This document provides recommendations for breastfeeding during maternal infections. It summarizes that while breastfeeding provides protection to infants, human milk can also transmit pathogens from infected mothers. The literature recommends that mothers infected with HIV or HTLV I should not breastfeed due to the risk of viral transmission. For other infections, breastfeeding can generally be continued with careful consideration. The healthcare provider must evaluate the risks and benefits of breastfeeding versus suspension on a case-by-case basis.
Important pregnancy vaccines that mommies to-be should getNavya_Sharma
Maternal vaccines help in preventing serious infections like the ones above. If you have more questions regarding the right vaccination for you, please consult your gynecologist. Visit, https://www.cordlifeindia.com/blog/important-pregnancy-vaccines-mommies-get/
Important pregnancy vaccines that mommies to-be should getNavya_Sharma
Maternal vaccines help in preventing serious infections like the ones above. If you have more questions regarding the right vaccination for you, please consult your gynecologist. Visit, https://www.cordlifeindia.com/blog/important-pregnancy-vaccines-mommies-get/
This is a compilation of recommendations for feeding of HIV-exposed infants based on WHO-UNICEF and the DOH Administrative Order. Ideally, patient's choice should still be considered whether exclusively breastfeeding or exclusively replacement feeding.
A publicação designada
‘Amamentação, o Presente de Mãe para Cada Criança’,
revela que “aumentar as taxas de aleitamento materno ajudaria a prevenir mais 20 mil mortes de mães por CA de mama”.
A investigação lembra que amamentar ajuda também a proteger a mulher das hemorragias e das depressões pós-parto, do CA nos ovários – além do CA de mama –, problemas cardíacos e diabetes do tipo 2.
...
Nosso presente de Dia das Mães! :)
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Health in infants born to mothers who received mefloquine or sulphadoxine pyr...Wendy.J. Seymour
Attention ADF Female Veterans who were administered Mefloquine prior,during and after deployments overseas.
Dr Jane Quinn (Spokesperson for Mefloquine and Tafenoquine (Mef n Taf) Veterans Australia group)
BScu(U Westminister),PhD (Edin) quoted:
This study does show that mefloquine-treated mothers Africa do have babies with some very mild developmental delay in some specific motor skills.
Now I KNOW this is not directly relevant to the Australian veterans experience, but I think this suggests that some of the genetic and epigenetic effects on children that we have had some discussion about cannot (YET) be ruled out.
I'm not being alarmist, there are many studies that have shown no effect, but this is probably one of the largest, most consistently undertaken, and most importantly: is not linked to Roche.
What's sad to see too is the poor outcomes for these babies overall.
Wendy J.Seymour (Me)
Makes me wonder how many Australian female veterans have been affected in this way too with their pregnancy? Were some of them pregnant whilst being administered Mefloquine? Can the ADF or AMI or DVA explain that one to me please? The reason why I ask is our Mef n Taf veterans not only women but men are asking each other if they are experiencing certain symptoms in their special needs child/children and if these antimalarials have caused this. I've seen their posts on social media and I hang my head in shame with a feeling of helplessness.
Please refer to the document attached for further information. This is another matter that GPs and Specialists,Advocates ADF and DVA need to look at closely also.
This lecture describes the approach to screening, diagnosis and management of HIV and TB infection among pregnant patients. Prevention of Mother to Child Transmission of HIV infection mainly based on the Philippine Obstetrical and Gynecological Society Clinical Practice Recommendations.
Socio Cultural Factors Related to Health and Disease Aditya Sharma
Socio Cultural Factors Related to Health and Disease
PPT
Heredity
Environment
Lifestyle
Socio-economic conditions
Health services
Education
Income
Housing
Approximately one-third of infants born to HIV-positive mothers contract HIV through mother-to-child transmission, becoming infected during their mothers' pregnancy, childbirth or breastfeeding without preventive interventions. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission of HIV (MTCT). Between 15 and 25% of children born to HIV-infected mothers get infected with HIV during pregnancy or delivery, while about 15% of the children get infected through breastfeeding.
This is a compilation of recommendations for feeding of HIV-exposed infants based on WHO-UNICEF and the DOH Administrative Order. Ideally, patient's choice should still be considered whether exclusively breastfeeding or exclusively replacement feeding.
A publicação designada
‘Amamentação, o Presente de Mãe para Cada Criança’,
revela que “aumentar as taxas de aleitamento materno ajudaria a prevenir mais 20 mil mortes de mães por CA de mama”.
A investigação lembra que amamentar ajuda também a proteger a mulher das hemorragias e das depressões pós-parto, do CA nos ovários – além do CA de mama –, problemas cardíacos e diabetes do tipo 2.
...
