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Rick AM, Beigi R. Maternal Immunizations: Past, Present, and Future. Clin Obstet Gynecol 2024:00003081-990000000-00163. [PMID: 38899806 DOI: 10.1097/grf.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Maternal vaccines during pregnancy offer crucial protection against infections for both the pregnant person and their newborn. Vaccines against influenza, pertussis, coronavirus disease 2019, and respiratory syncytial virus are routinely recommended by the Centers for Disease Control and Prevention to safeguard pregnant women and their infants from potentially severe complications. Administering these vaccines during pregnancy helps transfer protective antibodies from the mother to the baby, enhancing immunity during the vulnerable early months of life. Extensive research supports the safety and efficacy of maternal vaccines, with numerous studies demonstrating their protective benefits for both pregnant people and newborns.
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Affiliation(s)
- Anne-Marie Rick
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine
| | - Richard Beigi
- Department of Obstetrics, Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine
- UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
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2
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Suteerojntrakool O, Mekangkul E, Maitreechit D, Khabuan S, Sodsai P, Hirankarn N, Thumbovorn R, Chomtho S. Preservation of Anti-SARS-CoV-2 Neutralizing Antibodies in Breast Milk: Impact of Maternal COVID-19 Vaccination and Infection. Breastfeed Med 2024; 19:340-348. [PMID: 38506333 DOI: 10.1089/bfm.2023.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objectives: To investigate specific immunoglobulin A (sIgA), specific immunoglobulin G (sIgG), and neutralizing antibodies (NAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in breast milk and compare immunity in mothers with hybrid immunity (infection and vaccination) versus those solely vaccinated (coronavirus disease [COVID]-naïve). Methods: A longitudinal study was conducted among lactating mothers who received at least two doses of the coronavirus disease 2019 (COVID-19) vaccine or tested positive for SARS-CoV-2. Details of vaccination and infection were collected through questionnaires and interviews. Fifteen milliliters of breast milk samples, self-collected at 1, 3, and 6 months postvaccination or infection, were sent to analysis for sIgA, sIgG, and NAbs using enzyme-linked immunosorbent assay. Results: In total, 119 lactating mothers (202 milk samples) were enrolled; 82 participants had hybrid immunity, and 32 were COVID-19-naïve. Two-thirds received a combination of different vaccines and booster shots. Breast milk retained sIgA, sIgG, and NAbs for up to 6 months post-COVID vaccination or infection. At 3 months, mothers with hybrid immunity had significantly higher sIgA and NAbs compared with COVID-naïve mothers (geometric mean [95% confidence interval (CI)] of sIgA 2.72 [1.94-3.8] vs. 1.44 [0.83-2.48]; NAbs 86.83 [84.9-88.8] vs. 81.28 [76.02-86.9]). No differences in sIgA, sIgG, and NAbs were observed between lactating mothers receiving two, three, or more than or equal to three doses, regardless of hybrid immunity or COVID-naïve status. Conclusion: sIgA, sIgG, and NAbs against SARS-CoV-2 in breast milk sustained for up to 6 months postimmunization and infection. Higher immunity was found in mothers with hybrid immunity. These transferred immunities confirm in vitro protection, supporting the safety of breastfeeding during and after COVID-19 vaccination or infection.
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Affiliation(s)
- Orapa Suteerojntrakool
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ambulatory Division, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eakkarin Mekangkul
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Siriporn Khabuan
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pimpayao Sodsai
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattiya Hirankarn
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungtip Thumbovorn
- Department of Microbiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Sirinuch Chomtho
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Ismail S, Unger S, Budylowski P, Poutanen S, Yau Y, Jenkins C, Anwer S, Christie-Holmes N, Kiss A, Mazzulli T, Johnstone J, McGeer A, Whittle W, Parvez B, Gray-Owen SD, Stone D, O'Connor DL. SARS-CoV-2 antibodies and their neutralizing capacity against live virus in human milk after COVID-19 infection and vaccination: prospective cohort studies. Am J Clin Nutr 2024; 119:485-495. [PMID: 38309831 DOI: 10.1016/j.ajcnut.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND There is limited understanding of the impact of coronavirus disease 2019 (COVID-19) infection and vaccination type and interval on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human milk antibodies and their neutralizing capacity. OBJECTIVES These cohort studies aimed to determine the presence of antibodies and live virus neutralizing capacity in milk from females infected with COVID-19, unexposed milk bank donors, and vaccinated females and examine impacts of vaccine interval and type. METHODS Milk was collected from participants infected with COVID-19 during pregnancy or lactation (Cohort-1) and milk bank donors (Cohort-2) from March 2020-July 2021 at 3 sequential 4-wk intervals and COVID-19 vaccinated participants with varying dose intervals (Cohort-3) (January-October 2021). Cohort-1 and Cohort-3 were recruited from Sinai Health (patients) and through social media. Cohort-2 included Ontario Milk Bank donors. Milk was examined for SARS-CoV-2 antibodies and live virus neutralization. RESULTS Of females with COVID-19, 53% (Cohort-1, n = 55) had anti-SARS-CoV-2 IgA antibodies in ≥1 milk sample. IgA+ samples (40%) were more likely neutralizing than IgA- samples (odds ratio [OR]: 2.18; 95% confidence interval [CI]: 1.03, 4.60; P = 0.04); however, 25% of IgA- samples were neutralizing. Both IgA positivity and neutralization decreased ∼6 mo after symptom onset (0-100 compared with 201+ d: IgA OR: 14.30; 95% CI: 1.08, 189.89; P = 0.04; neutralizing OR: 4.30; 95% CI: 1.55, 11.89; P = 0.005). Among milk bank donors (Cohort-2, n = 373), 4.3% had IgA antibodies; 23% of IgA+ samples were neutralizing. Vaccination (Cohort-3, n = 60) with mRNA-1273 and shorter vaccine intervals (3 to <6 wk) resulted in higher IgA and IgG than BNT162b2 (P < 0.04) and longer intervals (6 to <16 wk) (P≤0.02), respectively. Neutralizing capacity increased postvaccination (P = 0.04) but was not associated with antibody positivity. CONCLUSIONS SARS-CoV-2 infection and vaccination (type and interval) impacted milk antibodies; however, antibody presence did not consistently predict live virus neutralization. Although human milk is unequivocally the best way to nourish infants, guidance on protection to infants following maternal infection/vaccination may require more nuanced messaging. This study was registered at clinicaltrials.gov as NCT04453969 and NCT04453982.
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Affiliation(s)
- Samantha Ismail
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada; Paediatrics, Sinai Health System, Toronto, Canada
| | - Patrick Budylowski
- Combined Containment Level 3 Unit, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Susan Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Yvonne Yau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Carleigh Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada
| | - Shaista Anwer
- Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | | | - Alex Kiss
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Jennie Johnstone
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Wendy Whittle
- Obstetrics and Gynecology, Sinai Health System, Toronto, Canada
| | | | - Scott D Gray-Owen
- Combined Containment Level 3 Unit, University of Toronto, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Debbie Stone
- Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada; Paediatrics, Sinai Health System, Toronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada.
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4
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de Graaf SC, Bondt A, van Rijswijck DMH, Juncker HG, Mulleners SJ, Damen MJA, Hoek M, van Keulen BJ, van Goudoever JB, Heck AJR, Dingess KA. A case series exploring the human milk polyclonal IgA1 response to repeated SARS-CoV-2 vaccinations by LC-MS based fab profiling. Front Nutr 2024; 10:1305086. [PMID: 38288064 PMCID: PMC10822949 DOI: 10.3389/fnut.2023.1305086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Upon vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) humans will start to produce antibodies targeting virus specific antigens that will end up in circulation. In lactating women such antibodies will also end up in breastmilk, primarily in the form of secretory immunoglobulin A1 (SIgA1), the most abundant immunoglobulin (Ig) in human milk. Here we set out to investigate the SIgA1 clonal repertoire response to repeated SARS-CoV-2 vaccination, using a LC-MS fragment antigen-binding (Fab) clonal profiling approach. Methods We analyzed the breastmilk of six donors from a larger cohort of 109 lactating mothers who received one of three commonly used SARS-CoV-2 vaccines. We quantitatively monitored the SIgA1 Fab clonal profile over 16 timepoints, from just prior to the first vaccination until 15 days after the second vaccination. Results In all donors, we detected a population of 89-191 vaccine induced clones. These populations were unique to each donor and heterogeneous with respect to individual clonal concentrations, total clonal titer, and population size. The vaccine induced clones were dominated by persistent clones (68%) which came up after the first vaccination and were retained or reoccurred after the second vaccination. However, we also observe transient SIgA1 clones (16%) which dissipated before the second vaccination, and vaccine induced clones which uniquely emerged only after the second vaccination (16%). These distinct populations were observed in all analyzed donors, regardless of the administered vaccine. Discussion Our findings suggest that while individual donors have highly unique human milk SIgA1 clonal profiles and a highly personalized SIgA1 response to SARS-CoV-2 vaccination, there are also commonalities in vaccine induced responses.
