extremely important that all infants of hepatitis B surface antigen positive (HBsAg) mothers receive active (hepatitis B immunoglobulin) and passive (hepatitis B vaccination) immunisation within 12 hours after birth.

Herpes Simplex

There is no contraindication to breastfeeding with herpes (cold sores). The virus that causes herpes is not present in breast milk; therefore, your baby cannot contract herpes by breastfeeding. However, the virus can be spread to your baby if they come in direct contact with a herpes lesion; e.g. where there is a lesion on your breast or close to the nipple. In this case, you would need to temporarily discontinue breastfeeding on the affected side and express your milk until the lesion heals. The expressed milk is safe to use to feed your baby.

Cytomegalovirus (CMV)

Infection with cytomegalovirus (CMV), a member of the herpes family, is very common. In most cases, a baby acquires the infection via breast milk; however, this has virtually no consequences for well babies born at term. CMV can cause severe symptomatic disease in preterm infants. Although breast milk may contain viruses, it also contains antibodies that are protective against CMV. Breastfeeding should continue in CMV affected mothers in most cases; however, discussion should take place with a neonatologist if babies are born preterm and generally breastfeeding will be avoided. In these cases, breast milk can be expressed to establish and/or maintain supply until your baby’s doctor agrees that breastfeeding may start or recommence.

Varicella (chicken pox)

Usually, if both the mother and infant are infected with varicella at birth, they will both be isolated but breastfeeding may continue. Breast milk is an excellent source of antibodies that are protective against varicella. Acyclovir, an antiviral, sometimes used to treat varicella is not contraindicated for use when breastfeeding.

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 02/11/2015.
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