Presence of Ebola Virus in Breast Milk and Its Risk of Transmission to Breastfeeding Infants: Synthesis of Evidence

Abstract Objectives This study aimed to synthesize evidence related to the presence in and transmission of the Ebola virus (EBOV) through breast milk to help inform global guidelines on infant feeding. Methods We conducted a comprehensive systematic search in international and regional databases to identify original studies describing women with suspected or confirmed EBOV infection intending to breastfeed or give breast milk to an infant. Studies documenting any breastfeeding woman who has been vaccinated or is suspected or confirmed of viral infection at any time during or after pregnancy were identified. Records were independently screened by two authors and after duplicate records were removed, studies that met the inclusion criteria were selected for data extraction. Results From a total of 24,473 non-duplicate studies, we found six case reports that included seven breastfeeding mothers with suspected or confirmed EBOV infection and their eight children (one mother with twins). EBOV was detected via RT-PCR and/or by culture in five out of six breast milk samples that were collected from the mothers. Five out of the seven breastfed infants were found positive for EBOV infection and all of the identified cases led to death. Conclusions Ebola virus was detected in 5 out of 6 breast milk samples analyzed. Since the virus has also been detected in tears, saliva, and sweat, it is not possible to conclude with certainty that the transmission was through breast milk. Prospective studies are needed in order to define the safety of feeding infants with breast milk from mothers infected with EBOV. Funding Sources Department of Nutrition and Food Safety, WHO.

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Update on the Transmission of Zika Virus Through Breast Milk and Breastfeeding: A Systematic Review of the Evidence

Viruses ◽

10.3390/v13010123 ◽

2021 ◽

Vol 13 (1) ◽

pp. 123

Author(s):

Elizabeth Centeno-Tablante ◽

Melisa Medina-Rivera ◽

Julia L. Finkelstein ◽

Heather S. Herman ◽

Pura Rayco-Solon ◽

...

Keyword(s):

Breast Milk ◽

Zika Virus ◽

Mother To Child Transmission ◽

Inclusion Criteria ◽

Rt Pcr ◽

Child Transmission ◽

Zikv Infection ◽

Milk Samples ◽

Clinical Complications ◽

Mother To Child

We systematically searched regional and international databases and screened 1658 non-duplicate records describing women with suspected or confirmed ZIKV infection, intending to breastfeed or give breast milk to an infant to examine the potential of mother-to-child transmission of Zika virus (ZIKV) through breast milk or breastfeeding-related practices. Fourteen studies met our inclusion criteria and inform this analysis. These studies reported on 97 mother–children pairs who provided breast milk for ZIKV assessment. Seventeen breast milk samples from different women were found positive for ZIKV via RT-PCR, and ZIKV replication was found in cell cultures from five out of seven breast milk samples from different women. Only three out of six infants who had ZIKV infection were breastfed, no evidence of clinical complications was found to be associated with ZIKV RNA in breast milk. This review updates our previous report by including 12 new articles, in which we found no evidence of ZIKV mother-to-child transmission through breast milk intake or breastfeeding. As the certainty of the present evidence is low, additional studies are still warranted to determine if ZIKV can be transmitted through breastfeeding.

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Immunoglobulin A antibodies directed againstCampylobacter jejuniflagellin present in breast–milk

Epidemiology and Infection ◽

10.1017/s0950268800057769 ◽

1994 ◽

Vol 112 (2) ◽

pp. 359-365 ◽

Cited By ~ 12

Author(s):

I. Nachamkin ◽

S. H. Fischer ◽

X.-H. Yang ◽

O. Benitez ◽

A. Cravioto

Keyword(s):

Breast Milk ◽

Protective Effect ◽

Statistical Significance ◽

Immunoglobulin A ◽

Specific Antibodies ◽

Breastfed Infants ◽

Milk Samples ◽

The Difference ◽

Campylobacter Infection ◽

The Relationship

SUMMAYWe studied the relationship between IgA anti–campylobacter flagellin antibodies in breast milk samples and protection of breastfed infants living in a rural Mexican village from campylobacter infection. There were fewer episodes of campylobacter infection (symptomatic and asymptomatic combined) in infants breastfed with milk containing specific anti-flagellin antibodies (1.2/child/year, 95% CI 0.6–1.8) versus non–breastfed children (3.3/child/year, 95% CI 1.8–4.8; P < 0.01). Infants breastfed with milk that was antiflagellin antibody negative by ELISA also had fewer episodes of infection compared with non-breastfed children, but the difference did not reach statistical significance (1.8/child/year, 95% CI 0.7–3.0 versus 3.3/child/year, 95% CI 1.8–4.8, P > 0.05). Breastfeeding has a protective effect against campylobacter infection and is associated with the presence of specific antibodies directed against campylobacter flagellin.

