Is breastfeeding a contraindication to the Purified Protein Derivative (PPD) test?

From the Guidelines

Breastfeeding is not a contraindication to the PPD test, and nursing mothers can safely undergo PPD testing while continuing to breastfeed their infants. The PPD test involves injecting a small amount of tuberculin protein under the skin, typically on the forearm, to check for a reaction that might indicate tuberculosis infection. This test does not introduce live bacteria into the body, and the tuberculin protein does not pass into breast milk in any significant amount 1. The test is read 48-72 hours after placement by measuring any area of induration (hardening) at the injection site. During this time, mothers can continue breastfeeding as normal without any interruption or special precautions.

Key Points to Consider

• The PPD test is the only method available for demonstrating infection with M. tuberculosis, and its results should be interpreted with knowledge of the antigen used, the immunologic basis for the reaction, and the technique used to administer and read the test 1.
• The intracutaneous (Mantoux) administration of a measured amount of PPD-tuberculin is currently the preferred method for doing the test, with one-tenth milliliter of PPD (5 TU) injected just beneath the surface of the skin on either the volar or dorsal surface of the forearm 1.
• All PPD tests should be administered, read, and interpreted in accordance with current guidelines by specified trained personnel, and healthcare providers should inform patients about the interpretation of both positive and negative PPD test results 1.
• The safety of PPD testing during lactation is well-established, and delaying tuberculosis screening due to breastfeeding could potentially delay diagnosis of a serious infection.
• Healthcare providers should be informed about breastfeeding status when taking a medical history, but this information will not affect the decision to administer the test or the interpretation of results.

From the Research

Breastfeeding and PPD Test

• There is no direct evidence to suggest that breastfeeding is a contraindication to the PPD test 2, 3, 4, 5, 6.
• The PPD test is used to diagnose tuberculosis infection, and its results are based on the appearance of an indurated area after administration of purified protein derivative (PPD) 2.
• Breastfeeding has been associated with a reduced risk of postpartum depression (PPD) 5, but this is not directly related to the PPD test.
• The studies provided do not discuss the interaction between breastfeeding and the PPD test, and therefore, it is unclear if breastfeeding would affect the results of the test.

Postpartum Depression and Breastfeeding

• Exclusive breastfeeding has been shown to be associated with a reduced risk of postpartum depression (PPD) 5.
• Non-exclusive breastfeeding mothers have been found to have higher odds of PPD compared to exclusive breastfeeding mothers 5.
• Breastfeeding has been identified as a factor that encourages initiation and sustains breastfeeding in mothers with PPD 3.

Tuberculosis and Breastfeeding

• There is no evidence to suggest that breastfeeding is a contraindication to tuberculosis treatment or diagnosis 2, 6.
• The BCG vaccine, which is used to prevent tuberculosis, has been found to be susceptible to anti-tuberculosis drugs, including isoniazid, rifampicin, streptomycin, and ethambutol 6.