ABSTRACT
Purpose of Study: Health policy regarding possible mother-to-child transmission of SARS-CoV-2 via breastfeeding was highly debated during the first months of the COVID-19 pandemic. However, subsequent research revealed that mother-to-infant transmission of SARS-COV-2 through breastmilk is highly unlikely, and the World Health Organization continues to recommend breastfeeding for all mothers, including those with confirmed COVID-19. Another mode of viral transmission and diagnostic testing that garnered scientific interest is the fecal route.The purpose of this study was to determine the detection rate of SARS-CoV-2 RNA in fecal samples collected from breastfeeding mothers with and without confirmed COVID-19. Methods Used: From April 2020 to March 2021, fecal samples were collected repeatedly over an 8-wk period from 28 nursing mothers with confirmed COVID-19 (162 total fecal samples) and from 24 healthy nursing mothers with no known exposure to COVID-19 (93 total fecal samples). For mothers enrolled within 7 d of a positive COVID-19 test, up to 7 repeated samples were collected: 3 in the first wk and 1 each at wk 2, 3, 4, and 8. For self-reported healthy mothers, up to 4 samples were collected: d 1, d 7, wk 3, and wk 8. RNA was isolated, and the presence of SARS-CoV-2 RNA was determined using RT-qPCR following a modified version of the CDC's SARS-CoV-2 assay. Summary of Results: Among COVID-19-positive mothers, 7/28 (25%) had SARS-CoV-2 in at least one fecal sample. Among these mothers, mean duration of presence of SARS-CoV-2 in feces was 1.6 +/- 1.4 wk. One mother had SARS-CoV-2 in feces in five samples (d 1, d 3, d 7, wk 2, wk 4), while two mothers only had SARS-CoV-2 in a single fecal sample. Among healthy breastfeeding mothers without known COVID-19 exposures, 1/24 (4.2%) had SARS-CoV-2 in a single sample (d 7). Conclusion(s): We detected SARS-CoV-2 in feces of 25% of breastfeeding mothers with COVID-19 and 4.2% of breastfeeding mothers who self-reported no known COVID-19 sickness or exposures. Our data reveal that only 5/28 (17.9%) of d 1 fecal samples collected from mothers with COVID-19 had detectable SARS-CoV-2. (Table Presented).