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Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study

JMIR Research Protocols ◽

10.2196/19119 ◽

2020 ◽

Vol 9 (11) ◽

pp. e19119

Author(s):

Oraporn Dumrongwongsiri ◽

Pattanee Winichagoon ◽

Nalinee Chongviriyaphan ◽

Umaporn Suthutvoravut ◽

Veit Grote ◽

...

Keyword(s):

Breast Milk ◽

Pregnant Women ◽

Iron Status ◽

Deuterium Oxide ◽

Nutrient Status ◽

Dietary Intakes ◽

Breastfed Infants ◽

Milk Samples ◽

Longitudinal Observational Study

Background Zinc and iron deficiencies among breastfed infants during the first 6 months of life have been reported in previous studies. The amounts of zinc and iron intakes from breast milk are factors that contribute to the zinc and iron status of breastfed infants. Objective This study aims to quantitatively determine zinc and iron intakes by breastfed infants during the first 4 months of life and to investigate the factors that predict zinc and iron status in breastfed infants. Methods Pregnant women at 28 to 34 weeks of gestation were enrolled. Zinc and iron status during pregnancy was assessed. At delivery, cord blood was analyzed for zinc and iron levels. Participants and their babies were followed at 2 and 4 months postpartum. Maternal dietary intakes and anthropometric measurements were performed. The amount of breast milk intake was assessed using the deuterium oxide dose-to-mother technique. Breast milk samples were collected for determination of zinc and iron levels. The amount of zinc and iron consumed by infants was calculated. Zinc and iron status was determined in mothers and infants at 4 months postpartum. Results A total of 120 pregnant women were enrolled, and 80 mother-infant pairs completed the study (56 provided full breastfeeding, and 24 provided breast milk with infant formula). All data are being managed and cleaned. Statistical analysis will be done. Conclusions This study will provide information on zinc and iron intakes in exclusively breastfed infants during the first 4 months of life and explore predictive factors and the possible association of zinc and iron intakes with infant growth and nutrient status. International Registered Report Identifier (IRRID) DERR1-10.2196/19119

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A Meta-Analysis of the Prevalence of Cardiac Valvulopathy in Patients With Hyperprolactinemia Treated With Cabergoline

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-01071 ◽

2018 ◽

Vol 104 (2) ◽

pp. 523-538 ◽

Cited By ~ 8

Author(s):

Craig E Stiles ◽

Eugene T Tetteh-Wayoe ◽

Jonathan P Bestwick ◽

Richard P Steeds ◽

William M Drake

Keyword(s):

Tricuspid Regurgitation ◽

Clinical Symptoms ◽

Single Case ◽

Case Reports ◽

Data Extraction ◽

Meta Analysis ◽

Pituitary Tumors ◽

Inclusion Criteria ◽

Case Control Studies ◽

Meta Analyses

Abstract Context Cabergoline is first-line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high dosages in Parkinson disease (PD) has largely been abandoned because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower dosages for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist. Objective To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically significant cardiac valvulopathy. Data Sources Full-text articles published through January 2017 were found via PubMed and selected according to strict inclusion criteria. Study Selection All case-control studies were included where patients had received ≥6 months of cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review articles, and articles pertaining solely to PD were excluded. Of 76 originally selected studies, 13 met inclusion criteria. Data Extraction Desired data were compiled and extracted from articles by independent observers. Each also independently graded article quality (bias) and met to reach consensus. Data Synthesis More tricuspid regurgitation was observed (OR 3.74; 95% CI, 1.79 to 7.8; P < 0.001) in the cabergoline-treated patients compared with controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy. Conclusions Treatment with low-dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this finding is unclear and warrants further investigation.

