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1.
Nestle Nutr Inst Workshop Ser ; 96: 57-71, 2021.
Article in English | MEDLINE | ID: covidwho-1840675

ABSTRACT

Donor milk (DM) is of increasing interest as primary nutritional source for preterm infants. Safe access requires special infrastructure, trained staff, sophisticated algorithms, and standard operating procedures as well as quality control measures. DM has limitations like low protein content and unpredictable composition of the other macronutrients, despite fortification frequently not meeting recommendations - both of them compromising growth. The first paragraph is devoted to COVID-19 and how it impacts processes of DM banking. The following paragraphs review aspects of "pasteurization," "safety audits/donor screening," and "DM nutrient variability." In summary, (i) Holder pasteurization still is the most suitable procedure for milk banks, but high-pressure pasteurization or ultraviolet C irradiation conserve the unique properties of DM better and deserve more research to make it suitable for clinical routine. (ii) In regard to safety/screening, guidelines are valuable for safe DM bank operation, but they differ between legislations. There is a surprisingly high rate of non-disclosed donor smoking (0.3%, p > 0.05) and of adulteration of delivered DM (up to 2%, p < 0.05) not detected by standard donor screening procedures. Frequencies differ between remunerated and non-remunerated programs. (iii) Neonatal caregivers should be aware of unpredictable composition of DM. They should be trained on how these can be overcome to avoid negative impact on growth and long-term outcomes like (a) measuring and disclosing nutrient contents of delivered DM batches to customers, (b) implementing certain types of donor pooling to reduce the risk of macronutrient depleted DM, (c) additional supplementation using 0.3-0.5 g protein/100 mL seems to be reasonable, (d) adjusted fortification may help to improve growth, but is not efficient in all preterm infants, (e) target fortification seems to improve growth (and probably also neurodevelopmental index) compared to standard fortification, (f) more research and clinical studies are needed.


Subject(s)
COVID-19 , Milk Banks , Humans , Infant , Infant, Newborn , Infant, Premature , Milk, Human/chemistry , Pasteurization/methods
2.
Obstet Gynecol ; 139(2): 181-191, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1774425

ABSTRACT

OBJECTIVE: To evaluate immune responses to coronavirus disease 2019 (COVID-19) mRNA-based vaccines present in breast milk and transfer of the immune responses to breastfeeding infants. METHODS: We enrolled 30 lactating women who received mRNA-based COVID-19 vaccines from January through April 2021 in this cohort study. Women provided serial milk samples, including milk expressed before vaccination, across 2-3 weeks after the first dose, and across 3 weeks after the second dose. Women provided their blood, spotted on cards (dried blood spots), 19 days after the first dose and 21 days after the second dose. Stool samples from the breastfed infants were collected 21 days after mothers' second vaccination. Prepandemic samples of milk, dried blood spots, and infant stool were used as controls. Milk, dried blood spots, and infant stool were tested by enzyme-linked immunosorbent assay for receptor-binding domain (RBD)-specific immunoglobulin (Ig)A and IgG. Milk samples were tested for the presence of neutralizing antibodies against the spike and four variants of concern: D614G, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1). Levels of 10 cytokines were measured in milk samples. RESULTS: Milk from COVID-19-immunized women neutralized the spike and four variants of concern, primarily driven by anti-RBD IgG. The immune response in milk also included significant elevation of interferon-γ. The immune response to maternal vaccination was reflected in breastfed infants: anti-RBD IgG and anti-RBD IgA were detected in 33% and 30% of infant stool samples, respectively. Levels of anti-RBD antibodies in infant stool correlated with maternal vaccine side effects. Median antibody levels against RBD were below the positive cutoffs in prepandemic milk and infant stool samples. CONCLUSION: Humoral and cellular immune responses to mRNA-based COVID-19 vaccination are present in most women's breast milk. The milk anti-RBD antibodies can neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike and variants of concern. Anti-RBD antibodies are transferred to breastfed infants, with the potential to confer passive immunity against SARS-CoV-2.