Nosso presente de Dia das Mães! :)
Prof. Marcus Renato de Carvalho
www.aleitamento.com
Health in infants born to mothers who received mefloquine or sulphadoxine pyr...Wendy.J. Seymour
Attention ADF Female Veterans who were administered Mefloquine prior,during and after deployments overseas.
Dr Jane Quinn (Spokesperson for Mefloquine and Tafenoquine (Mef n Taf) Veterans Australia group)
BScu(U Westminister),PhD (Edin) quoted:
This study does show that mefloquine-treated mothers Africa do have babies with some very mild developmental delay in some specific motor skills.
Now I KNOW this is not directly relevant to the Australian veterans experience, but I think this suggests that some of the genetic and epigenetic effects on children that we have had some discussion about cannot (YET) be ruled out.
I'm not being alarmist, there are many studies that have shown no effect, but this is probably one of the largest, most consistently undertaken, and most importantly: is not linked to Roche.
What's sad to see too is the poor outcomes for these babies overall.
Wendy J.Seymour (Me)
Makes me wonder how many Australian female veterans have been affected in this way too with their pregnancy? Were some of them pregnant whilst being administered Mefloquine? Can the ADF or AMI or DVA explain that one to me please? The reason why I ask is our Mef n Taf veterans not only women but men are asking each other if they are experiencing certain symptoms in their special needs child/children and if these antimalarials have caused this. I've seen their posts on social media and I hang my head in shame with a feeling of helplessness.
Please refer to the document attached for further information. This is another matter that GPs and Specialists,Advocates ADF and DVA need to look at closely also.
This lecture describes the approach to screening, diagnosis and management of HIV and TB infection among pregnant patients. Prevention of Mother to Child Transmission of HIV infection mainly based on the Philippine Obstetrical and Gynecological Society Clinical Practice Recommendations.
Socio Cultural Factors Related to Health and Disease Aditya Sharma
Socio Cultural Factors Related to Health and Disease
PPT
Heredity
Environment
Lifestyle
Socio-economic conditions
Health services
Education
Income
Housing
Approximately one-third of infants born to HIV-positive mothers contract HIV through mother-to-child transmission, becoming infected during their mothers' pregnancy, childbirth or breastfeeding without preventive interventions. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission of HIV (MTCT). Between 15 and 25% of children born to HIV-infected mothers get infected with HIV during pregnancy or delivery, while about 15% of the children get infected through breastfeeding.
Periodontal Disease: A Possible Risk-Factor for Adverse Pregnancy OutcomeDr. Anuj S Parihar
Bacterial invasion in subgingival sites especially of gram-negative organisms are initiators for periodontal diseases. The periodontal pathogens with persistent inflammation lead to destruction of periodontium. In recent years, periodontal diseases have been associated with a number of systemic diseases such as rheumatoid arthritis, cardiovascular-disease, diabetes mellitus, chronic respiratory diseases and adverse pregnancy outcomes including pre-term low-birth weight (PLBW) and pre-eclampsia. The factors like low socio-economic status, mother’s age, race, multiple births, tobacco and drug-abuse may be found to increase risk of adverse
pregnancy outcome. However, the same are less correlated with PLBW cases. Even the invasion of both aerobic and anerobic may lead to inflammation of gastrointestinal tract and vagina hence contributing to PLBW. The biological mechanism involved between PLBW and Maternal periodontitis is the translocation of chemical mediators of inflammation. Pre-eclampsia is one of the commonest cause of both maternal and fetal morbidity as it is characterized by
hypertension and hyperprotenuria. Improving periodontal health before or during pregnancy may prevent or reduce the occurrences of these adverse pregnancy outcomes and, therefore, reduce the maternal and perinatal morbidity and mortality. Hence, this article is an attempt to review the relationship between periodontal condition and altered pregnancy outcome.
HIV positive mother and her bABY, RISK OF TRANSMISSION, ANTENATAL CARE, INTRA...LalrinchhaniSailo
Globally, an estimated 1.3 million women and girls living with HIV become pregnant each year. In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from 15% to 45%. As such, identification of HIV infection should be immediately followed by an offer of linkage to lifelong treatment and care, including support to remain in care and virally suppressed and an offer of partner services.
In 2019, 85% of women and girls globally had access to antiretroviral therapy (ART) to prevent mother-to-child transmission (MTCT). However, high ART coverage levels do not reflect the continued transmission that occurs after women are initially counted as receiving treatment. Achieving retention in care and prevention of incident HIV infections in uninfected populations remain high priorities to reach global elimination targets. Since the global shift to, and accelerated rollout of, highly effective, simplified interventions based on lifelong ART for pregnant women living with HIV, virtual elimination of MTCT – also known as vertical transmission – has been shown to be feasible.
