Most sexually active people will have some strain at some point in their lives. Here's why HPV testing is important and what…. Health Conditions Discover Plan Connect. HPV affects a large number of adults. Passing HPV to your baby through breastfeeding is highly unlikely. Breastfeeding provides benefits for both mom and baby. Breastfeeding and HPV. What the research says. What are the benefits of breastfeeding?
They may also have a reduced risk of developing: type 2 diabetes rheumatoid arthritis high blood pressure high cholesterol. The bottom line. Parenthood Baby. Read this next. Research on Breastfeeding and HPV While there have been some findings that there may be a possible link between breastfeeding and HPV transmission, there is no conclusive evidence to back up these claims. Breastfeeding can help: Create a special bonding time and experience with your baby.
Shorten recovery time from childbirth. Reduce your risk of certain diseases. Lower the rates of chronic disease, obesity, and diabetes for both you and the baby. Lower your risk of developing certain types of cancers, such as uterine, breast, and ovarian cancers.
Improve the development of your growing baby. Lower your risk of high cholesterol and heart disease. Provide your baby with the ideal nutrition. Provide your baby with inexpensive, healthy nutrition. Reduce the incidence of pneumonia, respiratory viruses, and colds. Division of Nutrition, Physical Activity, and Obesity. Related Topics. Links with this icon indicate that you are leaving the CDC website. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website's privacy policy when you follow the link. In addition to standard precautions applied to all patients, droplet precautions include the use of a private room preferred and a mask if within 3 feet 0. Droplet precautions are recommended for adenovirus, diphtheria, respiratory infections, Haemophilus influenzae, Neisseria meningitidis or invasive infection, influenza, mumps, mycoplasma, parvovirus, pertussis, plague pneumonic , rubella, and streptococcal pharyngitis, pneumonia, or scarlet fever.
The institution of droplet precautions with a breastfeeding mother who has these infections should be specified for each particular infection. This may require some period of separation for the infant and mother for duration of the illness, for short-term or complete treatment of the mother, for the infectious period with use of expressed breast milk for nutrition in the interim. Contact precautions are meant to prevent transmission of infection via direct contact contact between the body surfaces of one individual with another and indirect contact contact of a susceptible host with an object contaminated with microorganisms from another individual.
Contact precautions include cohorting or a private room, gloves and gowns at all times, and handwashing after removal of gown and gloves. Contact precautions are recommended for a long list of infections, such as diarrhea in diapered or incontinent patients with Clostridium difficile infection, Escherichia coli OH7, Shigella , rotavirus, hepatitis A, respiratory illness with parainfluenza virus or respiratory syncytial virus RSV , multidrug-resistant MDR bacteria e.
Each of these transmission-based precautions can be used together for organisms or illnesses that can be transmitted by more than one route. They should always be used in conjunction with standard precautions, which are recommended for all patients.
The Red Book: Report of the Committee on Infectious Diseases by the American Academy of Pediatrics AAP 96 remains an excellent resource for infection control guidelines and recommendations to prevent transmission in specific situations and infections. See Chapter 21 for specific bacterial count standards for raw donor milk and for pasteurization of donor milk. Breastfeeding and the expression of or pumping of breast milk referred to as expressed breast milk for later use are not sterile activities.
The studies have been primarily concerned with premature or low-birth-weight LBW infants who remain hospitalized and are commonly fed via enteral tubes. A study from Canada tested samples of milk for use in 98 preterm infants. A study from Chicago examined gram-negative bacilli in the milk used in premature infants. This study recommended the routine bacteriologic testing of expressed breast milk. Another study from Arkansas focused on contamination of feeding tubes during administration of expressed breast milk or formula.
The three infants who were fed expressed breast milk with contamination at greater than organisms remained well, but the seven formula-fed infants with high levels of bacterial contamination in the feeding tubes developed necrotizing enterocolitis. The gram-negative bacteria with high level contamination in the feeding tubes were either Enterobacter or Klebsiella in all cases. Even less data are available concerning specific bacterial colony counts for gram-positive organisms and the risk to the infant.
Generally less than gram-positive organisms per mL of milk is considered acceptable, with only case reports and no controlled trials to support this cutoff. More important than hurrying to culture breast milk is the careful instruction of mothers on the proper technique for collecting expressed breast milk, storing it, and cleaning the collection unit.
