Hepatitis A
HAV is mainly transmitted through the fecal-oral route, which includes ingesting contaminated food or water, engaging in oral-anal sex, and other incidences where fecal matter can be passed from person to person. As such, good hygiene, including proper handwashing practices, is considered essential to prevent the spread of HAV. HAV, even during the acute infectious period, is not a contraindication to breastfeeding. ((Rad Children’s Hospital San Diego – Breastfeeding and Hepatitis)) No evidence of HAV has ever been found in human breastmilk.

Proper handling during any illness is important, as is labeling bags with any pertinent information, especially in case of a donor getting sick, so that recipients can be notified and exercise their full informed choice. When in doubt, expressed milk can be pasteurized at home.

Hepatitis B
HBV is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected. It is safe for those infected with the hepatitis B virus (HBV) to breastfeed their infant immediately after birth. Even before the availability of the hepatitis B vaccine, HBV transmission through breastfeeding was not reported. There is no need to delay breastfeeding until the infant is fully immunized. Those who breastfeed should take good care of their nipples to avoid cracking and bleeding. Someone who is HCV-positive and has cracked and bleeding nipples and/or surrounding areola is advised to stop breastfeeding temporarily. Instead, expressing and discarding the breastmilk should be considered until the nipples are healed in order to not compromise the milk supply. Once the breasts are no longer cracked or bleeding, breastfeeding may be fully resumed. ((CDC – Mothers with Hepatitis B or C infections can breastfeed their infants.)) ((HBV is part of the HMBNA milk donor panel. HBV is quite prevalent in the US and is complex to properly diagnose. (HHS – Viral Hepatitis in the United States: Data and Trends) (CDC – Interpretation of Hepatitis B Serologic Test Results)
In the US, the vast majority of babies are vaccinated for HBV at birth which greatly reduces their chances of acquiring an infection. This information, coupled with the fact that transmission from breastmilk alone is undocumented makes the results of the study Retrospective review of serological testing of potential human milk donors less of a concern for people participating in milksharing. The implications for a milk bank regarding testing expenses and logistics are different. From the perspective of a milk bank that will be testing the donors on a regular basis, it makes sense to exclude anyone with a history of false positives since the cost of pursuing confirmations at every testing opportunity is not only prohibitive for a non-profit org, it also can lead to logistical issues with the milk received from the donor.))

Hepatitis C
HCV is transmitted via blood. It is safe for someone infected with HCV to breastfeed their infant. There is no documented evidence that breastfeeding spreads Hepatitis C nor are there current data to suggest that HCV is transmitted by human breastmilk. Hepatitis C (HCV) is spread through infected blood. Someone who is HCV-positive and has cracked and bleeding nipples and/or surrounding areola is advised to stop breastfeeding temporarily. Instead, expressing and discarding the breastmilk should be considered until the nipples are healed in order to not compromise the milk supply. Once the breasts are no longer cracked or bleeding, breastfeeding may be fully resumed. ((CDC – Mothers with Hepatitis B or C infections can breastfeed their infants.))

Those with substance use disorders are at high risk for HBV. Despite the many factors that may make breastfeeding a difficult choice for someone with a substance use disorder, a drug-exposed infant, who is at high risk for medical, psychological, and developmental issues, as well as the breastfeeding parent, stand to benefit significantly from breastfeeding. With careful monitoring, treatment, postpartum care, and lactation support the dyad can be supported in their breastfeeding. ((Sarah Reece-Stremtan, et al. 2015. Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder))

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Each hepatitis virus carries its own risk of illness. The risks of breastfeeding with maternal hepatitis should be weighed against the known risks of NOT breastfeeding in each individual case and environment. Please also see Open sores, blisters and/or bleeding cracks on the skin, Handling Milk, and Introduction to Infectious Diseases for more information. 

In the case of milksharing, both donors and recipients can infect expressed milk by improper handling. Donors should disclose their hepatitis status and any past illness to prospective recipients and be aware of the fact that they may not know the status of their partner. Regular blood screening is recommended by milk banks. Please consult a healthcare provider for more information.

How can breastmilk be pasteurized at home?

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