Vaccination in pregnancy by dr alka & dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Maternal immunization provides important health benefits to both pregnant women and to their fetus. Vaccine-preventable diseases cause significant morbidity and mortality among maternal, neonatal, and young infant. Some infections are so serious even they can waste pregnancy, harm her baby during pregnancy or after delivery. These complications can be protected with vaccination. This is why vaccinations are so important for pregnant mothers. Vaccines strengthen the immune systems of body that can fight off serious infectious diseases. A vaccine can help in protection of the mother's body from infections and this immunity passes to her baby during pregnancy. This immunity keeps the child safe during the first few months of life until baby gets his own vaccination. Vaccination also protects mothers from getting a serious disease that could affect future pregnancies. Fetus getting any risk after vaccination of the mother during pregnancy primarily is theoretical. Globally, no scientific study exist which shows the risk of fetus after vaccination of pregnant women with inactivated vaccines or bacterial vaccines or toxoids. Even live vaccines causing risk to fetus is theoretical. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm. Not all vaccinations are safe during pregnancy but some of inactivated vaccines are considered safe which can be give to pregnant women who might be at risk of infection.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...
Recommendations for breastfeeding during maternal infections
1. http://www.scielo.br/scielo.php?pid=s0021-
75572004000700010&script=sci_arttext&tlng=en
Recommendations for breastfeeding during maternal
infections
Joel A. LamounierI; Zeina S. MoulinII; César C. XavierIII
IPh.D., University of California, Los Angeles, USA. Full professor, Department of Pediatrics,
School of Medicine, Universidade Federal de Minas Gerais (UFMG). Advisor of the Graduate
Program in Child and Adolescent Health, UFMG, Belo Horizonte, MG, Brazil
IIMSc. Professor, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo
Horizonte, MG, Brazil
IIIPh.D., School of Medicine, USP, Ribeirão Preto. Professor, School of Medicine, Universidade
Federal de Minas Gerais (UFMG). Advisor of the Graduate Program in Child and Adolescent ,
UFMG, Belo Horizonte, MG, Brazil
Correspondence
ABSTRACT
OBJECTIVE: To make a literature review on breastfeeding and maternal infectious diseases
in order to contribute with knowledge and information that can aid the pediatrician to decide
upon allowing infected mothers to breastfeed their babies or not.
SOURCES OF DATA: Lilacs and MEDLINE databases were searched for books, technical
rules and articles on the issue of breastfeeding and infected mothers.
SUMMARY OF THE FINDINGS: Infected lactating mothers can transmit pathogenic agents
to their infants. Although breastfeeding protects the child it can also be a dangerous source
of infection. Maternal diseases caused by bacteria, virus, fungi and parasites may
sometimes be transmitted via human milk. The literature points out that mothers infected
with HIV and T-lymphotropic human viruses (type I) should not breastfeed. With other
diseases a careful approach should be made, but, in general, breastfeeding is maintained.
CONCLUSION: The mother who is exposed to infectious diseases may transmit pathogenic
agents through the human milk, attention should also be made to milk from milk banks. The
healthcare provider must take his/her decision upon suspending breastfeeding or not, what
can be distressful, once he/she has a fundamental role in promoting and stimulating
breastfeeding.
Key words: Human milk and infection, mother's infectious illnesses, maternal breast-
feeding and infection.
2. Introduction
Human milk, in addition to its nutritional components, contains numerous cells, membranes
and molecules whose function is to protect newborn infants. In lactating women, the
enteromammary or bronchomammary immune system is activated when pathogens
(bacteria) come in contact with the mucous membranes of the intestine or respiratory tract
and are phagocytosed by macrophages. This stimulates T lymphocytes, causing the
differentiation of immunoglobulin A (IgA)-producing B lymphocytes. Lymphocytes migrate to
the mammary gland and, mediated by cytokines, turn into plasma cells that produce a
glycoprotein, which binds to IgA, and eventually turns into secretory immunoglobulin A
(sIgA). This is an important and specific protective function of human milk in newborns.1-5
Breastfeeding, given its benefits to mother and infant, is considered to be the best form of
nutrition for infants. However, maternal and infant diseases may hinder breastfeeding.
Under these circumstances, the health professional should be skilled, have technical
knowledge and adopt a favorable attitude so as to properly assess the viability of
breastfeeding. When the nursing mother presents with the symptoms of a disease, she has
already exposed her infant to the pathogen and the usual recommendation is that
breastfeeding should be maintained.6-9 If the mother discontinues breastfeeding after
symptom onset, infant protection against diseases is decreased, and the chances of the
infant falling ill are increased, since he/she is not provided with specific antibodies and other
protective factors from human milk.
No recommendation to discontinue breastfeeding, even if temporarily, exists in cases of
mothers with urinary tract infection, bacterial infection of the abdominal wall, episiorrhaphy,
mastitis or any other disease in which the nursing mother's physical conditions and general
state of health are not so compromised.
