Abstract
Background: Because of yellow fever’s serious impact on health, vaccination is the principal strategy to control the disease. Administration of the yellow fever vaccine to breastfeeding women should be before they complete 9 months post-delivery, in order to prevent transmission of the yellow fever vaccine virus to their infants through breast feeding. This study aimed to confirm whether the excretion of yellow fever vaccine virus is in milk of vaccinated breastfeeding mothers and to confirm the probable transmission to their infants through breast milk. Methods: Samples were taken as follows: one serum specimen was taken 3-14 days after the date of the vaccination, and breast milk specimens were taken at four different time points between 3-4 days apart. Specimens were obtained from eight nursing mothers, who received the YVF vaccine (17DD). Mothers were asymptomatic before and after the vaccine administration but their infants developed symptoms after administration. Maternal serum samples were tested for YFV specific IgM antibodies through immuno-fluorescent assay (IFA). RNA was extracted from serum and breast milk specimens and YFV RNA screened using real-time polymerase chain reaction (RT-PCR). Results: In total, five mothers (62.5%) were positive for YFV and two mothers (25%) had YFV RNA in serum. Among milk specimens, YFV RNA was detected during the four different mentioned collection times as follows (positive milk specimens/total milk specimens): 3/8 (37.5 %), 4/6 (66.6%) and 1/4(25%). RNA was completely undetectable in the last collection time. Conclusions: YFV transmission from mothers to their babies through breast-feeding was highly probable indicated by the temporal relationship to mother’s YF vaccination.
Highlights
The yellow fever virus is a mosquito-borne flavivirus that causes yellow fever,[1] a viral hemorrhagic fever that occurs only in Africa, Central and South America,[2] but historically has had many wide outbreaks in Europe and North America.[2]
yellow fever virus (YFV) RNA was detected by using real time polymerase chain reaction (PCR) in 2 (25%) serum samples and 3 (37.5 %) in breast milk (Table 1)
In April 2009 the first probable case of YF vaccine strain transmission through breast milk was reported in a Brazilian infant; yellow fever-specific IgM antibodies were detected in serum and CSF and yellow fever vaccine strain viral RNA was found in CSF of the infant
Summary
The yellow fever virus is a mosquito-borne flavivirus that causes yellow fever,[1] a viral hemorrhagic fever that occurs only in Africa, Central and South America,[2] but historically has had many wide outbreaks in Europe and North America.[2]. The line “Administration of the vaccine to breastfeeding women before 9 months post-delivery can transmit the yellow fever vaccine virus to their infants through breast milk.” is confusing: breastfeeding is a risk factor for transmission irrespective of time post-delivery. Administration of the yellow fever vaccine to breastfeeding women should be before they complete 9 months post-delivery, in order to prevent transmission of the yellow fever vaccine virus to their infants through breast feeding. This study aimed to confirm whether the excretion of yellow fever vaccine virus is in milk of vaccinated breastfeeding mothers and to confirm the probable transmission to their infants through breast milk. YFV RNA was detected during the four different mentioned collection times as follows (positive milk specimens/total milk specimens): 3/8 (37.5 %), 4/6 (66.6%) and 1/4(25%). Conclusions: YFV transmission from mothers to their babies through breast-feeding was highly probable indicated by the temporal version 1
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