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Acrylamide Content in Breast Milk: The Evaluation of the Impact of Breastfeeding Women’s Diet and the Estimation of the Exposure of Breastfed Infants to Acrylamide in Breast Milk

Toxics ◽

10.3390/toxics9110298 ◽

2021 ◽

Vol 9 (11) ◽

pp. 298

Author(s):

Hanna Mojska ◽

Iwona Gielecińska ◽

Joanna Winiarek ◽

Włodzimierz Sawicki

Keyword(s):

Breast Milk ◽

Human Milk ◽

Maillard Reaction ◽

Mature Milk ◽

Dietary Recall ◽

Breastfed Infants ◽

Milk Samples ◽

Dietary Acrylamide ◽

The Impact ◽

Carcinogenic Compound

Acrylamide in food is formed by the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. The aim of this study was to determine the level of acrylamide in breast milk at different lactation stages and to evaluate the impact of breastfeeding women’s diet on the content of this compound in breast milk. The acrylamide level in breast milk samples was determined by LC–MS/MS. Breastfeeding women’s diet was evaluated based on the 24 h dietary recall. The median acrylamide level in colostrum (n = 47) was significantly (p < 0.0005) lower than in the mature milk (n = 26)—0.05 µg/L and 0.14 µg/L, respectively. The estimated breastfeeding women’s acrylamide intake from the hospital diet was significantly (p < 0.0001) lower than that from the home diet. We found positive—although modest and borderline significant—correlation between acrylamide intake by breastfeeding women from the hospital diet µg/day) and acrylamide level in the colostrum (µg/L). Acrylamide has been detected in human milk samples, and a positive correlation between dietary acrylamide intake by breastfeeding women and its content in breast milk was observed, which suggests that the concentration can be reduced. Breastfeeding women should avoid foods that may be a source of acrylamide in their diet.

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Determining the Actual Zinc and Iron Intakes in Breastfed Infants: Protocol for a Longitudinal Observational Study (Preprint)

10.2196/preprints.19119 ◽

2020 ◽

Author(s):

Oraporn Dumrongwongsiri ◽

Pattanee Winichagoon ◽

Nalinee Chongviriyaphan ◽

Umaporn Suthutvoravut ◽

Veit Grote ◽

...

Keyword(s):

Breast Milk ◽

Pregnant Women ◽

Iron Status ◽

Deuterium Oxide ◽

Nutrient Status ◽

Dietary Intakes ◽

Breastfed Infants ◽

Milk Samples ◽

Longitudinal Observational Study

BACKGROUND Zinc and iron deficiencies among breastfed infants during the first 6 months of life have been reported in previous studies. The amounts of zinc and iron intakes from breast milk are factors that contribute to the zinc and iron status of breastfed infants. OBJECTIVE This study aims to quantitatively determine zinc and iron intakes by breastfed infants during the first 4 months of life and to investigate the factors that predict zinc and iron status in breastfed infants. METHODS Pregnant women at 28 to 34 weeks of gestation were enrolled. Zinc and iron status during pregnancy was assessed. At delivery, cord blood was analyzed for zinc and iron levels. Participants and their babies were followed at 2 and 4 months postpartum. Maternal dietary intakes and anthropometric measurements were performed. The amount of breast milk intake was assessed using the deuterium oxide dose-to-mother technique. Breast milk samples were collected for determination of zinc and iron levels. The amount of zinc and iron consumed by infants was calculated. Zinc and iron status was determined in mothers and infants at 4 months postpartum. RESULTS A total of 120 pregnant women were enrolled, and 80 mother-infant pairs completed the study (56 provided full breastfeeding, and 24 provided breast milk with infant formula). All data are being managed and cleaned. Statistical analysis will be done. CONCLUSIONS This study will provide information on zinc and iron intakes in exclusively breastfed infants during the first 4 months of life and explore predictive factors and the possible association of zinc and iron intakes with infant growth and nutrient status. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19119

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Update on the Transmission of Zika Virus Through Breast Milk and Breastfeeding: A Systematic Review of the Evidence

10.20944/preprints202012.0188.v1 ◽

2020 ◽

Author(s):

Elizabeth Centeno-Tablante ◽

Melisa Medina-Rivera ◽

Julia L Finkelstein ◽

Heather Herman ◽

Pura Rayco-Solon ◽

...