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Affiliation(s)
- Sebastiaan C. de Graaf
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Albert Bondt
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Danique M. H. van Rijswijck
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Hannah G. Juncker
- Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Sien J. Mulleners
- Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirjam J. A. Damen
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Max Hoek
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Britt J. van Keulen
- Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Albert J. R. Heck
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
| | - Kelly A. Dingess
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands
- Netherlands Proteomics Center, Utrecht, Netherlands
- Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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5
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Suteerojntrakool O, Mekangkul E, Ananta P, Maitreechit D, Khabuan S, Sodsai P, Hirankarn N, Thumbovorn R, Chomtho S. The Persistence of Specific Immunoglobulin A Against SARS-CoV-2 in Human Milk After Maternal COVID-19 Vaccination. Breastfeed Med 2023; 18:943-950. [PMID: 38100444 DOI: 10.1089/bfm.2023.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Objectives: To investigate SARS-CoV-2 specific immunoglobulin A (sIgA) in breast milk of Thai mothers post COVID-19 vaccination and/or SARS-CoV-2 infection, and to compare the sIgA among lactating mothers with varying COVID-19 vaccination regimes. Materials and Methods: A longitudinal study was conducted in lactating mothers receiving ≥2 doses of COVID-19 vaccine or confirming SARS-CoV-2-positive test as a part of an infant feeding survey. Vaccination and infection details were collected through questionnaires and interviews. Self-collected breast milk samples (30 mL) at 1, 3, and 6 months postvaccination or infection were analyzed for sIgA through enzyme-linked immunosorbent assay (ELISA). Results: Eighty-eight lactating mothers (152 milk samples), average age of 30.7 ± 6.2 years, were recruited. Fifty-five percent of milk samples were from lactating mothers with both SARS-CoV-2 infection and vaccination (hybrid immunity); 40% were from those with vaccination alone (COVID naïve). Sixty percent of lactating mothers received mixed types of vaccines. Median sIgA ratio in breast milk was 2.67 (0.82-7.85). Breast milk sIgA at 1, 3, and 6 months were higher in mothers with hybrid immunity than in COVID naïve (geometric mean [95% confidence interval]: 3.30 [2.06-5.29] versus 1.04 [0.52-2.04], 3.39 [2.24-5.13] versus 1.26 [0.77-2.06], 4.29 [3.04-6.06] versus 1.33 [0.74-2.42], respectively). No significant differences were observed among various vaccination regimes. Conclusion: sIgA against SARS-CoV-2 was detected in breast milk for up to 6 months after immunization together with infection at a greater level than after immunization or infection alone. This immunity could be transferred and protective against SARS-CoV-2 infection. Discontinuation of breastfeeding among mothers who received COVID vaccination or experienced infection should be discouraged. Clinical Trial Registration number: TCTR20220215012.
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Affiliation(s)
- Orapa Suteerojntrakool
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Ambulatory Division, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eakkarin Mekangkul
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Pattaraporn Ananta
- Division of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Siriporn Khabuan
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pimpayao Sodsai
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattiya Hirankarn
- Center of Excellence in Immunology and Immune-Mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungtip Thumbovorn
- Department of Microbiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Sirinuch Chomtho
- Pediatric Nutrition Research Unit, Division of Nutrition, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Francese R, Peila C, Donalisio M, Lamberti C, Cirrincione S, Colombi N, Tonetto P, Cavallarin L, Bertino E, Moro GE, Coscia A, Lembo D. Viruses and Human Milk: Transmission or Protection? Adv Nutr 2023; 14:1389-1415. [PMID: 37604306 PMCID: PMC10721544 DOI: 10.1016/j.advnut.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
Human milk (HM) is considered the best source of nutrition for infant growth and health. This nourishment is unique and changes constantly during lactation to adapt to the physiological needs of the developing infant. It is also recognized as a potential route of transmission of some viral pathogens although the presence of a virus in HM rarely leads to a disease in an infant. This intriguing paradox can be explained by considering the intrinsic antiviral properties of HM. In this comprehensive and schematically presented review, we have described what viruses have been detected in HM so far and what their potential transmission risk through breastfeeding is. We have provided a description of all the antiviral compounds of HM, along with an analysis of their demonstrated and hypothesized mechanisms of action. Finally, we have also analyzed the impact of HM pasteurization and storage methods on the detection and transmission of viruses, and on the antiviral compounds of HM. We have highlighted that there is currently a deep knowledge on the potential transmission of viral pathogens through breastfeeding and on the antiviral properties of HM. The current evidence suggests that, in most cases, it is unnecessarily to deprive an infant of this high-quality nourishment and that the continuation of breastfeeding is in the best interest of the infant and the mother.
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Affiliation(s)
- Rachele Francese
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy
| | - Chiara Peila
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Manuela Donalisio
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy
| | - Cristina Lamberti
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Simona Cirrincione
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Nicoletta Colombi
- Biblioteca Federata di Medicina "Ferdinando Rossi", University of Turin, Turin, Italy
| | - Paola Tonetto
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Laura Cavallarin
- Institute of the Science of Food Production - National Research Council, Grugliasco, TO, Italy
| | - Enrico Bertino
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks (AIBLUD), Milan, Italy.
| | - Alessandra Coscia
- Department of Public Health and Pediatrics, Neonatal Intensive Care Unit, University of Turin, Turin, Italy.
| | - David Lembo
- Department of Clinical and Biological Sciences, Laboratory of Molecular Virology and Antiviral Research, University of Turin, Orbassano (TO), Italy.
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7
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He YF, Liu JQ, Hu XD, Li HM, Wu N, Wang J, Jiang ZG. Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important? Front Pediatr 2023; 11:1253333. [PMID: 37744448 PMCID: PMC10511770 DOI: 10.3389/fped.2023.1253333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
The catastrophic coronavirus disease 2019 (COVID-19) pandemic has raised many health questions, and whether breast milk from SARS-CoV-2 infected mothers may be a vector for SARS-CoV-2 transmission has become a hot topic of concern worldwide. Currently, there are extremely limited and conflicting data on the risk of infection in infants through breastfeeding. For this reason, we investigated almost all current clinical studies and systematically analyzed the presence of SARS-CoV-2 and antibodies in the breast milk of mothers infected with SARS-CoV-2, their effects on newborns, and the mechanisms involved. A total of 82 studies were included in this review, of which 66 examined the presence of SARS-CoV-2 in breast milk samples from mothers diagnosed with COVID-19, 29 reported results of antibody detection of SARS-CoV-2 in breast milk, and 13 reported both nucleic acid and antibody test results. Seventeen studies indicated the presence of detectable SARS-CoV-2 nucleic acid in breast milk samples, and only two studies monitored viral activity, both of which reported that infectious viruses could not be cultured from RNA-positive breast milk samples. All 29 studies indicated the presence of at least one of the three antibodies, IgA, IgG and IgM, in breast milk. Five studies indicated the presence of at least one antibody in the serum of breastfed newborns. No COVID-19-related deaths were reported in all 1,346 newborns. Our study suggests that direct breastfeeding does not pose an additional risk of infection to newborns and that breast milk is a beneficial source of anti-SARS-CoV-2 antibodies that provide passive immune protection to infants. In addition, direct breastfeeding would provide maternal benefits. Our review supports the recommendation to encourage direct breastfeeding under appropriate infection control guidelines. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: 458043.
