Breastfeeding Answer Book p460:
"If a mother has hepatitis B during pregnancy, the newborn may be exposed
to the disease by coming in contact with maternal fluids at birth.  The
American Academy of Pediatrics Committee on Infectious Diseases (1994)
recommends that the baby be given hepatitis B hyperimmune gamma globulin
within the first twelve hours of life, followed by three doses of hepatitis
B vaccine.  The baby may be breastfed."

Lawrence 5th ed. p225 Table 7-2 "Summary of medical contraindications to
breastfeeding": says breastfeeding is okay "after infant receives HBIG" and
adds "first dose of hepatitis B vaccine should be given before hospital
discharge".

Riordan & Auerbach p231:
"The vast majority of exposure occurs during or immediately preceding
labor, so that immunoprophylaxis and vaccination in the early postnatal
period have an excellent chance of preventing infection. ...
Infants born to an HBV-positive mother, already exposed to maternal blood,
amniotic fluid, and vaginal secretions during delivery, may breastfeed
(Krugman, 1985; Peter et al., 1994).  The neonate should receive hepatitis
V immunoglobulin (HBIG) within 12 hours after birth, followed by a series
of injections of HBV vaccine..."
p232:
"Tseng, Lam, and Tam (1988) report that there is no evidence that
breastfeeding will increase the risk of HBV infection in infants,
regardless of their immunization status.  There were no differences in the
rate of development of antigenemia or immunity against hepatitis B between
the breastfed and bottle-fed babies during the first year of life, and
almost all infants were HBsAg-positive at one year of age, regardless of
how they were fed.  These researchers concluded that there was "no valid
contraindication for breastfeeding in infants born to HBsAg-positive
mothers," especially if the infants were immunized soon after birth.
"De Martino et al. (1987) followed 47 breastfed and 112 formula-fed infants
born to mothers who were positive for HBsAg.  No difference was observe4d
between the groups regarding the percentage of infants who seroconverted.
... Breastfeeding does not appear to increase the rate of infection among
infants.  Moreover, in areas of high prevalence of HBV and environmental
exposure, lack of breastfeeding places the infant at greater risk of
contracting the disease."

Elise

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