Keyword(s):

Breast Milk ◽

Zika Virus ◽

Mother To Child Transmission ◽

Inclusion Criteria ◽

Child Transmission ◽

Zikv Infection ◽

Milk Samples ◽

Clinical Complications ◽

Breastfeeding Practices ◽

Mother To Child

To gain new insights into the potential of mother-to-child transmission of Zika virus (ZIKV) through breast milk or breastfeeding practices, we systematically searched regional and international databases and screened 1,658 non-duplicate records describing women with suspected or confirmed ZIKV infection, intending to breastfeed or give breast milk to an infant. Fourteen studies met our inclusion criteria and inform this analysis. These studies reported on 97 mother-children pairs who provided breast milk for ZIKV assessment. Seventeen breast milk samples from different women were found positive for ZIKV via RT-PCR, and ZIKV replication was found in cell cultures from five out of seven breast milk samples from different women. Only three out of six infants who had ZIKV infection were breastfed, no evidence of clinical complications were found to be associated with ZIKV RNA in breast milk. This review updates our previous report by synthesizing the evidence from 12 new articles and we find no evidence of mother-to-child transmission through breast milk intake or breastfeeding. As the certainty of the present evidence is low, additional studies are still warranted to completely understand any potential of transmission of ZIKV through breastfeeding.

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AB1294-HPR LOW CONCENTRATIONS OF BIOLOGIC DMARDS IN BREASTMILK OF PATIENTS TREATED DURING LACTATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4431 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1937.1-1937

Author(s):

A. Zbinden ◽

K. Eriksson ◽

F. Förger

Keyword(s):

Breast Milk ◽

Certolizumab Pegol ◽

Average Concentration ◽

Limited Information ◽

Serum Samples ◽

Limit Of Quantification ◽

Biologic Dmards ◽

Breastfed Infants ◽

Milk Samples ◽

Infant Dose

Background:There is very limited information about the passage of biologics into breast milk and into the peripheral blood of breastfed infants. However, based on pharmacological properties of biologic DMARDs (bDMARDs) lactation may not be discouraged in patients with chronic inflammatory rheumatic disease to treat or prevent postpartum relapses. We here report two cases treated with bDMARDs during lactation: one woman with Muckle-Wells syndrome (MWS) treated with canakinumab and one woman with microscopic polyangiitis (MPA) treated with rituximab.Objectives:To determine the level of rituximab and canakinumab in breast milk, in sera of breastfed infants as well as in sera of the mother and to calculate the average daily infant dose and the relative infant dose.Methods:Serum and milk levels of Rituximab were measured by ELISA using commercially available coating and detection antibodies. For Canakinumab an ELISA was established by coating of plates with recombinant human IL-1beta and detection of Canakinumab in samples by a polyclonal anti-human IgG coupled to HRP. In both cases separate standard curves for serum and milk were established. Serum samples and milk samples of unexposed healthy controls were used to determine the lower limit of quantification.Results:One patient with MWS received canakinumab 150 mg s.c. to treat a worsening of her disease ten days postpartum. She continued to breastfeed her child. The average concentration of canakinumab in milk samples collected on 10 consecutive days was 15.8 ng/ml. The average daily infant dose was 0.002 mg/kg/day. The relative infant dose, which refers infant to maternal exposure on a dose/weight basis, was 0.11%. There was no detectable canakinumab in the serum of the infant.One patient with MPA received rituximab 500 mg i.v. as a remission maintenance therapy four months postpartum. She continued to breastfeed her child. The average concentration of rituximab in milk samples collected on 4 consecutive days was 3.71 ng/ml. The average daily infant dose was 0.001 mg/kg/day. The relative infant dose was 0.01%. There was no detectable rituximab in the serum of the infant.Conclusion:Only minimal concentrations of canakinumab and rituximab can be detected in breastmilk. For both bDMARDs, the relative infant dose was below 1% of the maternal dose, which is considered unlikely to be of clinical concern. The lack of detectable levels of canakinumab and rituximab in the infants’ sera supports the notion of low oral bioavailability of large monoclonal antibodies. Together, the results are similar to those seen in TNF inhibitors which are regarded to be compatible with breastfeeding, yet more data are needed (1, 2, 3).References:[1]Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. Epub 2016 Feb 17.[2]Clowse ME, Förger F, Hwang C, Thorp J, Dolhain RJ, van Tubergen A, Shaughnessy L, Simpson J, Teil M, Toublanc N, Wang M, Hale TW. Minimal to no transfer of certolizumab pegol into breast milk: results from CRADLE, a prospective, postmarketing, multicentre, pharmacokinetic study. Ann Rheum Dis. 2017 Nov;76(11):1890-1896. doi: 10.1136/annrheumdis-2017-211384. Epub 2017 Aug 16.[3]Matro R, Martin CF, Wolf D, Shah SA, Mahadevan U. Exposure Concentrations of Infants Breastfed by Women Receiving Biologic Therapies for Inflammatory Bowel Diseases and Effects of Breastfeeding on Infections and Development.Gastroenterology. 2018;155(3):696–704. doi:10.1053/j.gastro.2018.05.040Disclosure of Interests:Astrid Zbinden: None declared, Klara Eriksson: None declared, Frauke Förger Grant/research support from: Unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK

