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Li X, Hu Y, Lv Y, Obore N, Wang Y, Yu H. SARS-CoV-2 Antibodies in Human Milk After mRNA and Adenovector-Based Vaccination: A Systematic Review and Meta-Analysis. J Hum Lact 2024:8903344241252645. [PMID: 38798078 DOI: 10.1177/08903344241252645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND SARS-CoV-2 specific antibodies exist in human milk expressed by lactating parents after vaccination. In the existing research, the effects of vaccine types on human milk are inconsistent. RESEARCH AIM This study aims to perform a systematic review and meta-analysis of the existing observational studies to compare the positive rates of SARS-CoV-2 specific antibodies in human milk according to mRNA and adenovector-based vaccination. METHODS PubMed, Web of Science, Elsevier Science Direct and Cochrane Library databases were systematically searched for relevant articles published from December 30, 2019 to February 15, 2023. Observational studies were considered eligible provided they reported data on SARS-CoV-2 specific antibodies in human milk. The risk of bias in non-randomized studies of interventions (ROBINS-I) tool, the Newcastle-Ottawa Scale (NOS), and the Agency for Healthcare Research and Quality (AHRQ) were used to assess risk of bias. Seven studies, including 511 lactating participants, were included in this review and meta-analysis. RESULTS The positive rate of SARS-CoV-2 IgA is higher in mRNA vaccine groups than in adenovector-based vaccine groups (OR = 4.80, 95% CI [3.04, 7.58], p < 0.001). The positive rate of SARS-CoV-2 IgG was higher in mRNA vaccines than in adenovector-based vaccines. CONCLUSIONS Compared to adenovector-based vaccines, mRNA vaccines present a higher positivity rate of IgA and IgG in human milk after vaccination. In other words, mRNA vaccinations may offer breastfed children a higher level of protection than adenovector-based vaccinations. Further high-quality data is still required to substantiate these findings.
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Affiliation(s)
- Xuan Li
- Medical School of Southeast University, Nanjing, China
| | - Yan Hu
- Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
| | - You Lv
- Medical School of Southeast University, Nanjing, China
| | - Nathan Obore
- Medical School of Southeast University, Nanjing, China
| | - YiXiao Wang
- Medical School of Southeast University, Nanjing, China
| | - Hong Yu
- Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu, China
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2
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Valverde-Merino MI, Gomez-Guzman M, Piquer-Martinez C, Cabezas Lopez MD, Zarzuelo MJ. The importance of COVID-19 vaccination during lactation. Infect Dis Now 2024; 54:104831. [PMID: 37952583 DOI: 10.1016/j.idnow.2023.104831] [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: 06/15/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
The World Health Organization strongly supports breastfeeding as the main source of infant feeding to ensure maternal and child health. Since its emergence, COVID-19 has become a disease affecting the health of the world's population, and vaccines have been developed to prevent it. However, the decision to license COVID-19 vaccines for infants under 6 months of age has been delayed. Different studies have shown that during the breastfeeding period, the benefit-risk balance is much higher in favor of the benefit, at the immunological level for the infant, due to its low perception of adverse effects and the low transmission of products such as mRNA from the mother to the child. Different organizations and societies recommend vaccination in breastfeeding women. COVID-19 vaccines have been shown to be safe and effective.
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Affiliation(s)
- Maria Isabel Valverde-Merino
- Pharmaceutical Care Research Group. Department of Pharmacy and Pharmaceutical Technology. Faculty of Pharmacy. University of Granada, Spain
| | - Manuel Gomez-Guzman
- Department of Pharmacology. Faculty of Pharmacy. University of Granada, Spain
| | - Celia Piquer-Martinez
- Pharmaceutical Care Research Group. Department of Pharmacy and Pharmaceutical Technology. Faculty of Pharmacy. University of Granada, Spain
| | - Maria Dolores Cabezas Lopez
- Pharmaceutical Care Research Group. Department of Pharmacy and Pharmaceutical Technology. Faculty of Pharmacy. University of Granada, Spain
| | - Maria Jose Zarzuelo
- Pharmaceutical Care Research Group. Department of Pharmacy and Pharmaceutical Technology. Faculty of Pharmacy. University of Granada, Spain.
