Table 2.
Breastfeeding issues for selected viral maternal infectionsa
| Virusa | Predominant modes of transmissionb | Usual timing of infectionc | Evidence for transmission in breast milk | Clinical significanced |
|---|---|---|---|---|
| Cytomegaloviruse | Contact—body fluids | Congenital, perinatal, postnatal | Culture; CMV-DNA PCR | Full-term infants: BF/BM. |
| Premature, LBW, VLBWf | ||||
| Enteroviruses (coxsackie virus, enterovirus, poliovirus) | Contact—fecal-Oral | Perinatal, postnatal | None | BF/BM |
| Hepatitis A | Food; water, contact—body fluids | Postnatal | One case report | BF/BM |
| Immunoglobulin | ||||
| Hepatitis Be | Blood; body fluids; sexual | Perinatal | Hepatitis B Surface Antigen | Routine prevention with HBV vaccine and hepatitis B immunoglobulin, then BF/BMg |
| Hepatitis C | Blood; body fluids | Prenatal, perinatal | ? Possible HCV-RNA | BF/BM (increased transmission if coinfected with HIV) |
| HSV1, HSV2 | Contact | Perinatal (congenital, postnatal) | Transfer only with breast lesions | BF/BM (except with breast lesions) |
| HIV1 | Blood; body fluids; sexual | Perinatal, prenatal, postnatal | HIV-RNA PCR; culture | Avoid BF/BMe |
| HIV2 | Blood; body fluids; sexual | Prenatal, perinatal | Limited information | Avoid BF/BM (early weaning may be appropriate) |
| HTLV-I | Blood; body fluids | Postnatal, prenatal, perinatal | HTLV-I–RNA PCR | Avoid or limit BF/BM to less than 6 mo |
| Parvovirus | Contact; body fluids | Prenatal | Unknown | BF/BM |
| Respiratory syncytial virus | Droplets; contact | Postnatal (susceptible neonates and infants) | None; possible benefit of BM | BF/BM |
| Palivizumabh | ||||
| Varicella-zoster virus |
Contact; droplets | Postnatal (rare congenital or perinatal) | Only with lesions on breast; VZV-DNA | Avoid BF for PI |
| BM if no breast lesions Varicella-zoster immunoglobulin for infant |
This is a selected, limited list intended to consider some important viruses that cause infection in the neonate or infant and possible issues related to breastfeeding and breast milk.
Abbreviations: BF, breastfeeding; BM, expressed breast milk; HBV, hepatitis B virus; HCV, hepatitis C virus; LBW, low birth weight; PCR, polymerase chain reaction; PI, period of infection; VLBW, very low birth weight; VZV, varicella-zoster virus.
Viruses that cause a various of clinical illnesses in the infant and the mother; the specific illnesses are too numerous to list.
For breastfeeding and non-breastfeeding situations; does not include all possible or reported modes of transmission (airborne, body fluids, contact, droplet, food-borne).
Does not include all possible times of transmission.
Notes the appropriateness of breastfeeding or use of breast milk when the mother has a specific viral infection.
Refer to the text for more explanation.
CMV-positive breast milk should be avoided in these infants if they lack CMV-IgG. They are at greater risk to develop CMV-related disease.
Breast-fed infants who have received hepatitis B vaccine with or without hepatitis B immunoglobulin as indicated by maternal hepatitis B status are at no greater risk for HBV infection than formula-fed infants (who also should have received hepatitis B vaccine with or without hepatitis B immunoglobulin as indicated by maternal hepatitis B status).
Palivizamab is indicated for certain children at high risk for respiratory syncythial virus infection, regardless of feeding mode [16].