The reinforcement of proper technique from time to time, especially when a question of contamination arises, is equally important. Many small reports comment on the contamination of breast milk with different collection methods. Relative comparisons suggest decreasing contamination of expressed breast milk when collected by the following methods; drip milk, hand pumped milk, manual expression, modern electric pumped milk.
One group from Malaysia published results showing no difference in contamination between milk collected by electric pump versus manual expression when collected in the hospital. Expressed breast milk collected at home by breast pump had higher rates of contamination with staphylococci and gram-negative bacteria. No evidence shows that cleansing the breast with anything other than tap water decreases the bacterial counts in cultured expressed breast milk. If an infant is being fed expressed breast milk, collecting and culturing the milk at different points during collection utilizing the same technique the mother uses [manual expression, hand pump, or electric pump] and administration is appropriate.
This might include a sample from immediately after collection, another of stored expressed breast milk, and a sample of milk from the most recent infant feeding at the time the decision to culture is made. Please see Box for the basic steps in culturing expressed breast milk. Place a 3 to 5 mL sample of expressed breast milk in a sterile container with a nonleakable top.
Send separate samples for fungal culture, acid-fast bacilli, and viral culture as indicated, based on the clinical situation. Perform routine sensitivity testing on all potential pathogens. This will require some discussion with the clinician and perhaps a pediatric infectious disease specialist.
Interpretation of such culture results can be difficult and should involve a pediatric infectious disease expert, a microbiologist, and hospital epidemiologist. Additional organism identification is often required, utilizing antibiogram patterns or molecular fingerprinting by various techniques to correlate a bacterial isolate from breast milk with an isolate causing disease in infant or mother.
Misadministration of breast milk, also known as misappropriation, breast milk exposure, and accidental ingestion of breast milk, and other terms, is a medical-legal issue when it occurs in a hospital. This scenario occurs when one infant receives breast milk from another mother by mistake.
This occurrence can be very distressing to the families recipient patient, recipient parent, and donor mother and medical staff involved. The actual risk for transmission of an infectious agent to an infant via a single ingestion of expressed breast milk the most common occurrence from another mother is exceedingly low.
In this scenario, the CDC recommends treating this as an accidental exposure to a body fluid, which could be infectious. HCV is not a contraindication to breastfeeding and West Nile virus infection in lactating women is rare. Neither infection has a documented effective form of prevention or acute treatment. Testing either mother donor or of recipient infant for these agents is not warranted. Prenatal testing for HIV is more commonplace throughout the world. The incidence of HIV among women of childbearing age is low, although it varies significantly by geographic location, and the hospital or locale-specific incidence would be important to know to estimate risk.
Most women and medical staff are aware that HIV can be transmitted by breastfeeding; therefore breast milk from HIV-positive women is rarely if ever stored in hospitals.
Immunologic components in breast milk, along with time and cold of storage, inactivate the HIV in expressed breast milk. For these reasons, the risk for transmission of HIV via expressed breast milk consumed by another child is thought to be extremely low.
Limiting the duration of breastfeeding is effective in decreasing transmission. Here again the risk for CMV transmission from a single accidental exposure to CMV-positive expressed breast milk is extremely low. With a discussion of theoretical risk should be a discussion of possible preventive interventions, such as vaccination or antimicrobial postexposure prophylaxis. Additional important components of the hospital-based protocols for managing accidental expressed breast milk exposure include ongoing psychosocial support for the families and staff, documentation of medical discussions with the families, investigative steps, consents and interventions, and the demonstration of ongoing infection control efforts to prevent additional events of misadministration of breast milk.
Microorganisms produce a whole spectrum of clinical illnesses affecting mothers and infants. Many situations carry the risk for transmission of the involved organism from a mother to the infant, or vice versa; in general, however, infants are at greater risk because of such factors as inoculum size and immature immune response.
As always, an infection must be accurately diagnosed in a timely manner. Empiric therapy and initial infection control precautions should begin promptly based on the clinical symptoms and the most likely etiologic agents. When dealing with a maternal infection, clarifying the possible modes of transmission and estimating the relative risk for transmission to the infant are essential first steps to decision-making about isolating a mother from her infant and the appropriateness of continuing breastfeeding or providing expressed breast milk.