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3
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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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Hsiao HM, DiMaggio LS, Perez MA, Chen X, Stephens K, Gibson T, Anderson EJ, Rostad CA. SARS-CoV-2 Antibody Profiles in Maternal Serum and Breast Milk Following mRNA COVID-19 Vaccination: A Longitudinal Prospective Observational Cohort Study. Vaccines (Basel) 2023; 11:1643. [PMID: 38005975 PMCID: PMC10675665 DOI: 10.3390/vaccines11111643] [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: 09/10/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 vaccination during pregnancy protects infants against symptomatic COVID-19. Vaccination of lactating mothers may offer additional protection, but our understanding of immune responses in breast milk is limited. We, therefore, performed a single-center prospective cohort study of lactating mothers who received a COVID-19 mRNA primary vaccine series to evaluate the durability, breadth, and neutralizing capacity of the antibody responses in breast milk. Spike IgG- and IgA-binding antibodies of ancestral SARS-CoV-2 in serum and breast milk were quantified over 9 months using Meso Scale Discovery (MSD) V-PLEX assays, and ancestral titers were compared to four variants of concern (Alpha, Beta, Delta, Gamma) at a single time point. Neutralizing antibodies against ancestral SARS-CoV-2 and Omicron BA.4/5 were compared before and after vaccination using a pseudovirus-neutralization assay. Eleven lactating mothers received either Pfizer BNT162b2 (7/11) or Moderna mRNA-1273 (4/11) vaccine primary series. IgG and IgA titers increased in serum and breast milk following each dose, peaking 1-4 weeks after series completion. Titers remained significantly elevated for 7-9 months, except for in breast milk IgA which returned to baseline within 1 month. Furthermore, binding antibodies against all included variants were detected in breast milk collected 1-3 weeks after series completion. However, while vaccination induced a strong neutralizing response against ancestral SARS-CoV-2 in serum and more modest response in breast milk, it did not induce neutralizing antibodies against Omicron BA.4/5 in either specimen type. This study demonstrates that maternal COVID-19 mRNA vaccination may enhance immune protection for infants through breast milk via increased IgG- and IgA-binding-and-neutralizing antibodies; although, variant-specific boosters may be required to optimize immune protection.
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Affiliation(s)
- Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Langdon S. DiMaggio
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Maria A. Perez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Xuemin Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Kathleen Stephens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Christina A. Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (H.-M.H.); (L.S.D.); (M.A.P.); (X.C.); (K.S.); (T.G.)
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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5
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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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6
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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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7
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Cortés-Sarabia K, Guzman-Silva V, Martinez-Pacheco KM, Meza-Hernández JA, Luna-Pineda VM, Leyva-Vázquez MA, Vences-Velázquez A, Beltrán-Anaya FO, Del Moral-Hernández O, Illades-Aguiar B. Detection of IgA and IgG Antibodies against the Structural Proteins of SARS-CoV-2 in Breast Milk and Serum Samples Derived from Breastfeeding Mothers. Viruses 2023; 15:v15040966. [PMID: 37112946 PMCID: PMC10144911 DOI: 10.3390/v15040966] [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: 02/28/2023] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Background: COVID-19 vaccination or natural infection is associated with the development of immunity. The search of IgA and IgG antibodies against all the structural proteins (spike, nucleocapsid, membrane, and envelope) of SARS-CoV-2 in breastfeeding mothers is associated with immunity that can help the newborn avoid development of the infection. Methods: In this study, we analyzed 30 breastfeeding women that provided samples of breast milk and serum and evaluated the presence of IgA, total IgG, and subclasses against the structural proteins of SARS-CoV-2. Results: We reported a high seroprevalence to IgA (76.67-100%) and negativity to IgG against all analyzed proteins in breast milk. Seroprevalence in serum samples was around 10-36.67% to IgA and 23.3-60% to IgG. Finally, we detected the presence of the subclasses IgG1, IgG2, and IgG4 against all the structural proteins of SARS-CoV-2. Conclusions: This work provides evidence of the presence of IgA and IgG antibodies against the four structural proteins of SARS-CoV-2 in breast milk and serum samples derived from breastfeeding women, which can confer immunity to the newborn.
