Hepatitis B Vaccine and Breastfeeding

Summary of use during lactation

The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding infants and that breastfeeding is not a contraindication to the hepatitis B vaccine. Hepatitis B vaccine is recommended along with hepatitis B immune globulin to be given by injection to infants of mothers who are positive for hepatitis B surface antigen. No differences exist in infection rates between breastfed and formula-fed infants born to hepatitis B-infected women, as long as the infant receives these preventative measures at birth.[1] Breastfeeding improves the infant’s response to hepatitis B immunization.[2] Mothers with hepatitis B are encouraged to breastfeed their infants after their infants receive these preventative measures.[3,4] Breastfeeding also appears to reduce infant side effects associated with routine childhood immunization. Breastfed infants should be vaccinated according to the routine recommended schedules.[5-7]

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Breastfeeding can enhance the response of the infant to certain vaccine antigens.[2,5,6,8] Breastfed infants are also less likely to have fever and may be less likely to experience anorexia and reduced energy intake after routine childhood immunization than those who are not breastfed.[9,10] Breastfed infants of hepatitis B surface antigen positive mothers have a different response in the development of immunoglobulin subtypes after vaccination with hepatitis B vaccine than do formula-fed infants.[11] However, breastfeeding does not interfere with the infant's antibody response to hepatitis B vaccine.[12]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Xiao F, Lan A, Mo W. Breastfeeding from mothers carrying HBV would not increase the risk of HBV infection in infants after proper immunoprophylaxis. Minerva Pediatr 2020;72:109-15.28353321 PubMed
2. Liu H, Li L, Li Y, et al. Vaginal delivery and breastfeeding benefit infant immune response to hepatitis B vaccine: A prospective cohort study. J Clin Transl Hepatol 2023;11:899-907.37408801 PubMed
3. Visvanathan K, Dusheiko G, Giles M, et al. Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: Position paper produced by Australian, UK and New Zealand key opinion leaders. Gut 2016;65:340-50.26475631 PubMed
4. Dionne-Odom J, Tita AT, Silverman NS. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol 2016;214:6-14.26454123 PubMed
5. Kroger A, Bahta L, Long S, et al. CDC. General Best Practices for Immunization. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html
6. Kimberlin DW, Brady MT, Jackson MA, et al. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics. 2018.
7. Gruslin A, Steben M, Halperin S, et al. Immunization in pregnancy: No. 220, December 2008. Int J Gynaecol Obstet 2009;105:187-91.19367691 PubMed
8. Pabst HF. Immunomodulation by breast-feeding. Pediatr Infect Dis J 1997;16:991-5.9380478 PubMed
9. Pisacane A, Continisio P, Palma O, et al. Breastfeeding and risk for fever after immunization. Pediatrics 2010;125:e1448-52.20478932 PubMed
10. López-Alarcón M, Garza C, Habicht JP, et al. Breastfeeding attenuates reductions in energy intake induced by a mild immunologic stimulus represented by DPTH immunization: possible roles of interleukin-1beta, tumor necrosis factor-alpha and leptin. J Nutr 2002;132:1293-8.12042449 PubMed
11. Azzari C, Resti M, Rossi ME, et al. Modulation by human milk of IgG subclass response to hepatitis B vaccine in infants. J Pediatr Gastroenterol Nutr 1990;10:310-5.2324890 PubMed
12. Wang JS, Zhu QR, Wang XH. Breastfeeding does not pose any additional risk of immunoprophylaxis failure on infants of HBV carrier mothers. Int J Clin Pract 2003;57:100-2.12661791 PubMed