Hepatitis C
Transmission through transfusions with blood not screened for HCV, through the use
of inadequately sterilized or unsterilized equipment, or through needle-sharing
among drug-users, is well documented. Sexual and perinatal transmission
(breastfeeding) may also occur, although less frequently, and studies to better
understand these potential means of transmission are underway. Other modes of
transmission such as those linked to social, cultural and behavioral practices
using percutaneous procedures (e.g. ear and body piercing, circumcision,
tattooing) may be important. HCV is not as infectious as hepatitis B or HIV.
Although the risk of perinatal transmission may increase when the mother is
co-infected with HIV, further study is required to quantify this risk. In over
40% of cases the risk factor(s) cannot be identified. In some studies, the
careful assessment of past exposure to percutaneous intervention with
inadequately sterilized material has reduced the number of cases with
unidentified risk factors to 10%.
Hepatitis B
The question of whether breastfeeding plays a significant role in the
transmission of hepatitis
B has been asked for many years. It is important given the critical role of
breastfeeding and the fact that about 5% of mothers worldwide are chronic
hepatitis B virus (HBV) carriers. Examination of relevant studies indicates
that there is no evidence that breastfeeding poses any additional risk to
infants of HBV carrier mothers. HBV infection is of major public health
importance world-wide. It can cause asymptomatic infection, clinical acute
hepatitis, fulminant hepatitis, or persistent infection which is known as the
chronic carrier state. Globally, there are over 350 million chronic carriers of
HBV who are at high risk of developing severe sequelae including chronic active
hepatitis, cirrhosis, and primary hepatocellular carcinoma, complications which
kill more than 1 million persons per year. It has been estimated that as many as
25-35% of individuals who become chronic carriers will eventually die from
these complications (1)
Risk of transmission
by breastfeeding
Breastfeeding has been suggested to be a mechanism by which infants may acquire
HBV infection, because small amounts of Hepatitis B surface antigen (HBsAg)
have been detected in some samples of breast milk. However, there is no
evidence that breastfeeding increases the risk of mother to child transmission.
Research findings suggest strongly that any risk of transmission associated
with breast milk is negligible compared to the high risk of exposure to
maternal blood and body fluids at birth. Experts on hepatitis, however, do have
concerns that breast pathology such as cracked or bleeding nipples or lesions
with serous exudates could expose the infant to infectious doses of HBV.
Prevention of
perinatal and horizontal HBV transmission
Active immunization with HB vaccine is effective for the prevention of both
perinatal and horizontal transmission of HBV. However, neither screening of
pregnant women for HBV infection nor use of HBIG are feasible in most
developing countries. Routine immunization of infants with HB vaccine is
therefore recommended, the first dose to be given within 48 hours of birth
where feasible, and subsequent doses with routine childhood immunizations.
Delivery of HB vaccine at birth is possible with clinic or hospital deliveries
but is more difficult following home deliveries where contact with the
immunization system does not take place for several weeks or months. A dose of
HB vaccine around the time of birth is more important in Asia where perinatal
transmission is commoner. Infants who have received their first dose of vaccine
can safely breastfeed .
In areas where infants are not routinely immunized against HBV, the issue of wet-nurses and the use of donated breast milk must be considered. Most non-carrier mothers in endemic areas have previously been infected with HBV and have recovered, and have passively transferred anti-HBs antibody through the placenta to the infant, protecting them against HBV infection for approximately 6 months. In many industrial countries, wet-nurses and donor mothers are screened for HBsAg, and if positive their milk is not used for infants other than their own. However, this strategy is less feasible in developing countries where HBV testing may be unavailable. Infants immunized with HB vaccine have no risk of HBV infection through wet nurses or donated breast milk.
Recommendations
The World Health Organization (WHO) recommends that all infants receive
hepatitis B vaccine as part of routine childhood immunization. Where feasible,
the first dose should be given within 48 hours of birth or as soon as possible
thereafter. This will substantially reduce perinatal transmission, and
virtually eliminate any risk of transmission through breastfeeding or breast
milk feeding. Immunization of infants will also prevent infection from all
other modes of HBV transmission.