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Affiliation(s)
- Yan-fei He
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun-qiang Liu
- Department of Thoracic Surgery, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao-dong Hu
- Department of Endocrinology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Hu-ming Li
- Department of Respiratory Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ni Wu
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Wang
- Health Management Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi-gang Jiang
- Department of Statistics, Zunyi Medical University, Zunyi, China
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8
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Juncker HG, van den Akker CHP, Meerdink PL, Korosi A, Vaz FM, van Goudoever JB, van Keulen BJ. The influence of a maternal vegan diet on carnitine and vitamin B2 concentrations in human milk. Front Nutr 2023; 10:1107768. [PMID: 37599690 PMCID: PMC10436295 DOI: 10.3389/fnut.2023.1107768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/23/2023] [Indexed: 08/22/2023] Open
Abstract
Background The maternal diet greatly influences the nutritional composition of human milk. With the rise of vegan diets by lactating mothers, there are concerns about the nutritional adequacy of their milk. Two important nutrients, vitamin B2 and carnitine, are mostly ingested via animal products. Objective We investigated the influence of a vegan diet on the vitamin B2 and carnitine concentrations in milk and serum of lactating women. Methods In this case-control study, 25 lactating mothers following an exclusive vegan diet were comparted to 25 healthy lactating mothers with an omnivorous diet without use of supplements. High-performance liquid chromatography and liquid chromatography-tandem mass spectrometry were used to measure vitamin B2 and carnitine concentrations, respectively. A linear regression model was used to determine differences in human milk and serum concentrations between study groups. Results Vitamin B2 concentrations in human milk and serum did not differ between study groups. While the human milk free carnitine (C0) and acetyl carnitine (C2) concentrations did not differ between study groups, serum carnitine concentrations were lower in participants following a vegan diet than in omnivorous women (p < 0.0001). Conclusion A maternal vegan diet did not affect human milk concentration of vitamin B2 and carnitine. Breastfed infants of mothers following an exclusive vegan diet therefore are likely not at increased risk of developing a vitamin B2 or carnitine deficiency.
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Affiliation(s)
- Hannah G. Juncker
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences—Center for Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Chris H. P. van den Akker
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Pediatrics—Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Pauline L. Meerdink
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
| | - Aniko Korosi
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Frédéric M. Vaz
- Department of Clinical Chemistry and Pediatrics, Laboratory Genetic Metabolic Diseases, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Inborn Errors of Metabolism, Amsterdam, Netherlands
- Core Facility Metabolomics, Amsterdam UMC, Amsterdam, Netherlands
- United for Metabolic Diseases, Amsterdam, Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Pediatrics—Neonatology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Britt J. van Keulen
- Department of Pediatrics, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children’s Hospital, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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Juncker HG, van Doesburg M, de Groot CJ, Pajkrt D, Korosi A, van Gils MJ, van Goudoever JB, van Keulen BJ. Physical activity in lactating women influences SARS-CoV-2-specific antibodies in human milk. Heliyon 2023; 9:e19218. [PMID: 37654447 PMCID: PMC10466918 DOI: 10.1016/j.heliyon.2023.e19218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/27/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
Background Moderate exercise results in a significant increase in serum and salivary immunoglobulins. Maternal physical activity might therefore also be a factor influencing antibody levels in human milk. This study aims to determine the influence of physical activity on SARS-CoV-2-specific Immunoglobulin A (IgA) in human milk and Immunoglobulin G (IgG) in serum. Methods In this prospective cross-sectional cohort study, all lactating women in the Netherlands were eligible to participate. SARS-CoV-2-specific IgA in human milk and IgG in serum were determined using an enzyme-linked immunosorbent assay (ELISA). Data on performed physical activity was collected using the Short Questionnaire to Assess Health enhancing physical activity (SQUASH), which includes intensity and duration of the performed activity. Findings In total, 356 out of 2312 lactating women tested positive for SARS-CoV-2-specific antibodies in serum. Of them, 323 filled in the questionnaire and were included in the analysis. An association between the activity score and SARS-CoV-2-specific antibodies in human milk (B = 1·035, 95·0% CI = 1·019 to 1·052, p = 0·042) and serum (B = 1·019, 95·0% CI = 1·009 to 1·029, p = 0·048) was demonstrated. No association was found between the duration of physical activity and SARS-CoV-2-specific antibodies in human milk or serum. Interpretation Our findings suggest that physical activity is beneficial for the levels of SARS-CoV-2-specific antibodies in human milk and serum, with the intensity of the physical activity being the most important contributor to this relationship. A higher level of antibodies in human milk might provide better immunological protection for infants against COVID-19.
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Affiliation(s)
- Hannah G. Juncker
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Maritt van Doesburg
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Christianne J.M. de Groot
- Amsterdam UMC, Vrije Universiteit, Amsterdam Reproduction & Development Research Institute, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Marit J. van Gils
- Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Johannes B. van Goudoever
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Britt J. van Keulen
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
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10
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Karimi H, Mansouri V, Rezaei N. Vertical transmission and maternal passive immunity post-SARS-CoV-2. Future Virol 2023:10.2217/fvl-2023-0089. [PMID: 37822684 PMCID: PMC10564388 DOI: 10.2217/fvl-2023-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 10/13/2023]
Abstract
Since 2020, the highly contagious nature and various transmission routes of SARS-CoV-2 have rendered the pandemic interminable. Vertical transmission (VT) through the placenta and breast milk, which is frequent for certain virus types, is thought to exist for SARS-CoV-2 and is hypothesized by many researchers. Conversely, antibodies are produced to counteract the effect of viruses. Since newborns' immunologic system cannot produce proper antibodies, maternal antibodies are usually transferred from mother to infant/fetus to meet the need. This theory leads to the hypothesis of transmission of antibodies through the placenta and breast milk following SARS-CoV-2 infection or vaccination. This paper further discusses these hypotheses, considering consequences of fetus/infant harm versus benefit.
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Affiliation(s)
- Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Vahid Mansouri
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 14194, Iran
- Network of Immunity in Infection, Malignancy & Autoimmunity (NIIMA), Universal Scientific Education & Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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11
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Zaher K, Basingab F, Alrahimi J, Basahel K, Aldahlawi A. Gender Differences in Response to COVID-19 Infection and Vaccination. Biomedicines 2023; 11:1677. [PMID: 37371774 DOI: 10.3390/biomedicines11061677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Since COVID-19 first appeared, a number of follow-up events have taken place. In an effort to find a solution to this catastrophe, a great deal of study and analysis has been conducted. Because of the high morbidity and exceptionally large losses, scientists are being pushed to conduct more research and find vaccination and treatments. The virus has a wide range of effects, one of which is how it affects sexual activity in both men and women. The impact of the cardiovascular system and susceptibility to embolism, lung stress, and infection heightens the probability of hospitalization in the intensive care unit for pregnant women who have contracted COVID-19. There is no evidence of infection being passed from mother to child. In the current review, the role of COVID-19 infection and vaccination on male and female sexual activity, hormones, and the menstrual cycle for females, as well as on male sex hormones and sexual activity during infection and after vaccination, are being investigated. There are no reports of the virus being isolated from the semen of an infected patient or recently recovered patients. A recent investigation on the influence of the virus on gender susceptibility to sexual organs and function has been uncovered throughout this study.
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Affiliation(s)
- Kawther Zaher
- Immunology Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21859, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21859, Saudi Arabia
| | - Fatemah Basingab
- Department of Biological Sciences, Faculty of Sciences, King Abdulaziz University, Jeddah 21859, Saudi Arabia
- Immunology Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21859, Saudi Arabia
| | - Jehan Alrahimi
- Department of Biological Sciences, Faculty of Sciences, King Abdulaziz University, Jeddah 21859, Saudi Arabia
- Immunology Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21859, Saudi Arabia
| | - Kholood Basahel
- Department of Biological Sciences, Faculty of Sciences, King Abdulaziz University, Jeddah 21859, Saudi Arabia
- Immunology Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21859, Saudi Arabia
| | - Alia Aldahlawi
- Department of Biological Sciences, Faculty of Sciences, King Abdulaziz University, Jeddah 21859, Saudi Arabia
- Immunology Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21859, Saudi Arabia
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12
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Dimitroglou M, Sokou R, Iacovidou N, Pouliakis A, Kafalidis G, Boutsikou T, Iliodromiti Z. Anti-SARS-CoV-2 Immunoglobulins in Human Milk after Coronavirus Disease or Vaccination-Time Frame and Duration of Detection in Human Milk and Factors That Affect Their Titers: A Systematic Review. Nutrients 2023; 15:nu15081905. [PMID: 37111124 PMCID: PMC10141636 DOI: 10.3390/nu15081905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Human milk (HM) of mothers infected with or vaccinated against SARS-CoV-2 contains specific immunoglobulins, which may protect their offspring against infection or severe disease. The time frame and duration after infection or vaccination, during which these immunoglobulins are detected in HM, as well as the major factors that influence their levels, have not been fully elucidated. This systematic review aimed to collect the existing literature and describe the immune response, specifically regarding the immunoglobulins in HM after COVID-19 disease or vaccination in non-immune women. We conducted a systematic search of PubMed and Scopus databases to identify studies published up until 19 March 2023. In total, 975 articles were screened, and out of which 75 were identified as being relevant and were finally included in this review. Infection by SARS-CoV-2 virus primarily induces an IgA immune response in HM, while vaccination predominantly elevates IgG levels. These immunoglobulins give HM a neutralizing capacity against SARS-CoV-2, highlighting the importance of breastfeeding during the pandemic. The mode of immune acquisition (infection or vaccination) and immunoglobulin levels in maternal serum are factors that seem to influence immunoglobulin levels in HM. Further studies are required to determine the impact of other factors, such as infection severity, lactation period, parity, maternal age and BMI on immunoglobulin level in HM.
