Open Access Highly Accessed Research article

Should chronic hepatitis B mothers breastfeed? a meta analysis

Yingjie Zheng12*, Yihan Lu12, Qi Ye3, Yugang Xia12, Yueqin Zhou3, Qingqing Yao12 and Shan Wei12

Author Affiliations

1 Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China

2 The Key Laboratory on Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China

3 Library of Medical Centre, Fudan University, Shanghai 200032, China

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BMC Public Health 2011, 11:502  doi:10.1186/1471-2458-11-502

Published: 27 June 2011



Hepatitis B virus (HBV) exists in the breast milk of chronic hepatitis B (CHB) mothers. The authors use a meta-analytic technique to quantify the evidence of an association between breastfeeding and risk of CHB infection among the infants vaccinated against HBV.


Literature search is performed up to 2010 on the relationship between infantile CHB infection within one-year follow up after immunization with the third-dose hepatitis B vaccine and breastfeeding. Two reviewers independently extract the data and evaluate the methodological quality. A random-effects model is employed to systematically combine the results of all included studies.


Based on data from 32 studies, 4.32% (244/5650) of infants born of CHB mothers develop CHB infection. The difference in risk of the infection between breastfed and formula-fed infants (RD) is -0.8%, (95% confidence interval [CI]: -1.6%, 0.1%). Analysis of the data from 16 of the studies finds that RD for mothers who are positive for the HBeAg and/or the HBV DNA, 0.7% (95%CI: -2.0%, 3.5%), is similar to that for those who are negative for these infectivity markers, -0.5% (95%CI: -1.7%, 0.6%).


Breast milk is infectious; yet, breastfeeding, even by mothers with high infectivity, is not associated with demonstrable risk of infantile CHB infection, provided that the infants have been vaccinated against HBV at birth.