Hi,
  A mom, due in 2-3 wks asked me about risk to bf a baby if a woman had Hep
A about 6 yrs. ago.  I looked it up in BAB, which indicated no risk, just
concern for mom's health if illness is current & acute.  On Fri. she gave me
a copy of a handout given by her local HD:

     "Handout #37   Contraindications to Breastfeeding
        1.  Whooping cough
        2.  Active TB
        3.  AIDS or HIV+ mother
        4.  Chemotherapy
        5.  Some forms of Hepatitis
            --Non A, Non B with symptoms, do not bf
            --Type A   if in blood, do not bf
               if in liver only, can bf
           --Type B   if mother & baby are vaccinated, can bf
        6.  The mother is abusing drugs or alcohol"

  I contacted my LLL APL and got the following info, which came from Ruth
Lawrence (1995), pg. 490:

"HAV is the virus that causes the short incubabtion form of viral hepatitis
or "infectious hepatitis." It is characterized by an acute febrile illness
with jaundice, anorexia, nausea, and malaise. Fulminant disease is rare and
chronic infection is unknown. HAV is an RNA virus and a member of the
picodnavirus group. It is spread by the oral-fecal route. It can spread
through a day-care center. All household and sexual contacts should receive
0.02ml/kg of immune globulin (IG) as soon as possible after exposure.

"Unless the mother is ill and icteric [jaundiced] at the time of delivery,
no special care is required for the infant. IG is not recommended unless the
mother is icteric. The infant can be breastfed."

Reference:  Committee on Infectious Disease: Report of the Committee, Red
Book, ed 22, Elk Grove Village Illinois, 1991, Academy of Pediatrics.

  I confess to being VERY confused.  I just spoke with the mom; a bf peer
counselor had given her the HD handout.  The mom is going to call the HD
IBCLC and ask about the references for the handout (none given on the paper
itself).  The mom is also getting a copy of her medical report for her ped.
to see.  Ped. says she's seen nothing to indicate "old" Hep. A infection is
a bf risk.
  What wisdom do you all have for me (us, by extension!)?  BTW, my always
helpful APL is out of town--miss you, Melissa!
  TIA, Sara Reuning in Bristol, TN