Milk From Women Diagnosed With COVID-19 Does Not Contain SARS-CoV-2 RNA but Has Persistent Levels of SARS-CoV-2-Specific IgA Antibodies.

Abstract

Background:

Limited data are available regarding the balance of risks and benefits from human milk and/or breastfeeding during and following maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Objective:

To investigate whether SARS-CoV-2 can be detected in milk and on the breast after maternal coronavirus disease 2019 (COVID-19) diagnosis; and characterize concentrations of milk immunoglobulin (Ig) A specific to the SARS-CoV-2 spike glycoprotein receptor binding domain (RBD) during the 2 months after onset of symptoms or positive diagnostic test.

Methods:

Using a longitudinal study design, we collected milk and breast skin swabs one to seven times from 64 lactating women with COVID-19 over a 2-month period, beginning as early as the week of diagnosis. Milk and breast swabs were analyzed for SARS-CoV-2 RNA, and milk was tested for anti-RBD IgA.

Results:

SARS-CoV-2 was not detected in any milk sample or on 71% of breast swabs. Twenty-seven out of 29 (93%) breast swabs collected after breast washing tested negative for SARS-CoV-2. Detection of SARS-CoV-2 on the breast was associated with maternal coughing and other household COVID-19. Most (75%; 95% CI, 70-79%; n=316) milk samples contained anti-RBD IgA, and concentrations increased (P=.02) during the first two weeks following onset of COVID-19 symptoms or positive test. Milk-borne anti-RBD IgA persisted for at least two months in 77% of women.

Conclusion:

Milk produced by women with COVID-19 does not contain SARS-CoV-2 and is likely a lasting source of passive immunity via anti-RBD IgA. These results support recommendations encouraging lactating women to continue breastfeeding during and after COVID-19 illness.

• Authors: Ryan M Pace, Janet E Williams, Kirsi M Järvinen, Courtney L Meehan, Melanie A Martin, Sylvia H Ley, Celestina Barbosa-Leiker, Aline Andres, Laxmi Yeruva, Mandy B Belfort, Beatrice Caffé, Alexandra D Navarrete, Kimberly A Lackey, Christina D W Pace, Alexandra C Gogel, Bethaney D Fehrenkamp, Miranda Klein, Bridget E Young, Casey Rosen-Carole, Nichole Diaz, Stephanie L Gaw, Valerie Flaherman, Mark A McGuire, Michelle K McGuire, Antti E Seppo
• Journal: Frontiers in immunology (Front Immunol) Vol. 12 Pg. 801797 ( 2021) ISSN: 1664-3224 [Electronic] Switzerland
• PMID: 35003130 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 Pace, Williams, Järvinen, Meehan, Martin, Ley, Barbosa-Leiker, Andres, Yeruva, Belfort, Caffé, Navarrete, Lackey, Pace, Gogel, Fehrenkamp, Klein, Young, Rosen-Carole, Diaz, Gaw, Flaherman, McGuire, McGuire and Seppo.

Chemical References

• Antibodies, Viral
• Immunoglobulin A
• RNA, Viral

Topics

• Adult
• Antibodies, Viral (analysis, immunology)
• Breast Feeding
• COVID-19 (immunology)
• Female
• Humans
• Immunization, Passive
• Immunoglobulin A (analysis, immunology)
• Lactation
• Longitudinal Studies
• Milk, Human (immunology, virology)
• RNA, Viral (genetics)
• SARS-CoV-2 (immunology)