Breast-Feeding and Herpes
Vincent A. Fulginiti MD1
1 Chairman, AAP Committee on Infectious Diseases
Dr McNiel of Fort Dodge, Iowa writes: "Our infection committee noticed that in the new edition of the report of the Committee on Infectious Disease (Red Book) that mothers with active genital herpes may now breast-feed infants. Recent articles in Pediatric Infectious Diseases (1:81, 1982)and in Pediatrics in Review (2:259, 1981) show that herpes is still a devastating illness to most newborns who get it. Roughly 90% of babies who get neonatal herpes are either dead or damaged and with treatment the outlook is for better survival, but still a large percent of the survivors are damaged. If they consider it such a devastating infection in the newborn, I do not understand this change in recommendation from strict isolation to allowing infants to breast-feed. It seems a pretty big risk to consider that the mother will keep her hands off of her lesions while breast-feeding her infant and not touch her infant with contaminated hands.
Do you have any data or are you aware of any data on why the American Academy changed their recommendations?"
Reply: Dr McNiel's infection committee spotted one of the controversial areas of infectious diseases practice. The issue the committee faced was broader than just breast-feeding; it concerned the degree of contact permissible between an infected person and a newborn infant. Herpes in the newborn generally is a disease transmitted just prior to or at the time of delivery, following direct contact of the infant with herpes virus-rich lesions in the genital tract. There are exceptions, of course, in which caretakers appear to have been the source for infants after birth. Even in these circumstances direct contact appeared necessary (kissing an infant, etc).
Given this background, we were faced with the dilemma of what to do for the maternal-infant pair postdelivery. On the one hand, direct contact with lesions or with fingers contaminated with herpes carried a small but significant risk. On the other hand, as pediatricians we wished to encourage appropriate mother-infant contact, including breast-feeding.
Our experts advised us that: (1) The risk postdelivery was very low; some claimed there was no risk at all, that infants were infected during birth or not at all. (2) If the nipple and surrounding skin were unaffected, breast-feeding was not contraindicated. (3) To further reduce the minimal (if any) risk, primary lesions should be covered and thorough handwashing taught and practiced. Hence, our recommendation in the Red Book.