Subject(s)
Antibodies, Neutralizing/analysis , Breast Feeding , COVID-19 Vaccines/immunology , Cytokines/analysis , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , Antibodies, Viral/analysis , Cohort Studies , Female , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Infant , Infant, Newborn , Middle Aged , Vaccination
3.
Front Immunol ; 12: 783975, 2021.
Article in English | MEDLINE | ID: covidwho-1699418

ABSTRACT

Background: There is limited information on the functional neutralizing capabilities of breastmilk SARS-CoV-2-specific antibodies and the potential adulteration of breastmilk with vaccine mRNA after SARS-CoV-2 mRNA vaccination. Methods: We conducted a prospective cohort study of lactating healthcare workers who received the BNT162b2 vaccine and their infants. The presence of SARS-CoV-2 neutralizing antibodies, antibody isotypes (IgG, IgA, IgM) and intact mRNA in serum and breastmilk was evaluated at multiple time points using a surrogate neutralizing assay, ELISA, and PCR, over a 6 week period of the two-dose vaccination given 21 days apart. Results: Thirty-five lactating mothers, median age 34 years (IQR 32-36), were included. All had detectable neutralizing antibodies in the serum immediately before dose 2, with significant increase in neutralizing antibody levels 7 days after this dose [median 168.4 IU/ml (IQR 100.7-288.5) compared to 2753.0 IU/ml (IQR 1627.0-4712.0), p <0.001]. Through the two vaccine doses, all mothers had detectable IgG1, IgA and IgM isotypes in their serum, with a notable increase in all three antibody isotypes after dose 2, especially IgG1 levels. Neutralizing antibodies were detected in majority of breastmilk samples a week after dose 2 [median 13.4 IU/ml (IQR 7.0-28.7)], with persistence of these antibodies up to 3 weeks after. Post the second vaccine dose, all (35/35, 100%) mothers had detectable breastmilk SARS-CoV-2 spike RBD-specific IgG1 and IgA antibody and 32/35 (88.6%) mothers with IgM. Transient, low intact vaccine mRNA levels was detected in 20/74 (27%) serum samples from 21 mothers, and 5/309 (2%) breastmilk samples from 4 mothers within 1 weeks of vaccine dose. Five infants, median age 8 months (IQR 7-16), were also recruited - none had detectable neutralizing antibodies or vaccine mRNA in their serum. Conclusion: Majority of lactating mothers had detectable SARS-CoV-2 antibody isotypes and neutralizing antibodies in serum and breastmilk, especially after dose 2 of BNT162b2 vaccination. Transient, low levels of vaccine mRNA were detected in the serum of vaccinated mothers with occasional transfer to their breastmilk, but we did not detect evidence of infant sensitization. Importantly, the presence of breastmilk neutralising antibodies likely provides a foundation for passive immunisation of the breastmilk-fed infant.


Subject(s)
Antibodies, Neutralizing/analysis , Antibodies, Viral/analysis , Milk, Human/immunology , Adult , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , /blood , Cohort Studies , Female , Health Personnel , Humans , Immunoglobulin Isotypes/analysis , Immunoglobulin Isotypes/blood , Infant , Lactation , Milk, Human/chemistry , Prospective Studies
4.
Pediatrics ; 149(2)2022 02 01.
Article in English | MEDLINE | ID: covidwho-1607590