Although human milk contains antibodies, mononuclear cells and other protective factors, it
may be a possible source of infection for the infant in some maternal diseases.6,7 The
mononuclear cells in human milk, albeit providing protection, may transfer infectious
particles from the mother to the infant. Thus, when health professionals attend to a nursing
mother with active viral infection or another infectious disease, they may become
uncomfortable about whether they should discontinue or not breastfeeding, as their role is
to promote and encourage it.
Some infectious diseases may impede breastfeeding, either on a temporary or permanent
basis, due to maternal physical conditions such as severe cardiac, renal, and hepatic
diseases, psychosis and severe postpartum depression.10
In the present review, we discuss breastfeeding management in the presence of common
maternal diseases caused by bacteria, viruses, parasites and fungi.
Viral infections
3. In several maternal viral diseases, such as hepatitis, herpes, measles, mumps and rubella,
among others, the virus may be excreted into human milk. However, except for infections
caused by retroviruses, human immunodeficiency virus (HIV-1), human T-lymphotropic
virus type I (HTLV I) and human T-lymphotropic virus type II (HTLV II), transmission via
human milk has little epidemiological relevance. In most maternal viral diseases, other
sources of contamination of newborns should be considered before ascribing the cause to
breastfeeding only. The risk of transmission may be enhanced in cases of acute infection at
delivery, as the milk may contain a high concentration of viral particles and low titers of
protective antibodies able to neutralize the infectious agent. Therefore, in general, there is
no formal contraindication for breastfeeding in most cases of viral diseases, except for
diseases caused by retroviruses.
The transmission of RNA retrovirus, including HIV-1,11,12 HTLV I and HTLV II13 has already
been demonstrated. HIV-2 can also be transmitted from mother to infant, but the role of
breastfeeding in the transmission via human milk has not been clearly established yet. The
Epstein-Barr virus and herpesvirus 6 can be found in human milk, but so far, reports on
breastfed infants infected by these viruses have been few and far between. To some extent,
the fact that breastmilk is not much more infectious is surprising, especially due to the daily
volume ingested by exclusively breastfed infants. Supposedly, there may be other
protective factors than those widely known.
Table 1 summarizes the most important infections, with possible transmission of the virus to
the infant via breastmilk, and the corresponding breastfeeding management.
HIV infection
HIV is excreted freely or into cells in the milk of infected women, who may or may not
present with symptoms of the disease. Approximately 65% of vertical HIV transmission
occurs during labor and during delivery; the remaining 35% occurs in utero, mainly within
4. the last weeks of gestation and via breastfeeding. The viral load in breastmilk is an
important determinant for the risk of transmission.14-16 In newborns, the virus penetrates
the nasopharyngeal and gastrointestinal mucosae. During breastfeeding, viral transmission
may occur at any stage, but it seems to occur more often within the first weeks and
especially in most recent maternal infections. The viral load in colostrum is significantly
higher than in mature milk. Mixed breastfeeding seems to pose more risks than exclusive
breastfeeding, due to the major injury to the gastrointestinal mucosa resulting from artificial
feeding, which favors the penetration of the virus.17 The additional risk of transmission of
the virus via human milk ranges from 5 to 20%.18 Contamination via breastmilk in women
who acquired the infection after the postnatal period was detected in 29% (15-53%) of
cases.10,16,18 The presence of HIV-infected cells in breastmilk for over 15 days after delivery
is an important predictive factor for infection in the infant.17
Retroviruses can infect mammary epithelial cells before delivery, and can be found free or
infecting monocytes in milk, which account for 50% of cells found in breastmilk. These cells
can potentially carry the virus from the maternal bloodstream or from lymphoid tissues to
the infant's intestine. Some types of HIV use chymosin receptors to infect macrophages.
However, more studies are necessary to accurately define the role of human milk cells in
HIV infection.19-21
The use of antiretroviral therapy during pregnancy and delivery and its maintenance in
newborns results in a decrease in vertical HIV transmission for up to six months after
childbirth,22 even if breastfeeding is maintained. Nevertheless, HIV infection is one of the
few situations in which the contraindication for breastfeeding is a common agreement. In
Brazil, The Ministry of Health23 recommends that HIV-infected mothers should not
breastfeed. On the other hand, the World Health Organization and UNICEF recommend that,
in poor countries, where diseases such as diarrhea, pneumonia and malnutrition
substantially contribute to high rates of infant morbidity and mortality, the benefits of
breastfeeding should be considered in relation to the risk of HIV transmission. In these
cases, and if it is not possible to provide appropriate artificial feeding, breastfeeding should
be maintained, given its benefits to infants who live in precarious conditions.15,24,25Women
who receive combined antiretroviral therapy have lower rates of viral
transmission.22 Preliminary information obtained from a study conducted in South Africa
considers that it is possible to reduce or prevent the risk of postnatal transmission of HIV if
the infant receives human milk for a short period of time.14 The idea is to maintain
breastfeeding for four to six months. However, the efficacy and safety of such practice has
not been demonstrated yet, and studies still have been underway.
