Transmission of Zika virus through breast milk and other breastfeeding-related bodily-fluids: A systematic review.

Susannah Colt,Juan Pablo Peña-Rosas,Pura Rayco-Solon,Saurabh Mehta,Maria N Garcia-Casal,Julia L Finkelstein,Zita C Weise Prinzo,Olaf Horstick

doi:10.1371/journal.pntd.0005528

Susannah Colt, Juan Pablo Peña-Rosas + Show 6 more

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https://doi.org/10.1371/journal.pntd.0005528

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Abstract

BackgroundZika virus (ZIKV) infection is an emerging mosquito-borne disease, which is associated with an increase in central nervous system malformations and newborn microcephaly cases. This review investigated evidence of breastfeeding transmission from ZIKV-infected mothers to their children and the presence of ZIKV infection in breastfeeding-related fluids.Methodology/Principal findingsWe conducted a systematic review of observational studies, case studies, and surveillance reports involving breastfeeding women with ZIKV infection in several international databases. Data extraction and analysis were conducted following a PROSPERO-registered protocol. From 472 non-duplicate records, two case reports met criteria for inclusion. We reviewed three cases of ZIKV infection among lactating mothers near the time of delivery. Two of the three (2/3) associated newborns had evidence of ZIKV infection. ZIKV was detected in breast milk of all three mothers. Breast milk detection results were positive in all mothers (3/3) by RT-PCR, one was positive by culture (1/3), and none was tested for ZIKV-specific antibodies. Serum samples were ZIKV positive in all mothers (3/3), and sweat was not tested for ZIKV.Conclusions/SignificanceWe describe three cases of ZIKV-infected breastfeeding mothers who were symptomatic within three days of delivery, and two cases with ZIKV-infected newborns. While ZIKV was detected in the breast milk of all three mothers, the data are not sufficient to conclude ZIKV transmission via breastfeeding. More evidence is needed to distinguish breastfeeding transmission from other perinatal transmission routes.

Highlights

Zika virus (ZIKV) infection is an emerging vector-borne disease of the Flaviviridae family, which includes dengue, yellow fever, Japanese encephalitis, and West Nile viruses [1]
Zika virus (ZIKV) infection was considered a mild fever illness until the recent and ongoing outbreak in South America revealed that the virus can cause microcephaly and other neurological disorders
We conducted a systematic review of the literature to summarize evidence of ZIKV transmission via breastfeeding and the presence ZIKV in breast milk

Summary

Introduction

Zika virus (ZIKV) infection is an emerging vector-borne disease of the Flaviviridae family, which includes dengue, yellow fever, Japanese encephalitis, and West Nile viruses [1]. 90% (PRNT90) for ZIKV with titre ! Due to the possible cross reactivity with other members of the Flaviviridae family, the presence of IgM is not enough to rule out ZIKV infection, and the PRNT90 will determine if the in vitro inhibition of cell growth is produced by antibodies against ZIKV [4, 5]. An enzyme linked immunoassay (ELISA) for ZIKV has been developed by the Centers for Disease Control and Prevention, but is only available upon request for emergency use [6]. Zika virus (ZIKV) infection is an emerging mosquito-borne disease, which is associated with an increase in central nervous system malformations and newborn microcephaly cases. This review investigated evidence of breastfeeding transmission from ZIKV-infected mothers to their children and the presence of ZIKV infection in breastfeeding-related fluids

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