Breastfeeding infrequently is contraindicated in specific maternal infections. A clinical judgment must be made based on the site of infection, probable organisms involved, possible or actual mechanisms of transmission of these organisms to the infant, estimated virulence of the organism, and likely susceptibility of the infant. Additionally, by the time the illness is clearly recognized or diagnosed in a mother, the infant has already been exposed.
Given the dynamic nature of the immunologic benefits of breast milk, continuation of breastfeeding at the time of diagnosis or illness in a mother can provide the infant protection rather than continued exposure in most illnesses. Stopping breastfeeding is rarely necessary.
Many situations associated with maternal fever do not require separation of mother and infant, such as engorgement of the breasts, atelectasis, localized nonsuppurative phlebitis, or urinary tract infections.
Appendix F lists a number of clinical syndromes, conditions, and organisms that require infection control precautions in hospitals.
This appendix also includes short lists of possible etiologic agents for these conditions and appropriate precautions and recommendations concerning breastfeeding for different scenarios or organisms. This chapter considers specific infectious agents that are common, clinically significant, or of particular interest. Bacillus anthracis, a gram-positive, spore-forming rod, causes zoonotic disease worldwide.
Human infection typically occurs due to contact with animals or their products. Three forms of human disease occur: cutaneous anthrax the most common , inhalation anthrax, and gastrointestinal GI disease rare.
Person-to-person transmission can occur as a result of discharge from cutaneous lesions, but no evidence of human-to-human transmission of inhalational anthrax is available. No evidence of transmission of anthrax via breast milk exists. Standard contact isolation is appropriate for hospitalized patients or patients with draining skin lesions. The issue of anthrax as a biologic weapon has exaggerated its importance as a cause of human disease.
The primary concerns regarding anthrax and breastfeeding are antimicrobial therapy or prophylaxis in breastfeeding mothers and the possibility that infant and mother were exposed by intentional aerosolization of anthrax spores. The CDC published recommendations for treatment and prophylaxis in infants, children, and breastfeeding mothers.
Depending on the clinical situation and sensitivity testing of the identified anthrax strain, other agents can be substituted to complete the day course. The CDC has approved the use of ciprofloxacin and doxycycline for breastfeeding women for short courses of therapy less than several weeks.
Open cutaneous lesions should be carefully covered and, depending on the situation, simultaneous prophylaxis for the infant may be appropriate. Considerable justifiable concern has been expressed because of the reports of sudden infant death from botulism. Infant botulism is distinguished from food-borne botulism from improperly preserved food containing the toxin and from wound botulism from spores entering the wound.
Infant botulism occurs when the spores of Clostridium botulinum germinate and multiply in the gut and produce the botulinal toxin in the GI tract. The clinical picture is a descending, symmetric flaccid paralysis. Not every individual who has C. The age of infants seems to relate to their susceptibility to illness.
The illness is mainly in children younger than 12 months of age; the youngest patient described in the literature was 6 days old. The onset of illness seems to occur earlier in formula-fed infants compared with breastfed infants. When a previously healthy infant younger than 6 months of age develops constipation, then weakness and difficulty sucking, swallowing, crying, or breathing, botulism is a likely diagnosis.
The organisms should be looked for in the stools, and electromyography may or may not be helpful. In a group reviewed by Arnon et al, 19 33 of 50 patients hospitalized in California were still being nursed at onset of the illness.
A beneficial effect of human milk was observed in the difference in the mean age at onset, with breastfed infants being twice as old as formula-fed infants with the disease. Breastfed infants receiving iron supplements developed the disease earlier than those who were breastfed but unsupplemented. Of the cases of sudden infant death from botulism, no infants were breastfed within 10 weeks of death.
All were receiving iron-fortified formulas. In most cases, no specific food source of C. Honey may contain botulism spores, which can germinate in the infant gut. However, botulin toxin has not been identified in honey. It has been recommended that honey not be given to infants younger than 12 months of age. Arnon 18 reviewed the first 10 years of infant botulism monitoring worldwide. The disease has been reported from 41 of the 50 states in the United States and from eight countries on four continents.
The relationship to breastfeeding and human milk is unclear. In general the acid stools pH 5. Few facultative anaerobic bacteria, or clostridia, existing as spores, are present in breastfed infants. In contrast, formula-fed infants have stool pHs ranging from 5. Breast milk also contains additional protective immunologic components, which purportedly have activity against botulinum toxin.
