Introduction to Infectious Diseases

When babies are born, they acquire intestinal flora from their parent’s microbiota. The composition of this microbiota is affected by the mode of delivery as well as by genetics, the environment, and the mode of feeding. The act of breastfeeding influences the infant’s intestinal flora because of the transmission of the skin organisms of the parent. Breastmilk also contains components that allow for the growth of some beneficial microbes while offering protection from harmful ones. Breastmilk also directly influences the development of the infant’s immune system.

While human milk can be a source of normal microflora as well as harmful pathogens, there are very few infectious diseases for which breastfeeding needs to be stopped or interrupted.1 In developed countries, HIV-1, HIV-2, HTLV-I, and HTLV-II are the only infectious diseases that are considered absolute contraindications to breastfeeding.2 3

According to the CDC, someone with these conditions should not breastfeed or feed their expressed milk:4

  • If diagnosed with the human immunodeficiency virus (HIV)5
  • If infected with human T-cell lymphotropic virus type I or type II6
  • If using an illicit street drug, such as PCP (phencyclidine) or cocaine7
  • If suspected or confirmed to have Ebola virus disease8

Temporary contraindications to breastfeeding and/or feeding expressed milk are certain medications, diagnostic imaging with radiopharmaceuticals, anyone with active lesions from HSV, Hepatitis, Syphilis, Chickenpox, and Monkey Pox), and Brucellosis.9

When someone is diagnosed with an infectious disease, they have already exposed their infant to the pathogen. The interruption or the stopping of breastfeeding does not prevent exposure, and it may instead decrease the infant’s protection that comes through the protective factors found in breastmilk. Therefore, common bacterial, fungal, and viral infections in which someone’s health is not compromised are not contraindications to breastfeeding.

However, while certain infectious diseases are not transmitted through breastmilk, pathogens can be transmitted via handling, by the donor or by the recipient. Someone could have minor lesions and not know that they are a sign of an infectious disease. Someone may be in an open relationship and not know the status of their partner. Regular testing for certain infectious diseases is recommended by milk banks, and it is important to fully disclose any past or potential present exposure to infectious diseases. Please also see Home pasteurization when the donor status is not (fully) known.

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  1. Noni E MacDonald. 2016. Maternal Infectious Disease and Breastfeeding for a quick overview of infectious diseases and corresponding breastfeeding management. ↩︎
  2. Robert M. Lawrence. 2020. Transmission of Infectious Diseases Through Breast Milk and Breastfeeding ↩︎
  3. See Human Immunodeficiency Virus (HIV) for more information. ↩︎
  4. Human Milk Banking Association of North America. Archived. HMBANA|Donate Milk excludes donors who have had a positive blood test result for HIV, HTLV, Hepatitis B or C, or Syphilis, whose sexual partner is at risk for HIV, who use illegal drugs, who smoke or uses tobacco products, who have received an organ or tissue transplant or a blood transfusion in the last 12 month, who regularly have more than two ounces or more of alcohol per day, who have been in the United Kingdom for more than 3 months or in Europe for more than 5 years since 1980 and who were born in or has traveled to Cameroon, Central Africa Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria. ↩︎
  5. CDC – Human Immunodeficiency Virus (HIV) Note: recommendations about breastfeeding and HIV may be different in other countries. ↩︎
  6. AAP 2012. Breastfeeding and the Use of Human Milk ↩︎
  7. Exception: Narcotic-dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection and other illicit drugs can breastfeed. ↩︎
  8. CDC – Ebola Virus Disease ↩︎
  9. CDC – Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants ↩︎