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Affiliation(s)
- Margarita Dimitroglou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Abraham Pouliakis
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Georgios Kafalidis
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece
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13
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Dutra LV, Silva MH, Lebrão CW, Affonso-Fonseca FL, Suano-Souza FI. Impact of the Presence Anti-SARS-CoV-2 IgA in the Colostrum of Women Infected by COVID-19 During the Pregnancy in Neonatal Clinical Outcomes: A Cross-Sectional Study. Matern Child Health J 2023; 27:737-746. [PMID: 36670307 PMCID: PMC9859745 DOI: 10.1007/s10995-022-03553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe the presence of anti-SARS-CoV-2 IgA and IgG in the blood and colostrum of women with COVID-19 infection during pregnancy and associate the presence of anti-SARS-CoV-2 IgA in colostrum with clinical symptoms of their newborns. METHODS A cross-sectional study was developed with 165 participants with COVID-19 infection during pregnancy and their newborns. DATA COLLECTED characteristics COVID-19 infection in pregnant women, gestational age, and clinical symptoms in their newborns (fever, hypothermia, respiratory distress, hypotonia, hypoactivity, hypoglycemia, cyanosis, vomiting/regurgitation, abdominal distention, and jaundice). Maternal blood and colostrum samples were collected postpartum to to detect the presence of IgA and IgG anti-SARS-CoV-2. RESULTS The median interval between COVID-19 diagnosis and delivery was 37.5 days (IQ = 12.0, 73.0 days). Clinical symptoms during hospitalization were observed in 55 newborns (33.3%), and two (1.6%) tested RT-PCR positive for COVID-19. Positive colostrum for anti-SARS-CoV-2 IgA was found in 117 (70.9%) women. The presence of anti-SARS-CoV-2 IgA in colostrum was associated independently with lower clinical symptoms in their newborns (OR = 0.42; 95% CI 0.202 to 0.84; p = 0.015). CONCLUSIONS FOR PRACTICE The presence of anti-SARS-CoV-2 IgA in colostrum was detected in more than two-thirds of the women evaluated and was associated with a lower frequency of clinical symptoms in their newborns.
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Affiliation(s)
| | | | - Cibele Wolf Lebrão
- ABC Faculty of Medicine University Center (FMABC), Santo André, Brazil
- São Bernardo do Campo Municipal University Hospital (HMUSBC), São Paulo, Brazil
| | - Fernando Luiz Affonso-Fonseca
- ABC Faculty of Medicine University Center (FMABC), Santo André, Brazil
- São Paulo University, São Paulo, Brazil
- Federal University of São Paulo, Diadema Campus, São Paulo, Brazil
- Clinical Analysis Laboratory (FMABC), Santo André, Brazil
| | - Fabíola Isabel Suano-Souza
- Federal University of São Paulo, São Paulo, Brazil.
- Pediatrics Department, São Paulo School of Medicine, Federal University of São Paulo, Rua Botucatu, 598 - Vila Clementino, São Paulo, SP, 04023-062, Brazil.
- Pediatrics Department, ABC Faculty of Medicine University Center - FMABC, Santo André, Brazil.
- Multidisciplinary Team in Nutrition Therapy, São Bernardo Do Campo Municipal University Hospital (HMUSBC), São Paulo, Brazil.
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14
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Feng Q, Cui Q, Xiao Z, Liu Z, Fan S. Maternal and Perinatal Outcomes of SARS-CoV-2 and Variants in Pregnancy. MATERNAL-FETAL MEDICINE 2023. [DOI: 10.1097/fm9.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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15
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Lewis EL, Smoots AN, Woodworth KR, Olsen EO, Roth NM, Yazdy M, Shephard H, Sizemore L, Wingate H, Dzimira P, Reynolds B, Lush M, Fuchs EL, Ojo K, Siebman S, Hall AJ, Azziz-Baumgartner E, Perrine C, Hsia J, Ellington S, Tong VT, Gilboa SM. Breast Milk Feeding of Infants at Birth Among People With Confirmed SARS-CoV-2 Infection in Pregnancy: SET-NET, 5 States, March 29, 2020-December 31, 2020. Am J Public Health 2022; 112:S787-S796. [PMID: 36288521 PMCID: PMC9612185 DOI: 10.2105/ajph.2022.307023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To describe prevalence of breast milk feeding among people with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and examine associations between breast milk feeding, timing of maternal infection before delivery, and rooming-in status during delivery hospitalization. Methods. We performed a retrospective cohort study using data from Massachusetts, Minnesota, Nebraska, Pennsylvania, and Tennessee of whether people with confirmed SARS-CoV-2 infection during pregnancy in 2020 initiated breast milk feeding at birth. Results. Among 11 114 (weighted number) people with SARS-CoV-2 infection in pregnancy, 86.5% (95% confidence interval [CI] = 82.4%, 87.6%) initiated breast milk feeding during birth hospitalization. People with infection within 14 days before delivery had significantly lower prevalence of breast milk feeding (adjusted prevalence ratio [APR] = 0.88; 95% CI = 0.83, 0.94) than did those with infection at least 14 days before delivery. When stratified by rooming-in status, the association between timing of infection and breast milk feeding remained only among infants who did not room in with their mother (APR = 0.77; 95% CI = 0.68, 0.88). Conclusions. Pregnant and postpartum people with SARS-CoV-2 infection should have access to lactation support and be advised about the importance of breast milk feeding and how to safely feed their infants in the same room. (Am J Public Health. 2022;112(S8):S787-S796. https://doi.org/10.2105/AJPH.2022.307023).
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Affiliation(s)
- Elizabeth L Lewis
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Ashley N Smoots
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kate R Woodworth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Emily O'Malley Olsen
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Nicole M Roth
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mahsa Yazdy
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Hanna Shephard
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Lindsey Sizemore
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Heather Wingate
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Paula Dzimira
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Bethany Reynolds
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Mamie Lush
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Erika L Fuchs
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Kristen Ojo
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sam Siebman
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Aron J Hall
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Eduardo Azziz-Baumgartner
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Cria Perrine
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Jason Hsia
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Sascha Ellington
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Van T Tong
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
| | - Suzanne M Gilboa
- Elizabeth L. Lewis, Ashley N. Smoots, Kate R. Woodworth, Emily O'Malley Olsen, Nicole M. Roth, Aron J. Hall, Eduardo Azziz-Baumgartner, Cria Perrine, Jason Hsia, Sascha Ellington, Van T. Tong, and Suzanne M. Gilboa are with the Centers for Disease Control and Prevention (CDC) COVID-19 Response, Atlanta, GA. Mahsa Yazdy and Hanna Shephard are with the Massachusetts Department of Public Health, Boston. Lindsey Sizemore and Heather Wingate are with the Tennessee Department of Health, Nashville. Paula Dzimira and Bethany Reynolds are with the Pennsylvania Department of Health, Pittsburgh. Mamie Lush is with the Division of Public Health, Nebraska Department of Health and Human Services, Lincoln. Erika L. Fuchs is with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA. Kristen Ojo and Sam Siebman are with the Minnesota Department of Health, St. Paul
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16
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Grobben M, Juncker HG, van der Straten K, Lavell AHA, Schinkel M, Buis DTP, Wilbrink MF, Tejjani K, Claireaux MAF, Aartse A, de Groot CJM, Pajkrt D, Bomers MK, Sikkens JJ, van Gils MJ, van Goudoever JB, van Keulen BJ. Decreased Passive Immunity to Respiratory Viruses through Human Milk during the COVID-19 Pandemic. Microbiol Spectr 2022; 10:e0040522. [PMID: 35762813 PMCID: PMC9431045 DOI: 10.1128/spectrum.00405-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/11/2022] [Indexed: 11/20/2022] Open
Abstract
Infants may develop severe viral respiratory tract infections because their immune system is still developing in the first months after birth. Human milk provides passive humoral immunity during the first months of life. During the COVID-19 pandemic, circulation of common respiratory viruses was virtually absent due to the preventative measures resulting in reduced maternal exposure. Therefore, we hypothesized that this might result in lower antibody levels in human milk during the pandemic and, subsequently, decreased protection of infants against viral respiratory tract infections. We assessed antibody levels against respiratory syncytial virus (RSV), Influenza virus, and several seasonal coronaviruses in different periods of the COVID-19 pandemic in serum and human milk using a Luminex assay. IgG levels against RSV, Influenza, HCoV-OC43, HCoV-HKU1, and HCoV-NL63 in human milk were reduced with a factor of 1.7 (P < 0.001), 2.2 (P < 0.01), 2.6 (P < 0.05), 1.4 (P < 0.01), and 2.1 (P < 0.001), respectively, since the introduction of the COVID-19 restrictions. Furthermore, we observed that human milk of mothers that experienced COVID-19 contained increased levels of IgG and IgA binding to other respiratory viruses. Passive immunity via human milk against common respiratory viruses was reduced during the COVID-19 pandemic, which may have consequences for the protection of breastfed infants against respiratory infections. IMPORTANCE Passive immunity derived from antibodies in human milk is important for protecting young infants against invading viruses. During the COVID-19 pandemic, circulation of common respiratory viruses was virtually absent due to preventative measures. In this study, we observed a decrease in human milk antibody levels against common respiratory viruses several months into the COVID-19 pandemic. This waning of antibody levels might partially explain the previously observed surge of hospitalizations of infants, mostly due to RSV, when preventative hygiene measures were lifted. Knowledge of the association between preventative measures, antibody levels in human milk and subsequent passive immunity in infants might help predict infant hospital admissions and thereby enables anticipation to prevent capacity issues. Additionally, it is important in the consideration for strategies for future lockdowns to best prevent possible consequences for vulnerable infants.
