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