In response to Ted Greiner's inquiry about transmission of hepatitis in
breastmilk, I can offer some information.  Since the availability of
hepatitis B vaccine and hyperimmune hepatitis B globulin, which are
routinely given to all infants of hepatitis B carrier mothers, there has
been broad agreement that there is no risk to the breastfeeding newborn of
acquiring hepatitis B from breastmilk.  Of course, now in the U.S. and in
most Asian countries (Japan, Korea, Taiwan) it is routine to vaccinate all
newborns against hepatitis B with the vaccine (but not the hyperimmune
globulin).  I believe this is also being done in China, but I have no
specific information on the practice there.  In any event, if immunization
is available, there is certainly no reason to restrict breastfeeding.
Furthermore, even prior to the availability of vaccine and hyperimmune
globulin, there was some data from China that suggested that breastfeeding
might actually reduce the risk of chronic hepatitis B infection in infancy.
The virus is probably present in the milk of some mothers, but it is likely
that a passive-active immunization occurs that eliminates the viremia from
the infant while the infants develops antibody of its own.  It is certainly
appropriate for the hepatitis B mother to breastfeeding the infant, but it
would be best to immunize the infant for both immediate and future
protection.
     As for hepatitis A, there is no evidence of infection of newborns from
mothers who have had hepatitis A during pregnancy, whether breastfed or not.
There is no carrier state for hepatitis A, unlike hepatitis B.  If the
mother is healthy enough to breastfeed, there should be no restrictions.
     Hope this is helpful to you and the Chinese visitors.  Let me know if
there are more questions.

Lawrence M. Gartner, M.D.
The University of Chicago
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