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Nancy E. Wight MD, FAAP, IBCLC
Breastmilk is the ideal infant nutrition, and breastfeeding is the optimal delivery system. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and continued breastfeeding with the addition of appropriate complementary foods for at least one year, and thereafter for as long as mother and baby desire. The benefits of breastfeeding in terms of species specificity, balanced, changing nutrients and enzymes, host resistance factors, immunologic protection, allergy protection and psychosocial development, make breastmilk the most important and cost effective substance we have in medicine today.
Unfortunately, breastfeeding has been implicated as a possible mode of transmission of various forms of hepatitis from mothers to their infants. Acute viral hepatitis is a frequent cause of liver disease in the United States and results in significant morbidity and mortality. The range of viruses of concern is expanding significantly and has become a true alphabet soup, with Hepatitis A, B, C, D, E, and now Hepatitis G as well. Fortunately, vertical transmission of most forms of hepatitis via breastfeeding is rare.
Hepatitis A Virus (HAV)
Hepatitis A virus occurs worldwide and is transmitted predominantly by the fecal-oral route, through person-to-person contact or by contaminated food or water. Hepatitis A is characterized by an acute febrile illness with jaundice, anorexia, nausea and malaise. Newborns are rarely infected, and in infants and preschool-aged children, most infections are either asymptomatic or cause mild, non-specific symptoms without jaundice. Fulminant Hepatitis A is rare, and chronic infection does not occur.
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Hepatitis A, even during the acute infectious period, is not a contraindication to breastfeeding. Perinatal transmission of hepatitis A is rare, and there is no evidence for transmission via breastmilk. Some experts have advised giving the infant immune globulin if the mother has the onset of symptoms in the period from 2 weeks before to 1 week after delivery. Even without immunoprophylaxis, severe disease has not been reported in infants. Careful hand washing should still be emphasized to the mother.
Hepatitis B Virus (HBV)
Hepatitis B virus is transmitted parenterally, by sexual contact, perinatally, and rarely congenitally. A major route of transmission from an infected mother to her baby is via contact with blood at the time of birth. Household contacts of Hepatitis B virus carriers are also at high risk of acquiring infection. Hepatitis B virus (HBV) causes a wide spectrum of infections, ranging from asymptomatic seroconversion, subacute illness with nonspecific symptoms (anorexia, nausea, malaise) or extrahepatic symptoms, and clinical hepatitis with jaundice, to fulminant fatal hepatitis. Asymptomatic infection is most common in young children.
Chronic HBV virus infection with persistence of Hepatitis B surface antigen (HBsAg) occurs in as many as 90% of infants who become infected perinatally, and in 6-10% of older children, adolescents and adults who become infected postnatally. Chronically infected persons are at increased risk for developing chronic liver disease (cirrhosis, chronic active hepatitis, chronic persistent hepatitis) or primary hepatocellular carcinoma in later life.
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