Breastfeeding and Hepatitis B
We continue our discussion of the risks of breastfeeding. The question of whether breastfeeding plays a significant role in the transmission of hepatitis B has been asked for many years. It is important given the critical role of breastfeeding and the fact that about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers. Examination of relevant studies indicates that there is no evidence that breastfeeding poses any additional risk to infants of HBV carrier mothers.HBV infection remains a major public health concern worldwide. It can cause asymptomatic infection, clinical acute hepatitis, fulminant hepatitis, or persistent infection which is known as the chronic carrier state. Globally, there are over 350 million chronic carriers of HBV who are at high risk of developing chronic active hepatitis, cirrhosis, and primary liver carcinoma. Combined, these complications kill more than 1 million persons per year. It has been estimated that as many as 25-35% of individuals who become chronic carriers will eventually die from these complications.
The Risk of Hepatitis B Via Breastfeeding
Breastfeeding has been suggested to be a mechanism by which infants may acquire HBV infection, because small amounts of Hepatitis B has been detected in breast milk. However, there is no evidence that breastfeeding increases the risk of mother to child transmission. Research findings suggest strongly that any risk of transmission associated with breast milk is small compared to the high risk of exposure to maternal blood and body fluids at birth. Experts on hepatitis, however, do have concerns that breast pathology such as cracked or bleeding nipples or lesions with discharge or drainage could expose the infant to infectious levels of HBV.
Prevention HBV Infection
Immunization with HBV vaccine is an effective means to prevent HBV. However, screening of pregnant women for HBV infection is not feasible in most developing countries. Routine immunization of infants with HB vaccine is therefore recommended; the first dose to be given within 48 hours of birth are feasible, and subsequent doses with routine childhood immunizations.
Hepatitis B Vaccine Fact Sheet
Delivery of HB vaccine at birth is possible with clinic or hospital deliveries but is more difficult following home deliveries where contact with the immunization system does not take place for several weeks or months. A dose of HB vaccine around the time of birth is more important in Asia where perinatal transmission is more common. Infants who have received their first dose of vaccine can safely be breastfed.
In areas where infants are not routinely immunized against HBV, the issue of wet-nurses (women who breastfeed for other women) and the use of donated breast milk must be considered. Most non-carrier mothers in areas where there is a high incidence of HBV, have previously been infected with HBV and have recovered. These mothers have passively transferred HBV antibodies to their babies during pregnancy, protecting them against HBV infection for approximately 6 months after birth. In many industrial countries, wet-nurses and donor mothers are screened for HBV antibodies, and if positive their milk is not used for infants other than their own. However, this strategy is less feasible in developing countries where HBV testing may be unavailable. Infants immunized with HB vaccine have no risk of HBV infection through wet nurses or donated breast milk.
Hepatitis B Recommendations
The World Health Organization (WHO) recommends that:
- All infants receive hepatitis B vaccine as part of routine childhood immunization, substantially reducing perinatal transmission, and virtually eliminating any risk of transmission through breastfeeding. Immunization of infants will also prevent infection from all other modes of HBV transmission.
- Because of considerable risk of illness and possible death among infants who are not breastfed, WHO and UNICEF recommend that all infants be exclusively breastfed for at least 4 and if possible 6 months, and that they continue to breastfeed up to two years of age or beyond with the addition of other foods from about 6 months of age.
- There is no evidence that breastfeeding from an HBV infected mother poses an additional risk of HBV infection to her infant, even without immunization. Thus, even where HBV infection is common and immunization against HBV is not available, breastfeeding remains the recommended method of infant feeding.
