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#Grand Rounds

Can Replication-Competent SARS-CoV-2 Be Found in Breast Milk?

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BACKGROUND AND PURPOSE:

  • Case reports have documented viral RNA in breast milk samples
    • Unclear as to source of virus
    • Presence of viral RNA does not necessarily mean infectious virus is present
  • Chambers et al. (JAMA, 2020) examined breast milk samples from COVID-19 mothers to determine if viral RNA and/or replication-competent virus was present

METHODS:

  • Cohort study (March 27 and May 6, 2020)
  • Participants
    • Women who were breastfeeding
    • RT-PCR confirmed COVID-19 diagnosis
  • Study design
    • Women invited to participate through media awareness, website, and clinician referral
    • Breast milk sampled were self-collected and mailed to the study center
    • Samples tested with
      • Quantitative RT-PCR assay for SARS-CoV-2
      • Cell culture assay to determine presence of replication-competent virus
    • The authors also added SARS-CoV-2 to pasteurized and nonpastuerized breast milk from control donors

RESULTS:

  • A total of 18 breastfeeding women with COVID-19 were enrolled
    • Mean (SD) age: 34.4 (5.2) years
    • Offspring ranged in age from newborn to 19 months
    • Total 64 total samples | Women provided between 1 and 12 samples
  • One breast milk sample had detectable levels of SARS-CoV-2 RNA
    • This sample was collected on the day of symptom onset
    • A sample from this same participant taken 2 days prior to symptom onset and two samples take 12 and 41 days after onset tested negative
    • The breastfed infant was not tested
  • No replication-competent virus found in any sample
  • Following pasteurization, viral RNA was not detectable by RT-PCR in the samples that had been spiked with SARS-CoV-2
    • The virus was detected in the nonpasteurized samples

CONCLUSION:

  • Out of 64 breast milk samples, viral RNA was found in only 1 sample
    • The viral RNA did not represent replication-competent virus
  • When breast milk samples spiked with SARS-CoV-2 were pasteurized, no replication-competent virus or viral RNA was detectable | Reassuring regarding human milk available through milk banks
  • Limitations
    • Small sample size and nonrandom sampling
    • Self-collection of milk samples
  • The authors state

These data suggest that SARS-CoV-2 RNA does not represent replication-competent virus and that breast milk may not be a source of infection for the infant

Learn More – Primary Sources:

Evaluation for SARS-CoV-2 in Breast Milk From 18 Infected Women

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Related ObG Topics:

SARS-CoV-2: Is the Virus Present in the Female Genital Tract?
Infants Born to Mothers with COVID-19 Have Detectable Levels of Antibodies
Vertical Transmission in Pregnancies with Confirmed COVID-19

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