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Subject:
From:
Harry Chaikin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 1 Apr 1995 08:37:39 EST
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Dear Dr. Dise and other interested parties,
   Unfortunately our "mother computer" here at Stockton.edu has been down
some and losing mail so we're not sure if you were referring to our earlier
note or to one that perhaps we missed but nonetheless we'll venture a
response to your questions raised in your recent note on varicella/zoster.
Regarding shingles (the activation of the chickenpox virus along particular
dermatones supplied by the infected nerve root), we'll reiterate what we
wrote earlier based on info from Dr. Allan Arbeter, a pediatric infectious
disease specialist at Einstein Medical Center in Philadelphia.  His position
is similar to the one you described in that as long as there is no contact
between the baby and open lesions on the mother, breastfeeding may be
initiated and continued.
   Our concern is that the information in your note regarding chickenpox and
Lawrence's material could be misinterpreted.  Perhaps it would be helpful to
quote Lawrence verbatim.  In the 4th edition page 487:  "When maternal
chickenpox occurs within 6 days of delivery or immediately postpartum and no
lesions are present in the neonate, mother and infant should be isolated
separately...If no lesions develop [presumably on the neonate] by the time
the mother is *noninfectious*, the infant and the mother may be sent home
together.  When the mother and infant can be together, the child can be
breastfed.  Antibodies appear in the milk within 48 hours of the disease
onset, so that the infant can be breastfed *as soon as it is appropriate*
for the mother and infant to be together."  (emphasis is ours)
   We would suggest that the 48 hour statement is a red herring since (1) as
we described earlier based on the statements of Dr. Arbeter, those
antibodies transferred in breastmilk are not protective and (2) infectious
disease textbooks such as Mandell say that skin lesions may be infectious
for up to 4 days from the development of the first lesion.  Therefore it
follows that it is not appropriate for mother and infant to be together and
breastfeeding until 4-5 days after the mother's first skin lesions appeared.
   BTW Dr Arbeter is an accesible type of guy and I'm sure if you wish to
discuss the matter with this varicella/zoster specialist, he would be more
than willing to respond.
   Hopefully like you said, Dr. Dise, the availablility of the varicella
vaccine will eventually make this a moot issue.
   We hope this clarifies the issue some.
                       --Sarah and Harry Chaikin

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