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies have been detected in human milk up to 6 weeks post-coronavirus disease 2019 (COVID-19) vaccination. We evaluated SARS-CoV-2-specific antibodies, neutralization activity, effect of pasteurization, and persistence through 6 months after vaccination. METHODS: This prospective longitudinal study enrolled 30 pregnant or lactating women. SARS-CoV-2 antibodies and neutralization capacity were analyzed using an enzyme-linked immunosorbent assay compared at prevaccination and 1, 3, and 6 months postvaccination, and through Holder pasteurization. RESULTS: Human milk SARS-CoV-2-specific IgG levels peaked at 1 month postvaccination and persisted above prevaccination levels for at least 6 months (P = .005). SARS-CoV-2-specific IgA was detected at 1 and 3 months (both P < .001) but waned by 6 months compared with baseline (P = .07). Milk SARS-CoV-2-specific IgG and IgA correlated with serum IgG at the same time point (R2 = 0.37, P < .001 and R2 = 0.19, P < .001). Neutralization activity was seen in 83.3%, 70.4%, and 25.0% of milk samples at 1, 3, and 6 months postvaccination. Neutralization most strongly correlated with SARS-CoV-2-specific IgG (R2 = 0.57, P < .001). Pre- and postpasteurization samples showed similar IgG (0.84 vs 1.07, P = .36) and neutralizing activity (57.7% vs 58.7% inhibition, P = .27), but lower IgM and IgA levels postpasteurization (0.09 vs 0.06, P = .004 and 0.21 vs 0.18, P = .043). CONCLUSIONS: The data suggest that human milk SARS-CoV-2-specific antibodies may be available to milk-fed infants for up to 6 months. In addition, donor milk from vaccinated mothers retain IgG and neutralizing activity.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Vaccines , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , Breast Feeding , Female , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Infant , Infant, Newborn , Lactation , Longitudinal Studies , Pasteurization , Prospective Studies
5.
PLoS One ; 16(9): e0257878, 2021.
Article in English | MEDLINE | ID: covidwho-1443847

ABSTRACT

Extracellular microRNAs (miRNAs) have been proposed to function in cross-kingdom gene regulation. Among these, plant-derived miRNAs of dietary origin have been reported to survive the harsh conditions of the human digestive system, enter the circulatory system, and regulate gene expression and metabolic function. However, definitive evidence supporting the presence of plant-derived miRNAs of dietary origin in mammals has been difficult to obtain due to limited sample sizes. We have developed a bioinformatics pipeline (ePmiRNA_finder) that provides strident miRNA classification and applied it to analyze 421 small RNA sequencing data sets from 10 types of human body fluids and tissues and comparative samples from carnivores and herbivores. A total of 35 miRNAs were identified that map to plants typically found in the human diet and these miRNAs were found in at least one human blood sample and their abundance was significantly different when compared to samples from human microbiome or cow. The plant-derived miRNA profiles were body fluid/tissue-specific and highly abundant in the brain and the breast milk samples, indicating selective absorption and/or the ability to be transported across tissue/organ barriers. Our data provide conclusive evidence for the presence of plant-derived miRNAs as a consequence of dietary intake and their cross-kingdom regulatory function within human circulating system.


Subject(s)
Computational Biology/methods , MicroRNAs/genetics , Plants/genetics , Sequence Analysis, RNA/methods , Animal Feed/analysis , Animals , Brain Chemistry , Carnivora/genetics , Diet , Female , Herbivory/genetics , Humans , Milk, Human/chemistry , Organ Specificity , RNA, Plant/genetics , Sample Size
6.
Nutrients ; 13(3)2021 Mar 06.
Article in English | MEDLINE | ID: covidwho-1383899

ABSTRACT

In 2020, with the advent of a pandemic touching all aspects of global life, there is a renewed interest in nutrition solutions to support the immune system. Infants are vulnerable to infection and breastfeeding has been demonstrated to provide protection. As such, human milk is a great model for sources of functional nutrition ingredients, which may play direct roles in protection against viral diseases. This review aims to summarize the literature around human milk (lactoferrin, milk fat globule membrane, osteopontin, glycerol monolaurate and human milk oligosaccharides) and infant nutrition (polyunsaturated fatty acids, probiotics and postbiotics) inspired ingredients for support against viral infections and the immune system more broadly. We believe that the application of these ingredients can span across all life stages and thus apply to both pediatric and adult nutrition. We highlight the opportunities for further research in this field to help provide tangible nutrition solutions to support one's immune system and fight against infections.