The relationship between the introduction of solid foods or weaning in both formula-fed and breastfed infants and the onset of botulism remains unclear. For a breastfed infant, the introduction of solid food may cause a major change in the gut with a rapid rise in the growth of enterobacteria and enterococci followed by progressive colonization by Bacteroides species, clostridia, and anaerobic streptococci. Feeding solids to formula-fed infants minimally changes the gut flora as these organisms already predominate.
Although more hospitalized infants have been breastfed, sudden-death victims are younger and have been formula fed, which supports the concept of immunologic protection in the gut of a breastfed infant. Much work remains to understand this disease. Clinically, constipation, weakness, and hypotonicity in a previously healthy child constitute botulism until ruled out, especially with recent dietary changes. At this time, no reason exists to suspect breastfeeding as a risk for infant botulism, and some evidence suggests a possible protective effect from breastfeeding.
Breastfeeding should continue if botulism is suspected in mother or infant. Brucella melitensis has been isolated in the milk of animals. Foods and animals represent the primary sources of infection in humans. Brucellosis demonstrates a broad spectrum of illness in humans, from subclinical to subacute to chronic illness with nonspecific signs of weakness, fever, malaise, body aches, fatigue, sweats, arthralgia, and lymphadenitis.
In areas where the disease is enzootic, childhood illness has been described more frequently. The clinical manifestations in children are similar to those in adults. The transmission of B. There have been eight cases of brucellosis in infants that were possibly associated with breastfeeding, but Brucella was not isolated from the breast milk in any of those cases. Brucellosis mastitis or abscess should be considered in women presenting with appropriate symptoms and occupational exposure to animals, contact with domestic animals in their environment, or exposure to animal milk or milk products especially unpasteurized products.
The breast inflammation tends to be granulomatous in nature without caseation and is often associated with axillary adenopathy; occasionally systemic illness in the woman is evident. Treatment of brucellosis mastitis or abscess should be treated with surgery or fine needle aspiration as indicated and 4 to 6 weeks of combination antibiotic therapy with two or three medications. Temporary interruption of breastfeeding with breast pumping and discarding the milk to continue stimulation of milk production is appropriate.
Breastfeeding should then continue after an initial period of 48 to 96 hours of therapy in the mother. Acceptable medications for treating the mother while continuing breastfeeding include gentamicin, streptomycin, tetracycline, doxycycline, trimethoprim-sulfamethoxazole, and rifampin see Appendix D. Chlamydial infection is the most frequent sexually transmitted disease STD in the United States and is a frequent cause of conjunctivitis and pneumonitis in an infant from perinatal infection.
The major determinant of whether chlamydial infection occurs in a newborn is the prevalence rate of chlamydial infection of the cervix. No information is available on the role of milk antibodies in protection against infection in infants. Use of erythromycin or tetracycline to treat mothers and oral erythromycin and ophthalmic preparations of tetracyclines, erythromycin, or sulfonamides to treat suspected infection in infants are appropriate during continued breastfeeding.
Separating infants from mothers with chlamydial infections or stopping breastfeeding is not indicated. Simultaneous treatment of mothers and infants may be appropriate in some situations. Corynebacterium diphtheriae causes several forms of clinical disease, including membranous nasopharyngitis, obstructive laryngotracheitis, and cutaneous infection.
Complications can include airway obstruction from membrane formation and toxin-mediated central nervous system CNS disease or myocarditis. The overall incidence of diphtheria has declined even though immunization does not prevent infection but does prevent severe disease from toxin production. Fewer than five cases are reported annually in the United States.
Transmission occurs via droplets or direct contact with contaminated secretions from the nose, throat, eye, or skin. Infection occurs in individuals whether they have been immunized or not, but infection in those not immunized is more severe and prolonged. As long as the skin of the breast is not involved, no risk for transmission exists via breast milk. No toxin-mediated disease from toxin transmitted through breast milk has been reported in an infant.
Breastfeeding, along with chemoprophylaxis and immunization of affected infants, is appropriate in the absence of cutaneous breast involvement see Appendix F. Maternal infection with Neisseria gonorrhoeae can produce a large spectrum of illness ranging from uncomplicated vulvovaginitis, proctitis, pharyngitis, conjunctivitis, or more severe and invasive disease, including pelvic inflammatory disease, meningitis, endocarditis, or disseminated gonococcal infection.