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Affiliation(s)
- Marloes Grobben
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Hannah G. Juncker
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
- Center for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Karlijn van der Straten
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - David T. P. Buis
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maarten F. Wilbrink
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Khadija Tejjani
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Mathieu A. F. Claireaux
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Aafke Aartse
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, the Netherlands
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije K. Bomers
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jonne J. Sikkens
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Britt J. van Keulen
- Department of Pediatrics, Amsterdam Reproduction & Development Research Institute, Emma Children’s Hospital, University of Amsterdam, Amsterdam, the Netherlands
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17
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Szczygioł P, Łukianowski B, Kościelska-Kasprzak K, Jakuszko K, Bartoszek D, Krajewska M, Królak-Olejnik B. Antibodies in the breastmilk of COVID-19 recovered women. BMC Pregnancy Childbirth 2022; 22:635. [PMID: 35953773 PMCID: PMC9368700 DOI: 10.1186/s12884-022-04945-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Human milk contains antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which may serve as a protective factor through passive immunization in infants. The objective of this study was to measure the levels of anti-SARS-CoV-2 IgG and IgA in human milk and serum after a SARS-CoV-2 infection. Design Breast milk and serum samples from 72 lactating mothers with confirmed SARS-CoV-2 asymptomatic or symptomatic infection were collected 1-229 days after the onset of clinical symptoms related to COVID-19. Seventeen mothers with no history of COVID-19 served as a control group. Enzyme-Linked ImmunoSorbent Assay was performed to analyze antibodies against SARS-CoV-2. Results SARS-CoV-2-IgA human milk antibodies were detected in mothers and their concentrations were consistently higher than SARS-CoV-2-IgG antibodies. The serum and breastmilk samples of women with COVID-19 was characterized by a higher concentration of anti-RBD IgA and IgG than the serum from the control group without COVID-19. No statistically significant difference was observed between the antibody levels in the serum samples obtained from symptomatic and asymptomatic women exposed to SARS-CoV-2 and between the antibody level and the time from a positive SARS-CoV-2 test result over the period studied. Conclusion Our results confirm the presence of SARS-CoV-2 IgA and IgG antibodies in the breastmilk of COVID-19 recovered women and the possibility of these antibodies in providing specific immunologic benefits to breastfeeding infants such as protection against the virus transmission and severity of the acquired COVID-19 disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04945-z.
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Affiliation(s)
- Paulina Szczygioł
- Department of Neonatology, Wroclaw Medical University, 50-367, Wroclaw, Poland.
| | - Błażej Łukianowski
- Department of Neonatology, Wroclaw Medical University, 50-367, Wroclaw, Poland
| | | | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367, Wroclaw, Poland
| | - Dorota Bartoszek
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367, Wroclaw, Poland
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18
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Aknouch I, Sridhar A, Freeze E, Giugliano FP, van Keulen BJ, Romijn M, Calitz C, García-Rodríguez I, Mulder L, Wildenberg ME, Muncan V, van Gils MJ, van Goudoever JB, Stittelaar KJ, Wolthers KC, Pajkrt D. Human milk inhibits some enveloped virus infections, including SARS-CoV-2, in an intestinal model. Life Sci Alliance 2022; 5:e202201432. [PMID: 35926873 PMCID: PMC9354649 DOI: 10.26508/lsa.202201432] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Human milk is important for antimicrobial defense in infants and has well demonstrated antiviral activity. We evaluated the protective ability of human milk against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a human fetal intestinal cell culture model. We found that, in this model, human milk blocks SARS-CoV-2 replication, irrespective of the presence of SARS-CoV-2 spike-specific antibodies. Complete inhibition of both enveloped Middle East respiratory syndrome coronavirus and human respiratory syncytial virus infections was also observed, whereas no inhibition of non-enveloped enterovirus A71 infection was seen. Transcriptome analysis after 24 h of the intestinal monolayers treated with human milk showed large transcriptomic changes from human milk treatment, and subsequent analysis suggested that <i>ATP1A1</i> down-regulation by milk might be of importance. Inhibition of ATP1A1 blocked SARS-CoV-2 infection in our intestinal model, whereas no effect on EV-A71 infection was seen. Our data indicate that human milk has potent antiviral activity against particular (enveloped) viruses by potentially blocking the ATP1A1-mediated endocytic process.
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Affiliation(s)
- Ikrame Aknouch
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
- Viroclinics Xplore, Schaijk, The Netherlands
| | - Adithya Sridhar
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Eline Freeze
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Francesca Paola Giugliano
- Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism, Tytgat Institute for Intestinal and Liver Research, Amsterdam, The Netherlands
| | - Britt J van Keulen
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Emma Children's Hospital, Dutch National Human Milk Bank, Amsterdam, The Netherlands
| | - Michelle Romijn
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Emma Children's Hospital, Dutch National Human Milk Bank, Amsterdam, The Netherlands
| | - Carlemi Calitz
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Inés García-Rodríguez
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Lance Mulder
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Manon E Wildenberg
- Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism, Tytgat Institute for Intestinal and Liver Research, Amsterdam, The Netherlands
| | - Vanesa Muncan
- Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology and Metabolism, Tytgat Institute for Intestinal and Liver Research, Amsterdam, The Netherlands
| | - Marit J van Gils
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Emma Children's Hospital, Dutch National Human Milk Bank, Amsterdam, The Netherlands
| | - Koert J Stittelaar
- Department of Epidemiology, Bioinformatics and Animals Models, Wageningen University, Wageningen Bioveterinary Research, Wageningen, The Netherlands
| | - Katja C Wolthers
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, OrganoVIR Labs, Amsterdam, The Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
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19
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Onyinyechi Chionuma J, Onyeaka H, Ekwebelem OC, Darlington Nnaji N. SARS-CoV-2 variants and pregnant Women: A cause for Concern? Vaccine X 2022; 11:100185. [PMID: 35747762 PMCID: PMC9212993 DOI: 10.1016/j.jvacx.2022.100185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 03/06/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
Abstract
During pregnancy, women are at an increased risk of getting sick from respiratory viruses and when compared to non-pregnant women, pregnant women are more susceptible to severe illness from COVID-19. Owing to this fact and the emergence of a more infectious COVID-19 variants, pregnant women are currently classified as a vulnerable population, along with pediatric patients and older adults. While scientists are still learning more about the new variants, it is becoming clear that COVID-19 infected pregnant women are also at a real increased risk of poor pregnancy outcomes, as premature birth and babies born with lifelong health issues are possible if people become infected during pregnancy. Added to these facts, recommendation for COVID-19 has largely varied globally. The conspiracy-laden information on social media has led to pregnant women being hesitant about getting COVID-19 vaccine. Furthermore, as the transmissibility of COVID-19 is higher with this variant and the health system for maternal care in many countries regarded as “very bad” there is need to clearly highlight the impacts of the variants and for countries to speed up vaccination programme to reach all members of society.