Subject(s)
COVID-19/immunology , Food Ingredients/analysis , Immune System/virology , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , COVID-19/therapy , Female , Functional Food/analysis , Humans , Infant , Infant Nutritional Physiological Phenomena/immunology , Male , Nutrition Therapy/methods
7.
Pediatrics ; 148(5)2021 11.
Article in English | MEDLINE | ID: covidwho-1365458

ABSTRACT

BACKGROUND AND OBJECTIVES: Passive and active immunity transfer through human milk (HM) constitutes a key element in the infant's developing immunity. Certain infectious diseases and vaccines have been described to induce changes in the immune components of HM. METHODS: We conducted a prospective cohort single-institution study from February 2 to April 4, 2021. Women who reported to be breastfeeding at the time of their coronavirus disease 2019 (COVID-19) vaccination were invited to participate. Blood and milk samples were collected on day 14 after their second dose of the vaccine. Immunoglobulin G (IgG) antibodies against nucleocapsid protein as well as IgG, immunoglobulin M and immunoglobulin A (IgA) antibodies against the spike 1 protein receptor-binding domain against severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2 RBD-S1) were analyzed in both serum and HM samples. RESULTS: Most of the participants (ie, 94%) received the BNT162b2 messenger RNA COVID-19 vaccine. The mean serum concentration of anti-SARS-CoV-2 RBD-S-IgG antibodies in vaccinated individuals was 3379.6 ± 1639.5 binding antibody units per mL. All vaccinated study participants had anti-SARS-CoV-2 RBD-S1-IgG, and 89% of them had anti-SARS-CoV-2 RBD-S-IgA in their milk. The antibody concentrations in the milk of mothers who were breastfeeding 24 months were significantly higher than in mothers with breastfeeding periods <24 months (P < .001). CONCLUSIONS: We found a clear association between COVID-19 vaccination and specific immunoglobulin concentrations in HM. This effect was more pronounced when lactation periods exceeded 23 months. The influence of the lactation period on immunoglobulins was specific and independent of other variables.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Vaccines , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Milk, Human/chemistry , Milk, Human/immunology , SARS-CoV-2/immunology , Adult , Female , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Vaccination
8.
Front Immunol ; 12: 720716, 2021.
Article in English | MEDLINE | ID: covidwho-1354867

ABSTRACT

Objetive: To address the prevalence of SARS-CoV-2 and the evolutionary profile of immune compounds in breastmilk of positive mothers according to time and disease state. Methods: Forty-five women with term pregnancies with confirmed non-severe SARS-CoV-2 infection (case group), and 96 SARS-CoV-2 negative women in identical conditions (control group) were approached, using consecutive sample. Weekly (1st to 5th week postpartum) reverse transcription polymerase chain reaction (RT-PCR) in nasopharyngeal swabs (cases) and breastmilk (cases and controls) were obtained. Concentration of cytokines, chemokines, and growth factors in breastmilk (cases and controls) were determined at 1st and 5th week post-partum. Results: Thirty-seven (study group) and 45 (control group) women were enrolled. Symptomatic infection occurred in 56.8% of women in the study group (48% fever, 48% anosmia, 43% cough). SARS-CoV-2 RNA was not found in breastmilk samples. Concentrations of cytokines (IFN-γ, IL-1ra, IL-4, IL-6, IL-9, IL-13, and TNF-α) chemokines (eotaxin, IP-10, MIP-1α, and RANTES) and growth factors (FGF, GM-CSF, IL7, and PDGF-BB) were higher in breastmilk of the study compared with the control group at 1st week postpartum. Immune compounds concentrations decreased on time, particularly in the control group milk samples. Time of nasopharyngeal swab to become negative influenced the immune compound concentration pattern. Severity of disease (symptomatic or asymptomatic infection) did not affect the immunological profile in breast milk. Conclusions: This study confirms no viral RNA and a distinct immunological profile in breastmilk according to mother's SARS-CoV-2 status. Additional studies should address whether these findings indicate efficient reaction against SARS-CoV-2 infection, which might be suitable to protect the recipient child.


