Hepatitis C and breastfeeding: Is it safe?

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There are no documented cases of a baby contracting HCV through human milk. As such, it appears to be safe to give babies breast milk, even if the person feeding them has hepatitis C.

Evidence suggests that human breast milk may actually deactivate HCV. So caregivers who breastfeed, chest feed, or bottle feed using their own milk may not need to worry that doing so will transmit the virus.

At present, there is not enough data to determine whether cracked nipples could lead to HCV transmission.

In theory, it may be possible for a baby to ingest blood that contains HCV if a person’s nipples are cracked or bleeding. This applies whether the baby feeds at the breast or whether a person expresses milk into a bottle.

But it is unclear what the risk level is. For this reason, the CDC advises that people with hepatitis C temporarily stop feeding their baby with their own milk if they have cracked or bleeding nipples.

Until the nipples heal, people should:

• express and then discard their own milk safely, as it may be mixed with blood
• switch to donor human milk, or formula, to feed the baby
• speak with a lactation specialist for support, if necessary, especially to make a plan for maintaining their milk supply

In addition to the above precautions, parents and caregivers with HCV should take additional measures to help prevent transmission of the virus to babies.

General prevention

To help prevent the transmission of HCV from a caregiver to a baby, do not share personal items with them, such as nail scissors or clippers, toothbrushes, or jewelry that enters the skin, such as earrings.

Also regularly disinfect household, personal, and baby items that are likely to come into contact with blood.

In case of injury

If a caregiver injures themselves, they need to:

• clean up any spilled blood immediately using disposable cloths or paper towels
• dispose of the cloths or towels in a separate, sealed bag
• sterilize the area with bleach and then rinse with water

When a caregiver is bleeding or has a cut or wound, they also need to:

• keep any open cuts or areas of broken skin completely covered using bandages, sterile dressings, or other protective coverings
• avoid kissing a baby until any cuts or sores on or inside the mouth have healed
• avoid holding hands with a baby if either the baby or the caregiver has any kind of wound or broken skin on the hands
• dispose of band-aids, wound dressings, sanitary or menstrual products immediately in a sealed separate bag that is out of the reach of children

In case of exposure to blood

If a baby could have become exposed to the caregiver’s blood:

• Immediately wash them using warm running water and soap, or an antiviral product.
• Be sure to remove all of the blood, checking hard-to-reach areas, and pat dry with a fresh, clean towel.
• Clean and disinfect any personal items that may have come into contact with the blood, including bedding, towels, eating utensils, and drinkware.

Before seeking testing, it is useful to know what kinds of HCV tests are available and what they indicate.

There are two types of tests for HCV. Antibody or polymerase chain reaction (PCR) tests measure whether someone has the antibodies for HCV in their blood. Antibodies are special proteins the body creates to destroy or deactivate specific viruses and bacteria.

If an antibody test is positive, it means a person has had HCV at some point in their lives. It does not necessarily mean they have an active infection, though.

PCR tests are another type of test. These detect whether the virus is currently reproducing in the body. This indicates there is an active infection.

When adults can get tested

If a parent or caregiver believes they have HCV but are not sure, they should seek testing as soon as possible. In many cases, HCV does not cause symptoms initially, so it is important to confirm whether someone is a carrier.

People should also get tested for HCV if:

• they believe that they could have become exposed to HCV from someone else
• they develop symptoms, such as fatigue, fever, abdominal pain, or difficulty focusing
• they use injectable drugs, such as heroin

People with HCV should also have their HCV RNA levels tested after giving birth. This is because in some people, HCV appears to clear up spontaneously after the person gives birth.

A 2017 study at Cairo University, Egypt, found that 26.9% of people with HCV had undetectable levels of the virus’s DNA in their blood 12 months after giving birth. This appears to be associated with a specific genetic mutation.

When children can get tested

Most health authorities recommend that a baby born to someone with HCV receive testing when they are 18 months of age or older.

This is because young babies have maternal antibodies in their blood. A traditional HCV test would detect these HCV antibodies, resulting in a false-positive result.

If parents or caregivers are very concerned about whether a baby has HCV, they may be able to get testing at just 3 months of age, though this increases the risk of a false-positive result. In these cases, doctors use a PCR test instead of an antibody test.

Doctors test children over the age of 2 years for HCV in the same way as adults. Children that test positive can begin treatment once they reach 3 years of age.

Direct-acting antivirals (DAAs) are the class of drug doctors typically use to treat chronic hepatitis C. Most people who are not pregnant or breastfeeding take DAAs for around 8–12 weeks. Current therapies have a 90% or higher success rate.

But there is not yet enough research to prove that DAAs are safe for use during pregnancy or nursing. There is even less research exploring the effects of DAAs and other HCV therapies on babies.

Animal studies have shown that DAAs can cross the placenta and enter breast milk. But one 2019 review found that DAAs may be relatively safe for use during the second or third trimester of pregnancy and while breastfeeding.

Until there is more evidence proving DAAs are safe during breastfeeding, doctors will typically wait until after a person stops feeding a baby with breast milk to begin their treatment.

If a person wishes to breastfeed a baby, it is a good idea to seek help and support from a doctor or lactation specialist. Some questions to ask could include:

• How can I safely breastfeed, chest feed, or express breast milk?
• Are there any products, such as medical devices or cleaning products that I should buy?
• Is there any new information on breastfeeding safety or prevention measures for people with HCV?
• What should I do if my baby is exposed to HCV?
• Should my baby get testing for HCV?
• What happens if they test positive?
• When can I begin treatment?
• What are the options for treatment?

People with HCV can generally breastfeed, chest feed, or feed their bottled milk to a baby safely as long as they do not have cracked or bleeding nipples. If this occurs, stop breastfeeding and switch temporarily to donor milk or formula.

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