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Affiliation(s)
| | - Helen Onyeaka
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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20
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Borg B, Gribble K, Courtney‐Haag K, Parajuli KR, Mihrshahi S. Association between early initiation of breastfeeding and reduced risk of respiratory infection: Implications for nonseparation of infant and mother in the COVID‐19 context. MATERNAL & CHILD NUTRITION 2022; 18:e13328. [PMID: 35137545 PMCID: PMC9115244 DOI: 10.1111/mcn.13328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Bindi Borg
- School of Public Health University of Sydney Sydney New South Wales Australia
| | - Karleen Gribble
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | | | | | - Seema Mihrshahi
- School of Public Health University of Sydney Sydney New South Wales Australia
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21
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Juncker HG, Ruhé EJM, Korosi A, van Goudoever JB, van Gils MJ, van Keulen BJ. Maternal Stress and Human Milk Antibodies During the COVID-19 Pandemic. Front Nutr 2022; 9:923501. [PMID: 35845768 PMCID: PMC9280861 DOI: 10.3389/fnut.2022.923501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Importance SARS-CoV-2-specific antibodies in human milk might protect the breastfed infant against COVID-19. One of the factors that may influence human milk antibodies is psychological stress, which is suggested to be increased in lactating women during the COVID-19 pandemic. Objective To determine whether psychological stress is increased in lactating women during the COVID-19 pandemic, and if maternal stress is associated with the level of SARS-CoV-2-specific antibodies in human milk. Design Population-based prospective cohort study. Setting Data collection took place in the Netherlands between October 2020 and February 2021. Participants Lactating women living in the Netherlands were eligible to participate in this study. In total, 2310 women were included. Exposures Stress exposure during the COVID-19 pandemic was determined using the Perceived Stress Scale (PSS) questionnaire and maternal lifetime stress was determined by the Life Stressor Checklist – revised (LSC-r) questionnaire. Main Outcome(s) and Measure(s) Stress experience during the COVID-19 pandemic was compared with a pre-pandemic cohort. SARS-CoV-2-specific antibodies in human milk were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) with the Spike protein of SARS-CoV-2. The association between maternal stress and human milk antibodies was determined using a multiple regression model. Results The PSS score of lactating mothers was not increased during the pandemic compared to the PSS score in the prepandemic cohort. Six hundred ninety-one participants had SARS-CoV-2-specific antibodies and were included in the regression models to assess the association between maternal stress and human milk antibodies. No association was found between PSS scores and human milk antibodies. In contrast, the LSC-r score was negatively associated with SARS-CoV-2-specific IgA in human milk (β = 0.98, 95% CI: 0.96–0.997, p = 0.03). Conclusions and Relevance Our results suggest that lactating women in the Netherlands did not experience higher stress levels during the COVID-19 pandemic. Breastfed infants of mothers with high chronic stress levels receive lower amounts of antibodies through human milk, which possibly makes them more vulnerable to respiratory infections. This emphasizes the importance of psychological wellbeing during lactation.
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Affiliation(s)
- Hannah G. Juncker
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Eliza J. M. Ruhé
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Amsterdam, Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Johannes B. van Goudoever
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Britt J. van Keulen
- Department of Pediatrics, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Amsterdam, Netherlands
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Broad Cross-Reactive IgA and IgG against Human Coronaviruses in Milk Induced by COVID-19 Vaccination and Infection. Vaccines (Basel) 2022; 10:vaccines10060980. [PMID: 35746588 PMCID: PMC9229351 DOI: 10.3390/vaccines10060980] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/19/2022] Open
Abstract
It is currently unclear if SARS-CoV-2 infection or mRNA vaccination can also induce IgG and IgA against common human coronaviruses (HCoVs) in lactating parents. Here we prospectively analyzed human milk (HM) and blood samples from lactating parents to measure the temporal patterns of anti-SARS-CoV-2 specific and anti-HCoV cross-reactive IgA and IgG responses. Two cohorts were analyzed: a vaccination cohort (n = 30) who received mRNA-based vaccines for COVID-19 (mRNA-1273 or BNT162b2), and an infection cohort (n = 45) with COVID-19 disease. Longitudinal HM and fingerstick blood samples were collected pre- and post-vaccination or, for infected subjects, at 5 time-points 14–28 days after confirmed diagnosis. The anti-spike(S) and anti-nucleocapsid(N) IgA and IgG antibody levels against SARS-CoV-2 and HCoVs were measured by multiplex immunoassay (mPlex-CoV). We found that vaccination significantly increased the anti-S IgA and IgG levels in HM. In contrast, while IgG levels increased after a second vaccine dose, blood and HM IgA started to decrease. Moreover, HM and blood anti-S IgG levels were significantly correlated, but anti-S IgA levels were not. SARS2 acute infection elicited anti-S IgG and IgA that showed much higher correlations between HM and blood compared to vaccination. Vaccination and infection were able to significantly increase the broadly cross-reactive IgG recognizing HCoVs in HM and blood than the IgA antibodies in HM and blood. In addition, the broader cross-reactivity of IgG in HM versus blood indicates that COVID-19 vaccination and infection might provide passive immunity through HM for the breastfed infants not only against SARS-CoV-2 but also against common cold coronaviruses.
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Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116872. [PMID: 35682455 PMCID: PMC9180577 DOI: 10.3390/ijerph19116872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022]
Abstract
COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood.
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Juncker HG, Mulleners SJ, Ruhé EJ, Coenen ER, Bakker S, van Doesburg M, Harinck JE, Rood RD, Bouhuijs JH, Oomen M, de Groot PCJ, Pajkrt PD, Korosi A, van Goudoever PJB, van Gils MJ, van Keulen BJ. Comparing the human milk antibody response after vaccination with four COVID-19 vaccines: A prospective, longitudinal cohort study in the Netherlands. EClinicalMedicine 2022; 47:101393. [PMID: 35465077 PMCID: PMC9013951 DOI: 10.1016/j.eclinm.2022.101393] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vaccination of lactating women against COVID-19 may protect not only themselves but also their breastfed infant through human milk. Therefore, it is important to gain insight into the human milk antibody response after immunization with the various vaccines that are currently widely used. The aim of this study is to determine and compare the antibody response in human milk following vaccination with mRNA- and vector-based vaccines up to over two months post-vaccination. METHODS This prospective cohort study was conducted in the Netherlands between January 06, 2021 and July 31, 2021. Participants were recruited through social media. Human milk samples were collected longitudinally during a period of 70 days from women receiving one of the four different severe acute respiratory coronavirus 2 (SARS-CoV-2) vaccines: Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273), Oxford/AstraZeneca (AZD1222) and Johnson&Johnson (Ad26.COV2.S). SARS-CoV-2-specific antibodies were measured using an enzyme-linked immunosorbent assay. The area under the curve (AUC) of the Immunoglobulins A (IgA) and G (IgG) antibody response was determined over 15 and 70 days following the first vaccination and compared between the different vaccines. FINDINGS This study enrolled 134 vaccinated lactating women of whom 97 participated the entire study period. In total, 1887 human milk samples were provided. The human milk antibody response differed between SARS-CoV-2 vaccines over the study period. The mean AUC of SARS-CoV-2-specific IgA, but not IgG, in human milk over 15 days was higher after vaccination with an mRNA-based vaccine than a vector-based vaccine (AUC with respect to ground [AUCg] ± the standard error of the mean [SEM] for IgA was 6·09 ± 0·89 in the BNT162b2 group, 7·48 ± 1·03 in the mRNA-1273 group, 4·17 ± 0·73 in the AZD1222 group, and 5·71 ± 0·70 in the Ad26.COV2.S group). Over a period of 70 days, the mean AUCg of both IgA and IgG was higher after vaccination with an mRNA-based vaccine than a vector-based vaccine (AUCg ± SEM for IgA was 38·77 ± 6·51 in the BNT162b2 group, 50·13 ± 7·41 in the mRNA-1273 group, 24·12 ± 5·47 in the AZD1222 group, and 28·15 ± 6·69 in the Ad26.COV2.S group; AUCg ± SEM for IgG was 40·43 ± 2·67 in the BNT162b2 group, 37·01 ± 2·38 in the mRNA-1273 group, 16·04 ± 5·09 in the AZD1222 group, and 10·44 ± 2·50 in the Ad26.COV2.S group). INTERPRETATION Overall, maternal vaccination during lactation with an mRNA-based vaccine resulted in higher SARS-CoV-2 antibody responses in human milk compared to vector-based vaccines. Therefore, vaccination with mRNA-based vaccines, preferably with the mRNA-1273 vaccine, might not only provide better immunological protection for the mother but also for her breastfed infant. FUNDING Stichting Steun Emma Kinderziekenhuis and the Amsterdam Infection and Immunity Institute (grant 24175).
