A breastfeeding mother is potentially exposed to rabies, after being bitten by a stray dog that bit another person and disappeared. Rabies vaccine was started some 3 days after the bite, and reportedly safe during breastfeeding.
The baby is only 2 months old. So is the baby at risk? Does the baby need to continue breastfeeding? Get vaccinated?
Have a blessed day
Emmanuel.
Any type of vaccine can be given safely according to category of bite to the rabies exposed lactating mother. Breast feeding can be continued during the PEP treatment.Although the chances of human to human transmission of rabies are minimal.But as it is a fatal disease so if the lactating mother is a frank case of hydrophobia and chances of exposure to the saliva, then PEP should be given to an infant.
I agree with Mohan's comment above. So long as the mother is not symptomatic breastfeeding should be continued as post exposure prophylactic vaccination would not be necessary.
Let's identify some of the probabilities associated with this case:
P that mother was exposed to real rabies: moderate
P that she will develop rabies given real exposure: low to very very low (depending on PEP procedures)
P that she will shed virus without developing disease: zero
P that she will shed virus in the milk given clinical rabies: very very low (some weak evidence suggests it might be possible)
P that she will shed virus in her saliva given clinical rabies: probable
P that baby can contract rabies given viral shedding by mother: probable (although never recorded)
P that baby will receive protective antibodies through milk: very likely
Adding all these up I would say that the risk for the baby is low but can be mitigated by allowing it to breastfeed.
The mother is exposed, not sick- providing the PEP is given at an appropriate time and following protocol (which seems to be the case), she will not shed the virus. However it is likely that the vaccine antibodies will give protection to the baby through breast milk. So all in all I would advise to adhere strictly to the PEP guideline and continue breastfeeding. I presume the bite occured in Uganda?
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