Subject(s)
Chemokines/analysis , Cytokines/analysis , Intercellular Signaling Peptides and Proteins/analysis , Milk, Human/chemistry , Milk, Human/immunology , Adult , Breast Feeding , COVID-19 , Case-Control Studies , Female , Humans , Infant, Newborn , Mothers , Pregnancy , Prospective Studies , RNA, Viral
9.
Gac Med Mex ; 157(2): 194-200, 2021.
Article in English | MEDLINE | ID: covidwho-1285651

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected all dimensions of health care, including exclusive breastfeeding assurance and its promotion. The risk of contagion and the consequences of the pandemic have raised concerns among future mothers or in those who are already breastfeeding due to the risk of possible transmission of the virus through breast milk, although active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not yet been detected in breast milk. The fear of contagion has favored mother-child isolation policies. So far, there is no evidence of vertical transmission, and the risk of horizontal transmission in the infant is similar to that of the general population. In infants with COVID-19, breastfeeding can even favorably change the clinical course of the disease.


La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha afectado a todas las dimensiones de la atención en salud, entre ellas el aseguramiento de la lactancia materna exclusiva y su promoción. El riesgo de contagio y las consecuencias de la pandemia han provocado preocupación entre las futuras madres o las que se ya encuentran lactando debido al riesgo de una posible transmisión del virus a través de la leche materna. Aunque aún no se ha detectado el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) activo en la leche materna. El miedo al contagio ha favorecido las políticas de aislamiento madre-hijo. Hasta el momento no existe evidencia de transmisión vertical y el riesgo de transmisión horizontal en el lactante es similar al de la población general. En lactantes con COVID-19 la lactancia materna incluso puede cambiar favorablemente el curso clínico de la enfermedad.


Subject(s)
Breast Feeding , COVID-19 , Milk, Human , Pandemics , Breast Feeding/psychology , COVID-19/epidemiology , COVID-19/transmission , Colostrum/chemistry , Colostrum/metabolism , Disease Transmission, Infectious , Female , Gastrointestinal Microbiome/physiology , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Milk, Human/chemistry , Milk, Human/cytology , Milk, Human/metabolism , Milk, Human/virology , SARS-CoV-2/isolation & purification , Time Factors
10.
Nutrients ; 13(3)2021 Mar 06.
Article in English | MEDLINE | ID: covidwho-1244083

ABSTRACT

In 2020, with the advent of a pandemic touching all aspects of global life, there is a renewed interest in nutrition solutions to support the immune system. Infants are vulnerable to infection and breastfeeding has been demonstrated to provide protection. As such, human milk is a great model for sources of functional nutrition ingredients, which may play direct roles in protection against viral diseases. This review aims to summarize the literature around human milk (lactoferrin, milk fat globule membrane, osteopontin, glycerol monolaurate and human milk oligosaccharides) and infant nutrition (polyunsaturated fatty acids, probiotics and postbiotics) inspired ingredients for support against viral infections and the immune system more broadly. We believe that the application of these ingredients can span across all life stages and thus apply to both pediatric and adult nutrition. We highlight the opportunities for further research in this field to help provide tangible nutrition solutions to support one's immune system and fight against infections.


