Reply:

We would like to point out an omission in the AASLD Practice Guidelines on Chronic Hepatitis B published in the February 2007 issue of HEPATOLOGY.1 In the section discussing the counseling and prevention of hepatitis B on pages 508-509 and in the accompanying table (Table 3), when discussing infants born to hepatitis B virus (HBV)-infected mothers, the authors neglected to discuss the issue of breast-feeding. This is certainly worth mentioning because some mothers feel breast-feeding to be an integral part of the care they provide to their infants, and mothers prohibited from breast-feeding may feel some sense of inadequacy. As you know, breast-feeding is not prohibited in HBV-infected mothers, as proven by several studies, some of which are listed here.2-4 Furthermore, because infants should routinely receive HBV immune globulin and HBV vaccine, they are almost universally protected against postpartum maternal HBV transmission. We think an additional 1-2 sentences should be included in the guidelines to address this issue.