Another alternative is to reduce or eliminate HIV from human milk. Infected cells can be
removed from milk, but viral particles are difficult to eliminate. The inactivation of HIV in
breastmilk through pasteurization (62.5 ºC for 30 minutes, followed by rapid cooling) allows
infants to continue receiving breastmilk without increasing the postnatal risk of
infection.26,27
HTLV infection
HTLV belongs to the retrovirus family, the same of HIV. They are human T1 and T2
lymphotropic viruses called HTLV I and HTLV II. Type I causes a rare type of leukemia,
myelitis and eye infection that may result in blindness. HTLV II is not associated with
disease. They can be transmitted via blood, infected needles, sexual intercourse and from
mother to infant by means of breastfeeding. The principal mode of transmission is vertical,
but the predominant one is via breastfeeding.
5. Although HTLV affects a small portion of the population, with possible late development of
diseases in only 1 to 4% of infected individuals, its occurrence has increased in South
America, especially because of the lack of health surveillance. As the disorders caused by
these retroviruses are severe and cannot be treated or controlled with efficient therapy and
vaccine, contraindication for breastfeeding in infected women is a major way of reducing
their vertical transmission.
In Japan, freezing the milk of HTLV I-positive mothers at -20 ºC has been used as a way to
inactivate the virus. However, the Center for Disease Control and Prevention (CDC)
establishes that every HTLV I-infected mother should be advised not to breastfeed, and
does not have an opinion on the freezing of human milk in this situation. CDC considers the
current data on HTLV I transmission via frozen and thawed breastmilk to be insufficient.
The amount of HTLV I-infected cells in peripheral blood is very small compared to the
number of infected T cells in breastmilk, which explains the high risk of viral transmission
via human milk. Some risk factors have been considered in the transmission of HTLV I and
II via human milk: breastfeeding for over three months, advanced maternal age, antigen
levels in maternal blood and high titers of HTLV I antibodies in the nursing
mother.10,17However, Van Dyke et al.28 report that the transmission of HTLV II from mother
to infant may occur regardless of the type of feeding the infant receives in similar rat es to
those of HTLV I, thus showing that the virus can be transmitted to the infant in the absence
of breastfeeding.
Hepatites A, B and C
Hepatitis A, B and C viruses can be transmitted to the infant during pregnancy, delivery or
postnatal period. Viruses transmitted by the oral-fecal route, as in hepatitis A, have a higher
chance of being transmitted to the infant at delivery.
The hepatitis A virus can be excreted into human milk in the acute phase of the disease.
When delivery occurs in this phase of the disease, the infant should receive anti-hepatitis A
immunoglobulin at the dose of 0.02 ml/kg as prophylactic measure. This prophylaxis is
indicated for all infants, regardless of whether they are being breastfed or not, and provides
protection that outweighs the risk of the infant acquiring the disease. Thus, breastfeeding is
not contraindicated.7
Hepatitis B and C viruses are transmitted hematogenously and sexually. Hepatitis B surface
antigen (HBsAg) has been detected in the milk of HBsAg-seropositive women, and possibly,
small amounts of blood might be ingested by the newborn infant during breastfeeding, from
nipple injuries, even if these injuries are small. However, the major mode of transmission is
infant exposure to maternal blood, which occurs throughout labor and delivery.29
In case of HBsAg-seropositive mothers during pregnancy, the infant should receive the first
dose of the vaccine immediately after delivery and hepatitis B hyperimmune
immunoglobulin (0.5 ml IM) in the first 12 hours of life, given concomitantly, but in different
sites. This practice has an efficiency of 95% and eliminates the occasional risk of
transmission via breastmilk.7,30
When the mother has not been tested for HBsAg or if this information is not available, the
test should be requested immediately after delivery. While the test result is not available,
the newborn should receive the first dose of the vaccine. If the test yields a positive result,
immunoglobulin should be given as soon as possible, within the first seven days after
6. delivery. However, if HBsAG testing is not possible, giving all newborns immunoglobulin is
not recommended, since the vaccine alone is quite efficient in preventing the disease in 70
to 90% of cases.7
In cases of HBsAg-positive mothers, newborns should be thoroughly washed, in order to
remove all traces of blood or maternal fluids. Breastfeeding is not contraindicated even if
the mother has a bleeding nipple fissure.