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Affiliation(s)
- Hannah G. Juncker
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Sien J. Mulleners
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Eliza J.M. Ruhé
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Esmée R.M. Coenen
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Sjors Bakker
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Maritt van Doesburg
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Jolinda E. Harinck
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Romee D. Rood
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Joey H. Bouhuijs
- Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Melissa Oomen
- Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Prof. Christianne J.M. de Groot
- Amsterdam UMC, Vrije Universiteit, Amsterdam Reproduction & Development Research Institute, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Prof. Dasja Pajkrt
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Prof. Johannes B. van Goudoever
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
- Corresponding author at: Hans van Goudoever, Emma Children's Hospital - Amsterdam UMC, Meibergdreef 9, 1000 DE Amsterdam, The Netherlands. tel +31-20-5668885.
| | - Marit J. van Gils
- Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Britt J. van Keulen
- Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
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Wang J, Young BE, Li D, Seppo AE, Zhou Q, Wiltse A, Nowak-Wegrzyn A, Murphy K, Widrick K, Diaz N, Cruz-Vasquez J, Järvinen KM, Zand MS. Broad Cross-reactive IgA and IgG Against Human Coronaviruses in Milk Induced by COVID-19 Vaccination and Infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.03.13.22272281. [PMID: 35313594 PMCID: PMC8936120 DOI: 10.1101/2022.03.13.22272281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
UNLABELLED It is currently unclear if SARS-CoV-2 infection or mRNA vaccination can also induce IgG and IgA against common human coronaviruses (HCoVs) in lactating parents. Here we prospectively analyzed human milk (HM) and blood samples from lactating parents to measure the temporal patterns of anti-SARS-CoV-2 specific and anti-HCoV cross-reactive IgA and IgG responses. Two cohorts were analyzed: a vaccination cohort (n=30) who received mRNA-based vaccines for COVID-19 (mRNA-1273 or BNT162b2), and an infection cohort (n=45) with COVID-19 disease. Longitudinal HM and fingerstick blood samples were collected pre- and post-vaccination or, for infected subjects, at 5 time-points 14 - 28 days after confirmed diagnosis. The anti-spike(S) and antinucleocapsid(N) IgA and IgG antibody levels against SARS-CoV-2 and HCoVs were measured by multiplex immunoassay (mPlex-CoV). We found that vaccination significantly increased the anti-S IgA and IgG levels in HM. In contrast, while IgG levels increased after a second vaccine dose, blood and HM IgA started to decrease. Moreover, HM and blood anti-S IgG levels were significantly correlated, but anti-S IgA levels were not. SARS2 acute infection elicited anti-S IgG and IgA that showed much higher correlations between HM and blood compared to vaccination. Vaccination and infection were able to significantly increase the broadly cross-reactive IgG recognizing HCoVs in HM and blood than the IgA antibodies in HM and blood. In addition, the broader cross-reactivity of IgG in HM versus blood indicates that COVID-19 vaccination and infection might provide passive immunity through HM for the breastfed infants not only against SARS-CoV-2 but also against common cold coronaviruses. IMPORTANCE It is unknown if COVID-19 mRNA vaccination and infection in lactating mothers results in cross-reactive antibodies against other common human coronaviruses. Our study demonstrates that mRNA vaccination and COVID-19 infection increase anti-spike SARS-CoV-2 IgA and IgG in both blood and milk. IgA and IgG antibody concentrations in milk were more tightly correlated with concentrations in blood after infection compared to mRNA vaccination. Notably, both infection and vaccination resulted in increased IgG against common seasonal β -coronaviruses. This suggests that SARS-CoV-2 vaccination or infection in a lactating parent may result in passive immunity against SARS-CoV-2 and seasonal coronaviruses for the recipient infant.
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Yeo KT, Chia WN, Tan CW, Ong C, Yeo JG, Zhang J, Poh SL, Lim AJM, Sim KHZ, Sutamam N, Chua CJH, Albani S, Wang LF, Chua MC. Neutralizing Activity and SARS-CoV-2 Vaccine mRNA Persistence in Serum and Breastmilk After BNT162b2 Vaccination in Lactating Women. Front Immunol 2022; 12:783975. [PMID: 35087517 PMCID: PMC8787073 DOI: 10.3389/fimmu.2021.783975] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Wan Ni Chia
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wah Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Chengsi Ong
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- KK Human Milk Bank, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Joo Guan Yeo
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Jinyan Zhang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Kirsten Hui Zhi Sim
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
| | - Nursyuhadah Sutamam
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Camillus Jian Hui Chua
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Salvatore Albani
- Translational Immunology Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
- Singhealth Duke-NUS Global Health Institute, Singhealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women’s & Children’s Hospital, Singapore, Singapore
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- KK Human Milk Bank, KK Women’s & Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
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Shen CJ, Fu YC, Lin YP, Shen CF, Sun DJ, Chen HY, Cheng CM. Evaluation of Transplacental Antibody Transfer in SARS-CoV-2-Immunized Pregnant Women. Vaccines (Basel) 2022; 10:101. [PMID: 35062762 PMCID: PMC8778956 DOI: 10.3390/vaccines10010101] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy could result in adverse perinatal outcome. Clinical data on the assessment of the immune response in vaccinated pregnant women and subsequent transplacental antibody transfer are quite limited. OBJECTIVE To assess maternal and neonatal neutralizing antibody levels against both wildtype and Delta (B.1.617.2) variants after maternal mRNA vaccination. STUDY DESIGN This cohort study was conducted 29 pregnant women who were vaccinated at least one dose of Moderna (mRNA-1273) vaccine. Both neutralizing antibody (wildtype and Delta variant) and S1 receptor binding domain IgG antibody levels were evaluated in maternal and cord blood on the day of delivery. RESULTS Superiority of antibody level was significant in fully vaccinated women compared with the one-dose group (maternal sera, median, 97.46%; cord sera, median, 97.37% versus maternal sera, median, 4.01%; cord sera, median, 1.44%). No difference in antibody level was noted in relation to interval of second immunization to delivery in the two-dose group (95.99% in 0-2 weeks, 97.45% in 2-4 weeks, 97.48% in 4-8 weeks, 97.72% in 8-10 weeks). The most pronounced reduction was observed for the Delta variant. The wildtype neutralizing antibody level of full-vaccinated women was not influenced by the pertussis vaccination. CONCLUSION The data underscore the importance of full vaccination in pregnancy and support the recommendation of COVID-19 immunization for pregnant women. The lower level of vaccine-induced neutralizing antibodies for the Delta variant indicates insufficient protection for mother and newborn and highlights the need for development of effective vaccine strategies.
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Affiliation(s)
- Ching-Ju Shen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Yen-Pin Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Der-Ji Sun
- Department of Obstetrics and Gynecology, Pojen Hospital, Kaohsiung 804, Taiwan;
| | - Huan-Yun Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
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Juncker HG, Mulleners SJ, van Gils MJ, Bijl TPL, de Groot CJM, Pajkrt D, Korosi A, van Goudoever JB, van Keulen BJ. Comparison of SARS-CoV-2-Specific Antibodies in Human Milk after mRNA-Based COVID-19 Vaccination and Infection. Vaccines (Basel) 2021; 9:vaccines9121475. [PMID: 34960222 PMCID: PMC8706455 DOI: 10.3390/vaccines9121475] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
SARS-CoV-2-specific antibodies are secreted into human milk of infected or vaccinated lactating women and might provide protection to the breastfed infant against COVID-19. Differences in antibody response after these types of exposure are unknown. In this longitudinal cohort study, we compared the antibody response in human milk following SARS-CoV-2 vaccination or infection. We analyzed 448 human milk samples of 28 lactating women vaccinated with the SARS-CoV-2 vaccine BNT162b2 as well as 82 human milk samples of 18 lactating women with a prior SARS-CoV-2 infection. The levels of SARS-CoV-2-specific IgA in human milk were determined over a period of 70 days both after vaccination and infection. The amount of SARS-CoV-2-specific IgA in human milk was similar after SARS-CoV-2 vaccination and infection. After infection, the variability in IgA levels was higher than after vaccination. Two participants with detectable IgA prior to vaccination were analyzed separately and showed higher IgA levels following vaccination compared to both groups. In conclusion, breastfed infants of mothers who have been vaccinated with the BNT162b2 vaccine receive human milk with similar amounts of SARS-CoV-2-specific antibodies compared to infants of previously infected mothers.
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Affiliation(s)
- Hannah G. Juncker
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (H.G.J.); (S.J.M.); (D.P.); (B.J.v.K.)
- Center for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, 1098 XH Amsterdam, The Netherlands;
| | - Sien J. Mulleners
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (H.G.J.); (S.J.M.); (D.P.); (B.J.v.K.)
| | - Marit J. van Gils
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.J.v.G.); (T.P.L.B.)
| | - Tom P. L. Bijl
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.J.v.G.); (T.P.L.B.)
| | - Christianne J. M. de Groot
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Vrije Universiteit, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands;
| | - Dasja Pajkrt
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (H.G.J.); (S.J.M.); (D.P.); (B.J.v.K.)
| | - Aniko Korosi
- Center for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, 1098 XH Amsterdam, The Netherlands;
| | - Johannes B. van Goudoever
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (H.G.J.); (S.J.M.); (D.P.); (B.J.v.K.)
