careful hand hygiene must be used West Nile Virus (WNV) WNV is transmitted primarily by the bite of mosquitoes that acquired the virus from infected birds WNV transmission in utero has been documented, but infants infected with WNV are asymptomatic or rarely may develop mild disease To date only one case of WNV transmission through breast feeding has been documented and the infant remained healthy Current recommendations encourage mothers to breast feed even in areas of ongoing WNV transmission (CDC recommendation, 2002) Zika Virus Zika is transmitted primary by the bite of mosquitoes and can have catastrophic effects with in utero transmission Zika has been detected in breastmilk from infected mothers, but there are no documented cases of post-natal transmission via breastmilk Current recommendations are that benefits likely outweigh the risks and to continue to breastfeed (WHO, 2016) Rubella although wild and vaccine strains of rubella virus have been isolated from breast milk, this has not been associated with significant disease in infants women with rubella or women just immunized with live-attenuated rubella vaccine may breast feed Varicella-Zoster Virus (VZV) VSV is a herpesvirus A mother with chickenpox or zoster infection does not need to be isolated from her own baby Infants of mothers who develop chickenpox within 7 days before delivery or within 28 days after delivery should receive Varicella-Zoster Immune Globulin (VZIG) Varicella vaccine may be considered for a susceptible breast feeding mother if the risk of exposure to VZV is high Whether varicella vaccine virus is secreted in human milk or whether the virus would infect a breast feeding infant is unknown Breast feeding of babies infected with or exposed to VSV is encouraged Bacteria mastitis and breast abscesses may lead to the presence of bacterial pathogens in human milk mastitis resolves with continued breast feeding and expression during antibiotic therapy and does not pose a significant risk for the term infant more frequent breastfeeding or pumping is recommended to reduce symptoms breast abscesses are rare (3-5% of mastitis cases) but have the potential to rupture into the ductal system releasing a large number of bacteria, such as staphylococcus aureus into the milk feeding from a breast with an abscess is not recommended until the mother is appropriately treated with an antibiotic and the abscess surgically drained with an abscess, feeding from the opposite (unaffected) breast should continue and milk from the affected breast should be pumped and dumped Breast milk banks and donor milk When direct breastfeeding is not possible (e.g
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