The Brazilian Society of Pediatrics recommends that preterm newborns weighing less than
2,000 g born to an HBsAg-positive mother should receive four doses of the vaccine (at
birth, at 1, 2 and 6 months of life) besides immunoglobulin.30 If the first dose is not
administered in the neonatal period, then the infant should receive the three conventional
doses of the vaccine. In all situations, breastfeeding should be recommended. In mothers
with an infant aged less than one year and with hepatitis B diagnosed during the
breastfeeding period, breastfeeding should be maintained and the infant should be tested
for HBsAg, since he/she received the vaccine at birth. If the result of the test is negative,
the infant should be revaccinated and the prophylactic measures for the case should be
followed, that is: administer hepatitis B immunoglobulin (HBIG) intramuscularly at the dose
of 0.04 ml/kg, or standard gammaglobulin at the dose of 0.12 ml/kg IM.30,31
Although hepatitis C virus has been detected in the milk of HCV-positive mothers, its
transmission via breastmilk has not been confirmed. Therefore, breastfeeding is not
contraindicated in HCV-positive mothers. However, the prevention of nipple fissures is very
important, as it has not been yet determined whether the infant's contact with maternal
blood can facilitate the transmission of the disease. The American Academy of Pediatrics
Committee on Infectious Diseases recommends that mothers be informed of the theoretical
(but yet not confirmed) risk of transmitting the virus via breastmilk. The decision to
breastfeed should be analyzed on a case-by-case basis, assessing the role of breastfeeding
in the infant's life, since the definite role of breastfeeding in the transmission of hepatitis C
virus to the infant is not known.7
Cytomegalovirus infection
Cytomegalovirus (CMV) can be intermittently excreted in saliva, urine, genital secretions
and human milk for several years after the primary infection and in case of reactivation of
its latent forms. Infant or fetal infection may be acquired from mothers with primary
infection or during reactivation of the infection, occurring more frequently while the baby
passes through the birth channel or in the postnatal period. However, due to the
transplacental transfer of antibodies, this disease is not common among newborns.
In postnatal infection, the correlation with breastfeeding is evident, although the virus may
be acquired from the contact with other seropositive individuals who share the same
household. Studies show that 30% of breastfed infants born to seropositive mothers acquire
the infection in the first years of life, amounting to 70% of the cases when the virus is
isolated in breastmilk. Nevertheless, symptomatic infections or late sequelae have not been
observed in babies, possibly due to the transfer of specific maternal antibodies that protect
the infant against systemic disease. Early contamination of the breastfed infant seems to be
preferred, because if contamination occurs later on, the risk for symptomatic disease is
higher. These data confirm that breastfeeding should not be contraindicated.32,33
However, special attention should be given to preterm babies, especially those with a lower
gestational age. The decision to breastfeed preterm infants of CMV-positive mothers should
7. be considered in terms of risk of transmission of the disease versus breastfeeding benefits.
Preterm babies might not have protective antibodies and have symptomatic infections.
However, the virus can become inactive by pasteurization of human milk and the viral load
can be reduced by freezing the milk at -20 ºC.32,33
A recent study with preterm infants who acquired infection in the early postnatal period, via
breastmilk of CMV-positive mothers, has shown that neurological development and hearing
were not compromised in the infants. Nevertheless, given the small number of assessed
infants, follow-up studies with preterm infants with infections acquired in the postnatal
period are necessary.34
Varicella
A mother who presents with varicella up to five days before or two days after delivery may
transmit the disease to the infant in its severe form, when the risk for viremia is high. In
these cases, the mother should be isolated during the contagious phase of lesions up to the
crust phase, and VZIG (varicella-zoster immunoglobulin) at the dose of 125 intramuscular
units or a 2-ml single IM dose of standard immunoglobulin should be given to the infant as
soon as possible, although the value of the latter medication is arguable.10 The infant should
be observed up to the 21st day of life. It is unclear whether the virus can be found in
human milk and whether it could infect the infant. Thus, during this period, breastmilk can
be expressed and given to the infant. However, if the infant develops the disease during this
period, acyclovir therapy should be implemented.34
A mother with varicella whose onset of the disease occurred more than five days before
delivery or after the third day postpartum can produce and transfer antibodies to the infant,
transplacentally or via breastmilk. In this case, the infant may develop the mild form of the
disease, with no need for isolation or prophylaxis. The mother can breastfeed the infant,
provided that precautions such as handwashing, wearing of a mask and covering of lesions
are properly taken.35
Herpes simplex
Newborn infants can be contaminated with herpes simplex in utero via a hematogenous
transplacental route, during delivery (more frequent) or in the postnatal period. The risk of
neonatal contamination is higher for primary infection or non-primary infection if it occurs in
the last month of gestation. However, in the last week before delivery, transmission rates
are low for recurrent disease.
The risk of viral transmission via breastmilk is very low. In nursing mothers with herpes,
breastfeeding should not be interrupted, except when the herpetic vesicles are located on
the breasts. Active lesions in other body parts should be covered, and the nursing mother's
hygiene should not be overlooked so that breastfeeding can be maintained.