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Affiliation(s)
- Karen Cortés-Sarabia
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Vianey Guzman-Silva
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Karla Montserrat Martinez-Pacheco
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Jesús Alberto Meza-Hernández
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Víctor Manuel Luna-Pineda
- Unidad de Investigación en Inmunología y Proteómica, Laboratorio de Investigación en COVID-19, Hospital Infantil de México "Federico Gómez", Mexico City 06720, Mexico
| | - Marco Antonio Leyva-Vázquez
- Laboratorio de Biomedicina Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Amalia Vences-Velázquez
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Fredy Omar Beltrán-Anaya
- Laboratorio de Biomedicina Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Oscar Del Moral-Hernández
- Laboratorio de Virología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39086, Mexico
| | - Berenice Illades-Aguiar
- Unidad de Investigación en Inmunología y Proteómica, Laboratorio de Investigación en COVID-19, Hospital Infantil de México "Federico Gómez", Mexico City 06720, Mexico
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8
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Anti-Spike Antibodies Present in the Milk of SARS-CoV-2 Vaccinated Mothers Are Complement-Activating. Int J Mol Sci 2023; 24:ijms24054395. [PMID: 36901824 PMCID: PMC10002545 DOI: 10.3390/ijms24054395] [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: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Although only 0.8-1% of SARS-CoV-2 infections are in the 0-9 age-group, pneumonia is still the leading cause of infant mortality globally. Antibodies specifically directed against SARS-CoV-2 spike protein (S) are produced during severe COVID-19 manifestations. Following vaccination, specific antibodies are also detected in the milk of breastfeeding mothers. Since antibody binding to viral antigens can trigger activation of the complement classical - pathway, we investigated antibody-dependent complement activation by anti-S immunoglobulins (Igs) present in breast milk following SARS-CoV-2 vaccination. This was in view of the fact that complement could play a fundamentally protective role against SARS-CoV-2 infection in newborns. Thus, 22 vaccinated, lactating healthcare and school workers were enrolled, and a sample of serum and milk was collected from each woman. We first tested for the presence of anti-S IgG and IgA in serum and milk of breastfeeding women by ELISA. We then measured the concentration of the first subcomponents of the three complement pathways (i.e., C1q, MBL, and C3) and the ability of anti-S Igs detected in milk to activate the complement in vitro. The current study demonstrated that vaccinated mothers have anti-S IgG in serum as well as in breast milk, which is capable of activating complement and may confer a protective benefit to breastfed newborns.
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9
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Detection of SARS-CoV-2-Specific Antibodies in Human Breast Milk and Their Neutralizing Capacity after COVID-19 Vaccination: A Systematic Review. Int J Mol Sci 2023; 24:ijms24032957. [PMID: 36769279 PMCID: PMC9917673 DOI: 10.3390/ijms24032957] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
SARS-CoV-2 is the virus that causes the infectious disease known as Corona Virus Disease 2019 (COVID-19). The severe impact of the virus on humans is undeniable, which is why effective vaccines were highly anticipated. As of 12 January 2022, nine vaccines have obtained Emergency Use Listing by the World Health Organization (WHO), and four of these are approved or authorized by the Centers for Disease Control and Prevention (CDC) in the United States. The initial clinical trials studying COVID-19 vaccine efficacy excluded pregnant and lactating individuals, meaning that data on the effects of the vaccine on breast milk were lacking. Until today, none of the authorized vaccines have been approved for use in individuals under six months. During the first months of life, babies do not produce their own antibodies; therefore, antibodies contained in their mothers' breastmilk are a critical protective mechanism. Several studies have shown the presence of SARS-CoV-2 antibodies in the breast milk of women who have been vaccinated or had been naturally infected. However, whether these are protective is still unclear. Additionally, research on the BNT162b2 mRNA vaccine developed by Pfizer-BioNTech and the mRNA-1273 vaccine developed by Moderna suggests that these vaccines do not release significant amounts, if any, of mRNA into breast milk. Hence, there is no evidence that vaccination of the mother poses any risk to the breastfed infant, while the antibodies present in breast milk may offer protection against the virus. The primary objective of this systematic review is to summarize the current understanding of the presence of immunoglobulins in human milk that are elicited by SARS-CoV-2 vaccines and to evaluate their ability to neutralize the virus. Additionally, we aim to quantify the side effects experienced by lactating mothers who have been vaccinated, as well as the potential for adverse effects in their infants. This study is critical because it can help inform decision-making by examining the current understanding of antibody secretion in breastmilk. This is particularly important because, although the virus tends to be less severe in younger individuals, infants who contract the disease are at a higher risk of requiring hospitalization compared to older children.