Subject(s)
COVID-19/immunology , Food Ingredients/analysis , Immune System/virology , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , COVID-19/therapy , Female , Functional Food/analysis , Humans , Infant , Infant Nutritional Physiological Phenomena/immunology , Male , Nutrition Therapy/methods
13.
Int J Mol Sci ; 22(8)2021 Apr 08.
Article in English | MEDLINE | ID: covidwho-1178284

ABSTRACT

BACKGROUND: Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) play a critical role in neurodevelopment, where breast milk is a significant dietary source. The impact of previous COVID-19 infection and mastitis on the concentration of BDNF and NGF in human milk was investigated. METHODS: Concentrations of BDNF and NGF were measured via ELISA in human milk samples collected from 12 mothers with a confirmed COVID-19 PCR, 13 mothers with viral symptoms suggestive of COVID-19, and 22 unexposed mothers (pre-pandemic Ctl-2018). These neurotrophins were also determined in 12 mothers with previous mastitis and 18 mothers without mastitis. RESULTS: The NGF concentration in human milk was lower in the COVID-19 PCR and viral symptoms groups than in the unexposed group, but BDNF did not differ significantly. Within the COVID-19 group, BDNF was higher in mothers who reported headaches or loss of smell/taste when compared with mothers without the respective symptom. BDNF was lower in mothers with mastitis than in mothers without mastitis. CONCLUSIONS: Previous COVID-19 and mastitis infections changed differently the secretion of NGF and BDNF in human milk. Whether the changes in NGF and BDNF levels in milk from mothers with infection influence their infant's development remains to be investigated.


Subject(s)
Brain-Derived Neurotrophic Factor/metabolism , COVID-19/metabolism , Mastitis/metabolism , Milk, Human/chemistry , Nerve Growth Factor/metabolism , Adult , Bodily Secretions/chemistry , Brain-Derived Neurotrophic Factor/analysis , COVID-19/complications , Female , Humans , Mastitis/complications , Mothers , Nerve Growth Factor/analysis
14.
Front Public Health ; 8: 589736, 2020.
Article in English | MEDLINE | ID: covidwho-1143436

ABSTRACT

COVID-19 pandemic since the end of 2019 spreads worldwide, counting millions of victims. The viral invasion, systemic inflammation, and consequent organ failure are the gravest features of coronavirus disease 2019 (COVID-19), and they are associated with a high mortality rate. The aim of this study is to evaluate the role of breast milk in the COVID-19 pandemic, analyzing its antiviral, anti-inflammatory, and immunoregulatory effects due to its bioactive components, so numerous and important for the protection of infants. The study tried to demonstrate that all the components of human milk are capable of performing functions on all the pathogenic events recognized and described in COVID-19 disease. Those human milk factors are well-tolerated and practically free of side effects, so breast milk should become a research topic to discover therapies even in this epidemic. In the first part, the mechanisms of protection and defense of the breast milk elements will be delineated; in the second section, it will describe the human milk effects in viral infections and it will be hypothesized how the known mechanisms could act in COVID infection.


Subject(s)
Anti-Infective Agents/analysis , Anti-Inflammatory Agents/analysis , Antiviral Agents/analysis , COVID-19/prevention & control , Immunologic Factors/analysis , Milk, Human/chemistry , Milk, Human/virology , Adult , Female , Humans , Infant , Infant, Newborn , Male , Pandemics/prevention & control , SARS-CoV-2
15.
J Perinatol ; 41(5): 952-960, 2021 05.
Article in English | MEDLINE | ID: covidwho-1111968

ABSTRACT

OBJECTIVE: The influence of previous viral symptoms on the level and duration of human milk antibodies reactive to SARS-CoV-2, and common human coronaviruses (HCoVs) was investigated. STUDY DESIGN: Antibodies reactive to S1 and S2 subunits from SARS-CoV-2, HCoV-OC43, and HCoV-229E were measured via ELISA in human milk samples collected from March to June 2020 in mothers with and without viral symptoms. RESULTS: The presence of viral symptoms influenced the levels of SARS-CoV-2 S2-reactive SIgA/IgA and tended to influence SARS-CoV-2 S1 SIgA/IgA and S2-reactive SIgM/IgM in human milk but did not relate to IgG. HCoV-229E S1 + S2-reactive SIgA/IgA and SIgM/IgM, as well as HCoV-OC43 S1 + S2-reactive IgG were related to the symptoms. The duration of antibody levels in human milk in mothers with viral symptoms varied between 3 and 4 months post maternal report of viral symptoms. CONCLUSION: Previous viral symptoms and individual mothers may change the antibody cross-reactive levels to SARS-CoV-2 and HCoVs in human milk.