Extra precaution should be taken if vesicles are present on the fac e and fingers, as well as
with other sources of herpes simplex virus, such as gingivostomatitis in other family
members. If there is suspicion or confirmation that the infant is infected with herpes
simplex, he/she should be isolated from other infants but not from his/her mother. There is
a case report of a 15-month-old who was contaminated with the disease by a five-year-old
sibling who had gingivostomatitis. Both of the mother's breasts were contaminated by the
infant during breastfeeding.36
8. Rubella
Acute exanthematic disease caused by a virus that can be eliminated in respiratory
secretions between 10 days before and 15 days after the appearance of the exanthema.
Most cases are asymptomatic or subclinical, but may transmit the infection. No data exist
that contraindicate breastfeeding in a nursing mother with rubella. In case of vaccination
against rubella, breastfeeding may be maintained as well.10
Measles
Highly contagious exanthematic disease caused by a virus transmitted by respiratory
secretions few days before and during the course of the disease. The measles virus has not
been isolated in human milk yet, but, on the other hand, specific antibodies were found in
the milk of immunized women. If measles is confirmed in a nursing mother, the infant
should receive immunoglobulin, and the mother should be isolated up to 72 hours after the
appearance of the exanthema. However, expressed breastmilk can be given to the infant
because secretory IgA begins to be secreted after 48 hours of the appearance of the
exanthema in the mother.10
Mumps
Viral disease transmitted by direct contact with respiratory droplets or fomites. Infection is
rare in infants younger than one year due to the passive transfer of antibodies via placenta.
If a susceptible nursing mother is infected, she should continue breastfeeding because
exposure occurred seven days before the development of parotiditis and IgAs in human milk
may help mitigate the symptoms in the infant.10
Bacterial infections
Tuberculosis
Breastfeeding recommendations for mothers with tuberculosis depend on the time at which
diagnosis was made. According to the World Health Organization, it is not necessary to
separate the mother from the infant and, under no circumstance, should breastfeeding be
discontinued.9,37 Koch's bacillus is exceptionally excreted into breastmilk, and if the infant is
infected, the respiratory tract usually serves as a portal of entry. Thus, a mother with
extrapulmonary tuberculosis does not require any special care to breastfeed.
According to the American Academy of Pediatrics, an infant of a mother with pulmonary
tuberculosis in the contagious phase, untreated or with less than three weeks on
antitubercular drugs at delivery, should be separated from the mother but fed with
expressed human milk, as transmission often occurs via the airways. The mother's sputum
should be submitted to the acid-fast smear test, and she should only be allowed to be in
contact with her infant after the test yields negative results.10 The infant should receive
chemoprophylaxis with isoniazid, at the dose of 10 mg/kg/day for three months and then be
submitted to the tuberculin skin test. If the test result is positive, the disease should be
traced by clinical and radiological examination. If no active infection is detec ted, surveillance
and chemoprophylaxis should be maintained up to the sixth month, when intradermal BCG
is applied. If the tuberculin test is negative at three months of life, chemoprophylaxis may
9. be interrupted and intradermal BCG applied, and clinical surveillance should be maintained.
Situations in which there may be risks of not following up the infant on isoniazid therapy,
concomitant intradermal BCG vaccination is recommended.7,17
According to the WHO, breastfeeding should be maintained, but the close contact between
mother and infant should be reduced, and the following precautions should be taken: a
mask or similar device should be worn while breastfeeding, hands should be carefully
washed, and those infected with the disease, especially household members, should be
identified. The infant should be treated with hydrazide (INH) at the dose of 10 mg/kg, once
a day for six months. After chemoprophylaxis is over, the infant should receive intradermal
BCG. Breastfeeding should not be discontinued in any of these phases.9,37
There are no restrictions on breastfeeding for mothers who are in the non-contagious phase
of tuberculosis, whose treatment began more than three weeks ago, and in this case, the
baby should be vaccinated with intradermal BCG at birth. In cases in which the diagnosis of
maternal tuberculosis was established after the onset of breastfeeding, the infant should be
regarded as potentially infected and should receive chemoprophylaxis.
Breastfeeding should not be discontinued because the administration of antitubercular drugs
in the mother is not a contraindication for breastfeeding.
Table 2 shows the WHO recommendations for tuberculosis cases and the management of
breastfeeding, considering the possibility of not using the tuberculin skin test.
It is paramount to underscore that all infants should be monitored as to their weight gain
and health status. Special attention should be given to infants whose mothers have risk
factors for multidrug-resistant tuberculosis. In this case, the separation of mother and infant
may be necessary, as the mother, under this circumstance, shows increased infectiousness
and takes longer to respond to therapy. Breastfeeding may be maint ained provided that
expressed milk is used, thus reducing the respiratory contact between mother and infant.17
Hansen's disease
Hansen's disease is a chronic infectious disease with high infectiousness and low
pathogenicity. Its clinical course varies, basically depending on the individual's cellular
immune response. The disease is transmitted by person-to-person contact, especially long
contact, by means of nasal and cutaneous secretions. The bacillus can be isolated in
breastmilk in cases of untreated Hansen's disease, as well as in patients treated during less
than three months with sulfone (dapsone or clofazimine) or less than three weeks with
rifampicin. Skin lesions on the breast can be a source of infection for the infant.