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Terson sign:

Jornal Memorial da Medicina ◽

10.37085/jmmv2.n1.2020.pp.38-43 ◽

2020 ◽

Vol 2 (1) ◽

pp. 38-43

Author(s):

Luiz Severo Bem Junior ◽

Gustavo De Souza Andrade ◽

Joao Ribeiro Memória Júnior ◽

Hildo Rocha Cirne de Azevedo Filho

Keyword(s):

Subarachnoid Hemorrhage ◽

Early Recognition ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Reports ◽

Clinical Status ◽

Vitreous Hemorrhage ◽

Anterior Communicating Artery ◽

Inclusion Criteria ◽

Relationship Of ◽

The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

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COVID-19 Vaccine mRNABNT162b2 Elicits Human Antibody Response in Milk of Breastfeeding Women

Vaccines ◽

10.3390/vaccines9070785 ◽

2021 ◽

Vol 9 (7) ◽

pp. 785

Author(s):

Maurizio Guida ◽

Daniela Terracciano ◽

Michele Cennamo ◽

Federica Aiello ◽

Evelina La Civita ◽

...

Keyword(s):

Breast Milk ◽

Antibody Response ◽

Human Milk ◽

Human Antibody ◽

Serum Antibodies ◽

Serum Samples ◽

Low Concentration ◽

Milk Samples ◽

Milk Antibodies ◽

Roche Diagnostics

Objective: The objective of this research is to demonstrate the release of SARS-CoV-2 Spike (S) antibodies in human milk samples obtained by patients who have been vaccinated with mRNABNT162b2 vaccine. Methods: Milk and serum samples were collected in 10 volunteers 20 days after the first dose and 7 seven days after the second dose of the mRNABNT162b2 vaccine. Anti-SARS-CoV-2 S antibodies were measured by the Elecsys® Anti-SARS-CoV-2 S ECLIA assay (Roche Diagnostics AG, Rotkreuz, Switzerland), a quantitative electrochemiluminescence immunometric method. Results: At first sample, anti-SARS-CoV-2 S antibodies were detected in all serum samples (103.9 ± 54.9 U/mL) and only in two (40%) milk samples with a low concentration (1.2 ± 0.3 U/mL). At the second sample, collected 7 days after the second dose, anti-SARS-CoV-2 S antibodies were detected in all serum samples (3875.7 ± 3504.6 UI/mL) and in all milk samples (41.5 ± 47.5 UI/mL). No correlation was found between the level of serum and milk antibodies; the milk antibodies/serum antibodies ratio was on average 2% (range: 0.2–8.4%). Conclusion: We demonstrated a release of anti-SARS-CoV-2 S antibodies in the breast milk of women vaccinated with mRNABNT162b2. Vaccinating breastfeeding women could be a strategy to protect their infants from COVID-19 infection.

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