Subject(s)
Antibodies, Viral/analysis , COVID-19/immunology , Milk, Human/chemistry , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Adult , Antibodies, Neutralizing/analysis , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/pathology , Coronavirus 229E, Human/immunology , Coronavirus OC43, Human/immunology , Cross Reactions/immunology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Immunoglobulin Isotypes/blood , Immunoglobulin Isotypes/immunology , Young Adult
16.
Ann Acad Med Singap ; 49(11): 857-869, 2020 11.
Article in English | MEDLINE | ID: covidwho-1001259

ABSTRACT

INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION: The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.


Subject(s)
COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , Abortion, Spontaneous/epidemiology , Adult , COVID-19/physiopathology , COVID-19/transmission , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cohort Studies , Disease Transmission, Infectious/statistics & numerical data , Female , Fetal Blood/immunology , Humans , Infectious Disease Transmission, Vertical/statistics & numerical data , Live Birth/epidemiology , Maternal Age , Milk, Human/chemistry , Milk, Human/virology , Obesity, Maternal/epidemiology , Placenta/pathology , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Trimester, First , Pregnancy Trimester, Second , Prospective Studies , RNA, Viral/analysis , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Singapore/epidemiology , Umbilical Cord/pathology , Young Adult
19.
CMAJ ; 192(31): E871-E874, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-639297

ABSTRACT

BACKGROUND: Provision of pasteurized donor human milk, as a bridge to mother's own milk, is the standard of care for very low-birth-weight infants in hospital. The aim of this research was to confirm that Holder pasteurization (62.5°C for 30 min) would be sufficient to inactivate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in donated human milk samples. METHODS: We spiked frozen milk samples from 10 donors to the Rogers Hixon Ontario Human Milk Bank with SARS-CoV-2 to achieve a final concentration of 1 × 107 TCID50/mL (50% of the tissue culture infectivity dose per mL). We pasteurized samples using the Holder method or held them at room temperature for 30 minutes and plated serial dilutions on Vero E6 cells for 5 days. We included comparative controls in the study using milk samples from the same donors without addition of virus (pasteurized and unpasteurized) as well as replicates of Vero E6 cells directly inoculated with SARS-CoV-2. We reported cytopathic effects as TCID50/mL. RESULTS: We detected no cytopathic activity in any of the SARS-CoV-2-spiked milk samples that had been pasteurized using the Holder method. In the SARS-CoV-2-spiked milk samples that were not pasteurized but were kept at room temperature for 30 minutes, we observed a reduction in infectious viral titre of about 1 log. INTERPRETATION: Pasteurization of human milk by the Holder method (62.5°C for 30 min) inactivates SARS-CoV-2. Thus, in the event that donated human milk contains SARS-CoV-2 by transmission through the mammary gland or by contamination, this method of pasteurization renders milk safe for consumption and handling by care providers.


Subject(s)
Betacoronavirus/growth & development , Coronavirus Infections/prevention & control , Milk Banks , Milk, Human/virology , Pandemics/prevention & control , Pasteurization/methods , Pneumonia, Viral/prevention & control , Virus Inactivation , COVID-19 , Hot Temperature , Humans , Milk, Human/chemistry , Ontario , SARS-CoV-2 , Time Factors , Viral Plaque Assay
20.
Int Breastfeed J ; 15(1): 82, 2020 09 14.
Article in English | MEDLINE | ID: covidwho-757073

ABSTRACT

BACKGROUND: The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers. METHODS: Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice. RESULTS: Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly. CONCLUSIONS: Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.


Subject(s)
Breast Feeding , Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Humans , Milk, Human/chemistry , Mothers/statistics & numerical data , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2
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