Anthrax and Breastfeeding

By Catherine Genna and Barbara Wilson-Clay
Anthrax is an animal disease that can be transmitted to humans, but cannot be passed from person to person. Anthrax is not passed from mother to child during breastfeeding or through breast milk. There are safe medicines to treat breastfeeding mothers who have been exposed to anthrax.

Exposure to a single spore will not usually cause the disease; usually thousands of spores must be breathed in, eaten, or enter a cut before a person becomes ill. Anthrax takes different forms, depending on how the bacteria entered the body. Inhalation (respiratory) anthrax is the most dangerous and cutaneous (skin) anthrax is the mildest. Gastrointestinal anthrax is usually contracted by eating undercooked contaminated meat. Anthrax spores on the hands can theoretically enter the mouth when eating. Washing hands with soap and water after opening mail, before eating or preparing food, and after handling raw meat can help prevent anthrax, whether the source is natural or not.

Since anthrax is a bacterial disease, antibiotics can be used to control it if the disease is recognized and treated early. Most naturally occurring anthrax is susceptible to penicillin, but some laboratory created strains are not. Because of this fact, ciprofloxacin was initially chosen to treat victims of terrorism. However, further analysis indicated that the anthrax strain used in the 2001 US Postal Service attacks is also treatable using penicillin and doxycycline.

Antibiotics are used when a person becomes ill with anthrax (treatment), or to prevent the illness in a person who is likely to have been exposed (prophylaxis). Antibiotics must be taken for 60 days, because anthrax spores can remain in the lungs for this long. In bioterrorist events, cutaneous (skin) anthrax is treated for 60 days as well, due to the risk that the person also breathed in spores. Persons who have not been exposed to anthrax should not use antibiotics “just in case” as overuse of antibiotics can cause common germs to become hard to treat.

The CDC recommends that infants infected with anthrax be treated with ciprofloxacin or doxycycline, at least for the first 10-21 days of the 60 day treatment. No problems have been reported in breastfed infants of women treated with short-term use of doxycycline, and the AAP considers it to be a drug compatible with breastfeeding. Owing to the risk that long-term doxycycline use may cause dental staining in the infant, the CDC suggest that nursing infants or breastfeeding women infected with anthrax switch to other medications for the remainder of the 60-day course of treatment. The CDC maintains an on-line list of these alternative antibiotics.

A cell free vaccine is available for those who are most likely to be exposed to anthrax (vets, farm workers, or soldiers). The anthrax vaccine used in the US is made from only part of the bacterium, and like all “killed” vaccines, is considered safe for breastfeeding mothers. The vaccine must be given in 6 doses over 18 months, and yearly booster shots are required to maintain full protection. Consult your MD with further questions.

American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776--89.

CDC Notice to Readers: Update: Interim Recommendations for Antimicrobial Prophylaxis for Children and Breastfeeding Mothers and Treatment of Children with Anthrax. MMWR Weekly; November 16, 2001/50(45);1014-16.

Hale, T. Medications and Mother’s Milk, 12 Edition (2006), Hale Publishing. Pg 61-2.
Inglesby, et al, Working Group on Civilian Biodefense; Anthrax as a Biological Weapon, Medical and Public Health Management, JAMA 281(18), May 12, 1999.

What everyone needs to know about the anthrax vaccine, Feb 2001, US Coast Guard.