- Correspondence: ; Tel.: +31-20-566-8885
| | - Britt J. van Keulen
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands; (H.G.J.); (S.J.M.); (D.P.); (B.J.v.K.)
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29
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Larcade R, DeShea L, Lang GA, Caballero MT, Ferretti A, Beasley WH, Tipple TE, Vain N, Prudent L, Lang ML, Polack F, Ofman G. Maternal-fetal immunologic response to SARS-CoV-2 infection in a symptomatic vulnerable population: A prospective cohort. J Infect Dis 2021; 225:800-809. [PMID: 34865064 DOI: 10.1093/infdis/jiab591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19 disproportionally affects pregnant women and their newborn, yet little is known about the variables that modulate the maternal-fetal immune response to infection. METHODS We prospectively studied socioeconomic, biologic and clinical factors affecting humoral immunity in 87 unvaccinated pregnant women admitted to hospital in the Buenos Aires metropolitan area for symptoms consistent with COVID-19 disease. RESULTS The number of days between symptom onset and childbirth predicted maternal and newborn virus Spike protein Receptor Binding Domain (RBD)-specific IgG. These findings suggest newborns may benefit less when mothers deliver soon after COVID-19 infection. Similarly, a longer time between symptom onset and birth predicted higher in utero transfer of maternal IgG and its concentration in cord blood. Older gestational ages at birth were associated with lower maternal IgG: cord blood IgG ratios. Eighty seven percent of women with confirmed SARS-CoV-2 infection developed RBD-specific IgA responses in breast milk within 96 h of childbirth. IgA was not significantly associated with time from infection but correlated with maternal serum IgG and placental transfer. CONCLUSIONS These results demonstrate the combined role of biologic, clinical and socioeconomic variables associated with maternal SARS-CoV-2 RBD-specific antibodies and supports early vaccination strategies for COVID-19 in socioeconomically vulnerable pregnant women.
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Affiliation(s)
| | - Lise DeShea
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Gillian A Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | - Mauricio T Caballero
- Fundación INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - William H Beasley
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Trent E Tipple
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | | | | | - Mark L Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | | | - Gaston Ofman
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA.,Fundación INFANT, Buenos Aires, Argentina
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30
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Pérez-Bermejo M, Peris-Ochando B, Murillo-Llorente MT. COVID-19: Relationship and Impact on Breastfeeding-A Systematic Review. Nutrients 2021; 13:2972. [PMID: 34578848 PMCID: PMC8470649 DOI: 10.3390/nu13092972] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). One major problem faced is whether breastfeeding by mothers infected with the virus is safe. The objective of this work is to study the impact that the SARS-CoV-2 virus can have on breastfeeding, and whether the virus or antibodies can be transmitted from mother to child through milk. We carried out a systematic review of studies focusing on the impact of SARS-CoV-2 on breastfeeding by mothers infected with the virus. The bibliographic search was done through Medline (Pubmed), MedlinePlus and Google Scholar. From 292 records, the title and summary of each were examined according to the criteria, and whether they meet the selection criteria was also analysed. A total of 30 articles are included, of which 26 deal with the study of RNA virus in breastmilk and its involvement in breastfeeding and four on the study of SARS-CoV-2 antibodies in milk. Most studies have been conducted in China. Breastfeeding by mothers infected with SARS-CoV-2 is highly recommended for infants, if the health of the mother and the infant allow for it. Direct breastfeeding and maintaining appropriate protective measures should be encouraged. Should the mother's health condition not permit direct breastfeeding, infants should be fed with pumped breastmilk or donor milk.
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Affiliation(s)
- Marcelino Pérez-Bermejo
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain;
| | - Belén Peris-Ochando
- School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain;
| | - María Teresa Murillo-Llorente
- SONEV Research Group, School of Medicine and Health Sciences, Catholic University of Valencia San Vicente Mártir, C/Quevedo nº 2, 46001 Valencia, Spain;
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31
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Juncker HG, Mulleners SJ, van Gils MJ, de Groot CJM, Pajkrt D, Korosi A, van Goudoever JB, van Keulen BJ. The Levels of SARS-CoV-2 Specific Antibodies in Human Milk Following Vaccination. J Hum Lact 2021; 37:477-484. [PMID: 34176363 DOI: 10.1177/08903344211027112] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are being administered around the world; however, lactating women were excluded from SARS-CoV-2 vaccine trials. Therefore, knowledge about the effect of vaccination in this specific group is limited. This information is essential to empower lactating women to make a well-informed decision on their choice for vaccination. After natural infection, SARS-CoV-2 specific antibodies are present in human milk, which might offer protection for her newborn. The dynamics of these antibodies in human milk following vaccination remain to be elucidated. RESEARCH AIM To determine the effect of vaccination with BNT162b2 on the levels of SARS-CoV-2 specific IgA in human milk. METHODS In this prospective longitudinal study, we included lactating women who received the BNT162b2 vaccine. Human milk samples were collected prior to vaccination and 3, 5, 7, 9, 11, 13, and 15 days after both vaccine doses. Samples were analyzed using enzyme-linked immunosorbent assay against the spike protein of SARS-CoV-2. RESULTS In total, 366 human milk samples from 26 lactating women were analyzed. A biphasic response was observed, with SARS-CoV-2 specific immunoglobulin A (IgA) starting to increase between day 5 and 7 after the first dose of the vaccine. After the second dose, an accelerated IgA antibody response was observed. CONCLUSION After vaccination with the mRNA-based BNT162b2 vaccine, a SARS-CoV-2 specific antibody response was observed in human milk. The presence of SARS-CoV-2 specific IgA after vaccination is important as antibodies are transferred via human milk, and thereby might provide protection to infants against COVID-19.
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Affiliation(s)
- Hannah G Juncker
- 332563 Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands.,Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Sien J Mulleners
- 332563 Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Marit J van Gils
- 26066 Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Christianne J M de Groot
- 120984709 Amsterdam UMC, Vrije Universiteit, Amsterdam Reproduction & Development Research Institute, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Dasja Pajkrt
- 332563 Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences - Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- 332563 Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
| | - Britt J van Keulen
- 332563 Amsterdam UMC, Vrije Universiteit, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction & Development Research Institute, Department of Pediatrics, Amsterdam, the Netherlands
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32
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Abstract
BACKGROUND The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has infected over 127 million people worldwide, with almost 2.8 million deaths at the time of writing. Since no lactating individuals were included in initial trials of vaccine safety and efficacy, research on SARS-CoV-2 vaccination in lactating women and the potential transmission of passive immunity to the infant through mother's milk is needed to guide patients, clinicians, and policy makers on whether to recommend immunization during the worldwide effort to curb the spread of this virus. RESEARCH AIMS (1) To determine whether SARS-CoV-2 specific immunoglobins are found in human milk after vaccination, and (2) to characterize the time course and types of immunoglobulins present. METHODS A longitudinal cohort study of lactating women (N = 7) who planned to receive both doses of the Pfizer-BioNTech or Moderna SARS-CoV-2 vaccine between December 2020 and January 2021 provided milk samples. These were collected pre-vaccination and at 11 additional timepoints, with the last sample at 14 days after the second dose of vaccine. Samples were analyzed for levels of SARS-CoV-2 specific immunoglobulins A and G (IgA and IgG). RESULTS We observed significantly elevated levels of SARS-CoV-2 specific IgG and IgA antibodies in human milk beginning approximately 7 days after the initial vaccine dose, with an IgG-dominant response. CONCLUSIONS Maternal vaccination results in SARS-CoV-2 specific immunoglobulins in human milk that may be protective for infants.
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Affiliation(s)
| | - Shawn M Jensen
- 25165 Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR, USA
| | - Walter J Urba
- 25165 Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR, USA
| | - Bernard A Fox
- 25165 Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR, USA
| | - Jason R Baird
- 25165 Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR, USA
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33
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Calil VMLT, Palmeira P, Zheng Y, Krebs VLJ, Carvalho WBD, Carneiro-Sampaio M. CoronaVac can induce the production of anti-SARS-CoV-2 IgA antibodies in human milk. Clinics (Sao Paulo) 2021; 76:e3185. [PMID: 34190859 PMCID: PMC8221553 DOI: 10.6061/clinics/2021/e3185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Patricia Palmeira
- Laboratorio de Pediatria Clinica (LIM36), Departamento de Pediatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Yingying Zheng
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vera Lúcia Jornada Krebs
- Instituto da Crianca e do Adolescente, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Magda Carneiro-Sampaio
- Laboratorio de Pediatria Clinica (LIM36), Departamento de Pediatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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