The risk for transmission from mother to infant occurs mainly during delivery in the passage through the infected birth canal and occasionally from postpartum contact with the mother or her partner.
Risk for transmission from breast milk is negligible, and N. Infection in neonates is most often ophthalmia neonatorum and less often a scalp abscess or disseminated infection. Mothers with presumed or documented gonorrhea should be reevaluated for other STDs, especially Chlamydia trachomatis and syphilis, because some therapies for gonorrhea are not adequate for either of these infections. With the definitive identification of gonorrhea in a mother, empiric therapy should begin immediately, and the mother should be separated from the infant until completion of 24 hours of adequate therapy.
Treatment of the mother with ceftriaxone, cefixime, penicillin, or erythromycin is without significant risk to the infant. Single-dose treatment with spectinomycin, ciprofloxacin, ofloxacin, or azithromycin has not been adequately studied but presumably would be safe for the infant given the hour separation and a delay in breastfeeding without giving the infant the expressed breast milk pump and discard.
Doxycycline use in a nursing mother is not routinely recommended. Careful preventive therapy for ophthalmia neonatorum should be provided, and close observation of the infant should continue for 2 to 7 days, the usual incubation period. Empiric or definitive therapy against N. The mother should not handle other infants until after 24 hours of adequate therapy, and the infant should be separated from the rest of the nursery population, with or without breastfeeding.
Haemophilus influenzae type B can cause severe invasive disease such as meningitis, sinusitis, pneumonia, epiglottitis, septic arthritis, pericarditis, and bacteremia. Shock can also occur. Because the increased utilization of the H. Most invasive disease occurs in children 3 months to 3 years of age. Older children and adults rarely experience severe disease but do serve as sources of infection for young children. Children younger than 3 months of age seem to be protected because of passively acquired antibodies from the mothers, and some additional benefits may be received from breast milk.
Transmission occurs through contact with respiratory secretions, and droplet precautions are protective. No evidence suggests transmission through breast milk or breastfeeding.
Evidence supports that breast milk limits the colonization of H. In the rare case of maternal infection, an inadequately immunized infant in a household is an indication to provide rifampin prophylaxis and close observation for all household contacts, including the breastfeeding infant.
Although uncommon in the United States, leprosy occurs throughout the world. This chronic disease presents with a spectrum of symptoms depending on the tissues involved typically the skin, peripheral nerves, and mucous membranes of the upper respiratory tract and the cellular immune response to the causative organism, Mycobacterium leprae.
Transmission occurs through long-term contact with individuals with untreated or multibacillary large numbers of organisms in the tissues disease. Leprosy is not a contraindication to breastfeeding, according to Jeliffe and Jeliffe. No mother-infant contact is permitted except to breastfeed. Dapsone, rifampin, and clofazimine are typically and safely used for infant and mother regardless of the method of feeding see Appendix D.
Listeriosis is a relatively uncommon infection that can have a broad range of manifestations. In immunocompetent individuals, including pregnant women, the infection can vary from being asymptomatic to presenting as an influenza-like illness, occasionally with GI symptoms or back pain.
Severe disease occurs more frequently in immunodeficient individuals or infants infected in the perinatal period pneumonia, sepsis, meningitis, granulomatosis infantisepticum.
Although listeriosis during pregnancy may manifest as mild disease in a mother and is often difficult to recognize and diagnose, it is typically associated with stillbirth, abortion, and premature delivery. It is thought that transmission occurs through the transplacental hematogenous route, infecting the amniotic fluid, although ascending infection from the genital tract may occur.
Neonatal infection occurs as either early- or late-onset infection from transplacental spread late in pregnancy, ascending infection during labor and delivery, infection during passage through the birth canal, or, rarely, during postnatal exposure. No evidence in the literature suggests that Listeria is transmitted through breast milk. Treatment of the mother with ampicillin, penicillin, or trimethoprim-sulfamethoxazole is not a contraindication to breastfeeding as long as the mother is well enough.
Expressed colostrum or breast milk also can be given if the infant is able to feed orally. The management of lactation and feeding in neonatal listeriosis is conducted supportively, as it is in any situation in which an infant is extremely ill, beginning feeding with expressed breast milk or directly breastfeeding as soon as reasonable.
0コメント