Response to Verd re: “Academy of Breastfeeding Medicine's 2017 Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant”

To the Editor:

We appreciate the comments of Dr. Verd ¹ related to the recent Academy of Breastfeeding Medicine's 2017 Position Statement on Informal Breast Milk Sharing for the Term Healthy Infant ² and agree that full adherence to hepatitis B virus (HBV) prophylaxis recommendations is more important in reducing mother-to-infant transmission of HBV than whether the HBV-infected mother breastfeeds or not. This has been confirmed in a recent meta-analysis that concluded that breastfeeding would not increase the risk of HBV transmission after proper infant immunoprophylaxis. ³

Our concern is that there are parents who decline or defer vaccination and there are countries that have not introduced universal immunization. The WHO recently reported that, in 2016, global coverage with the third dose of hepatitis B vaccine reached 84%, and global coverage with the birth dose of hepatitis B vaccine was 39%. ⁴ In addition, infants do not receive hepatitis B immune globulin if their mothers are HBV negative. Therefore, our recommendation is that HBV-positive mothers should not be informal breast milk donors.