Senecca
Interesting - and worrying - situation! I feel for the mom, and for you!
I had a similar case in December of 1998, and wrote in for help to
LACTNET (Dec 4th). I received a HUGE response, and was so very
grateful. If you search the Archives, you'll see. A lot of it was
quite conflicting., and there was concern not just for the risk of
rabies from the bite, but the mother's vaccine on the breastfed baby.
Finally I received a response from Dr Ruth Lawrence, which seemed to clinch it:
-------------------
From: "Lawrence, Ruth" <[log in to unmask]>
To: "'Pamela Morrison IBCLC'" <[log in to unmask]>
Subject: RE: HELP! Rabies and breastfeeding
Date: Mon, 7 Dec 1998 12:49:01 -0500
To Pamela Morrison,
Your request for information arrived courtesy of Kay Hoover.
There is no known risk to the infant of the rabies
vaccine. It is
an inactivated virus preparation that is given IM, implying that it is not
orally available.
With respect to the rabies virus in the breast milk,
it would only
occur during viremia. This mother received her first vaccine within 4 hours
so viremia would not occur.
Conclusion: No reason to limit or restrict breastfeeding.
Ruth
A. Lawrence, M.D.
Medical
Director of the
Breastfeeding and
Human
Lactation Study Center
University
of Rochester
Medical Center
Rochester,
NY 14642
-------------------------
A month later the mother herself followed up with me again, and this
is taken from my notes:
Cherith called to pay account, brought gift.......
Baby big, fat, thriving, still breastfed, refuses bottle, but takes
water/juice in cup, "so good" and sleeps through the night.
Rabies vaccine was given - immediately after exposure, and at
3 days
7 days
14 days
28 days (just
had) and to be given at
60 days
90 days
Dr Trace (vet) was extremely helpful to her, said he KNOWS about
rabies, and his opinion is virus would not have entered milk, goes
to nerves and she would have been protected from the very first shot.
Last month has been very worrying - she has had nightmares. Made up
her mind not to worry about it now.
Has just taken baby for his 6 mo check-up with Dr P...., who said he
found out more about it, glad she is still breastfeeding. His
caution had been that although the risk is infinitessimal, rabies is
fatal - hence his advice to stop.
I asked if she will follow up with me in March or thereabouts.
Gave verbal permission for me to write this up as case history, if
wished, in the future.
---------------------
I hope this helps!
Best wishes to the mom
Pamela Morrison IBCLC
Rustington, England (case was in Zimbabwe)
------------------------
Date: Thu, 15 Apr 2010 11:46:05 -0400
From: Senecca Kirkhart <[log in to unmask]>
Subject: RABIES and Breastfeeding
This is my first posting to the list...but a pretty interesting one.
I just received a call from a mom who is breastfeeding her 6 month
old baby and has just confirmed that her horse has rabies. The horse
has been sick for a few days and this mom has been in very close
contact caring for the horse, touching its oral secretions, etc., and
has been continuing to breastfeed as she did not know that it was
rabies until today.
Do any of you have any experience with this?
I recommended that she continue breastfeeding as I expect the baby
has already been exposed. I advised her to take herself and her
entire family to the ER for Rabies vaccine (including the 6 mos old
baby). The mom and the baby should receive the vaccine. So I assume
if the baby can receive the vaccine, then there is no
contraindication to continuing breastfeeding.
I also advised this mom to contact UVA Pediatric Infectious Disease
ASAP for a consult.
Thanks for your interest and help!
Senecca Kirkhart, CPNP
Halifax County, VA
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