WHO and UNICEF recommend that all infants be exclusively breastfed for at least 4 and if possible 6 months, and that they continue to breastfeed up to two years of age or beyond with the addition of adequate complementary foods from about 6 months of age. There is a considerable risk of morbidity and mortality among infants who are not breastfed. There is no evidence that breastfeeding from an HBV infected mother poses an additional risk of HBV infection to her infant, even without immunization. Thus, even where HBV infection is highly endemic and immunization against HBV is not available, breastfeeding remains the recommended method of infant feeding.
Approximately 5 percent of infants born to mothers with chronic hepatitis C virus (HCV) become infected with the virus. When the infection actually occurs and the mechanism of maternal-fetal transmission have not been established. A higher incidence of infection exists in children born to mothers who are concurrently infected with human immunodeficiency virus (HIV). One issue with HCV transmission is whether the virus can be transmitted from mother to infant through breast milk, and the few published studies to date have produced conflicting results. Polywka and colleagues conducted a prospective study to evaluate the risk of HCV transmission from mother to infant through breast milk.
Mothers with confirmed HCV infection who tested negative for HIV were enrolled in the study. Breast-milk samples were obtained between day 1 and day 73 after delivery. Serum samples were obtained from the mothers between 59 days before and 73 days after delivery, although the mean time of collection was 2.1 days postpartum. The majority of samples of breast milk and serum were collected within one week of each other. Serum samples for HCV were obtained from 76 newborn infants during the first week of life and again between one and three months of age. In 38 infants, additional serum samples were obtained at follow-up visits for as long as 28 months.
The serum samples of mothers and infants were tested for antibodies to HCV by standard enzyme immunoassay. Confirmatory testing was performed using the immunoblot assay. The fresh serum or breast-milk samples were tested for HCV RNA with the polymerase chain reaction technique. The breast-milk samples were determined to be negative if at least two or three assays were negative compared with a positive control specimen.
All 76 infants of the 73 HCV-infected mothers were breast-fed. None of the breast-milk samples from the women was positive for HCV RNA. All maternal serum samples tested for antibodies to HCV were confirmed positive, and approximately 60 percent of mothers tested for HCV RNA had HCV viremia. During the follow-up component of the study, 75 of the infants remained negative for HCV RNA. One child, who was infected, tested negative at day 3 but had a positive HCV RNA assay at 27 days of age. Testing for antibody to HCV revealed that it took from three to 28 months for the infant to lose maternal antibodies to HCV, although the mean was nine months.
The authors conclude that HCV is not transmitted via breast milk; therefore, breast-feeding by an HCV-infected mother does not pose a risk to the infant. It is not necessary to prohibit HCV-positive mothers from breast-feeding. In their discussion, the authors cite another study that found HCV RNA in a large percentage of samples of colostrum, but no new pediatric infections were found in those children who were breast-fed.
JEFFREY T. KIRCHNER, D.O.
Hepatitis C & Breast-Feeding
Only five percent of infants born to women infected with chronic hepatitis C infections actually develop the disease themselves. Why only certain infants develop the disease and how it is transmitted from the mother to the fetus or newborn isn't known.
One possible route of infection is via breast milk. To test this hypothesis, the breast milk of 73 hepatitis C infected women was tested for the hepatitis C virus. Even though the blood of all of these women tested positive for the virus, none of their breast milk did. None of their babies tested positive for hepatitis C during the newborn period. One did test positive at age 27 days of age. The cause of this infection was never determined.
This study demonstrates that it is safe for hepatitis C positive women to breast-feed their infants.
American Family Physician, 3/1/00, p. 1476.
This
article is from Volume 19, Number 4
Hepatitis C is NOT spread by:
·
breast feeding
·
sneezing
·
hugging
·
coughing
·
sharing eating
utensils
·
sharing drinking
glasses
·
cooking or
serving food or water
·
casual contact
·
kissing
·
toilet seats