There is no contraindication for breastfeeding if the mother is receiving proper
treatment.10 The infant should be treated as early as possible, simultaneously with the
mother. The drugs used are the same ones used in the mother and may cross into human
milk at low concentrations, but there is no report of severe side effects. The infant should be
followed up and submitted to regular clinical exams for early detection of possible signs of
the disease. Moreover, the following is recommended before and during breastfeeding:
careful handwashing, wearing of a mask while handling the infant and covering of breast
lesions.
10. The contagious mother (untreated or treated for less than three months with sulfone or
three weeks with rifampicin) should avoid contact with her baby, except to breastfeed; she
should wear a mask or similar device, wash her hands carefully before handling the infant
and disinfect nasal secretions and baby wipes.10
Syphilis
Syphilis is a disease that is basically sexually transmitted; however, other modes of
transmission exist, such as contact with people with active lesions in mucous membranes,
genital region and breasts. There is no evidence of transmission via human milk, without
breast lesions. A nursing mother with primary or secondary syphilis with breast involvement
can infect the infant through the contact of lesions with the mucous membranes. If there
are lesions on the breasts, especially on the areola, breastfeeding or use of expressed milk
is contraindicated until full treatment and regression of lesions. Twenty-four hours after
penicillin therapy, the infectious agent (spirochete) is seldom detected in the lesions. Thus,
there is no contraindication for breastfeeding after proper treatment.10,38
Brucellosis
Detection of Brucella melitensis in human milk has been reported, and so have cases of
brucellosis in exclusively breastfed infants. This confirms the possibility of brucellosis being
transmitted via breastmilk.
In the acute phase of severe disease in the mother, breastfeeding should be avoided, but
the use of expressed and pasteurized human milk is allowed. Breastfeeding may be restored
as soon as the disease is treated with antimicrobials and the nursing mother shows clinical
improvement.39,40
Parasitic infections
Malaria
Since malaria is not transmitted among humans, breastfeeding may be maintained if the
mother's clinical conditions allow so. There is no evidence indicating that malaria can be
transmitted via breastfeeding.38 For mothers who need to be treated, chloroquine, quinine
and tetracycline are recommended. Sulfonamides should be avoided in the first month of
breastfeeding.18 Therefore, a nursing mother with malaria may breastfeed during the
treatment with specific drugs.
Chagas' disease
Studies show that Trypanosoma cruzi can be isolated in human milk in acute and chronic
forms of Chagas' disease. There was a case report of acute infection in a two-month-old
infant breastfed by an infected mother.41Although late sequelae may develop, acute disease
in the infant tends to be benign. This, combined with the remote possibility of transmission
of the disease, is reason enough for maintaining breastfeeding in women with the chronic
form of the disease, except if the nipples bleed and have fissures.42 In cases of acute
disease, breastfeeding should be contraindicated.41,42
11. Lab experiments using samples of human milk contaminated with the protozoan and tested
under different conditions demonstrate that milk pasteurization prevents the transmission of
the disease. Rats orally and intraperitoneally inoculated with human milk containing the
parasite were infected; however, the control group with animals inoculated with pasteurized
milk was not infected.43,44 Animal experiments using human milk heated to 63 oC in a
household microwave oven (7 minutes, 45% power) proved efficient in reducing the
transmission of Trypanossoma cruzi.45
Fungal infections
Paracoccidioidomycosis
Systemic granulomatous disease caused by a fungus, whose transmission occurs via
respiratory secretions. There is no contraindication for breastfeeding. However, it should not
be forgotten that cotrimoxazole, commonly used for the treatment of
paracoccidioidomycosis, is excreted into breastmilk and may produce severe side effects in
the infant.38,40
Cryptococcosis
Fungal disease with worldwide distribution. Immunocompromised patients, including those
with HIV/AIDS, are at greater risk for cryptococcosis. The transmission of particles in the
environment occurs via aerosol droplets, and no documentation exists of person-to-person
transmission. Therefore, breastfeeding is not contraindicated.38,40
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Correspondence to
Joel A. Lamounier
Av. Alfredo Balena,190
CEP 30130-100 – Belo Horizonte, MG
15. Brazil
Phone: +55 (31) 3248.9632
E-mail:jalamo@medicina.ufmg.br
All the contents of this journal, except where otherwise noted, is licensed under a Creative
Commons Attribution License
Av. Carlos Gomes, 328 cj. 304
90480-000 Porto Alegre RS Brazil
Tel.: +55 51 3328-9520
jpe