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10
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Berger J, Burnham L, Nickel N, Knapp R, Gambari A, Beliveau P, Merewood A. Policies and Practices in a Cohort of Mississippi Birthing Hospitals During the COVID-19 Pandemic. Breastfeed Med 2023; 18:138-148. [PMID: 36800335 DOI: 10.1089/bfm.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background and Objectives: Guidance around maternity care practices and infant feeding during the COVID-19 pandemic changed over time and was sometimes conflicting. Hospital maternity practices influence breastfeeding, an important preventive strategy against viral illness. Most birthing hospitals in Mississippi are enrolled in CHAMPS, a quality improvement initiative to support breastfeeding and continuously collect maternity care data. The aims of this study were to (1) assess changes to maternity care policies in response to COVID-19, and (2) compare hospital-level breastfeeding, skin-to-skin, and rooming-in rates, at cohort hospitals, before and during the pandemic, overall and stratified by race. Methods: Hospitals responded to a survey on maternity policies in May and September 2020 (Aim 1); hospitals submitted data on breastfeeding and maternity care practices before and during the pandemic (Aim 2). We tested for differences in survey responses using chi-squared statistics and performed an interrupted time series analysis on breastfeeding and maternity care practices data. Results: Twenty-six hospitals responded to the May and September 2020 surveys. Hospitals used different sources to create maternity care policies, and policies differed between institutions. Trends in rates of any and exclusive breastfeeding in the hospital cohort plateaued during the pandemic, in comparison to previous gains, and rates of skin-to-skin and hospital rooming-in decreased. No differences were evident between races. Conclusions: Policies (Aim 1) and practices in the quality improvement cohort hospitals were inconsistent during the COVID-19 pandemic, and changes measured to practices were detrimental (Aim 2). Ongoing monitoring is recommended.
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Affiliation(s)
- Jacqueline Berger
- Department of Sociology and Anthropology, Georgia Southern University, Statesboro, Georgia, USA
| | - Laura Burnham
- Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Nathan Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Rebecca Knapp
- Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Aishat Gambari
- Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Paige Beliveau
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Anne Merewood
- Division of General Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
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Lechosa-Muñiz C, Paz-Zulueta M, Irure-Ventura J, Mendez-Legaza JM, Cuesta González R, Gómez-Acebo I, López-Hoyos M, Llorca J, Cabero-Pérez MJ. Development of SARS-CoV-2 specific IgG and IgA antibodies in serum and milk with different SARS-COV-2 vaccines in lactating women. Int Breastfeed J 2023; 18:3. [PMID: 36627706 PMCID: PMC9831888 DOI: 10.1186/s13006-022-00536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/18/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Our main objective was to determine the evolution of IgG and IgA antibodies directed against SARS-CoV-2 protein S in the blood of lactating women and in breast milk. METHODS A cohort of 110 uninfected and vaccinated breastfeeding women was followed-up for 6 months at the Marqués de Valdecilla University Hospital, Spain, in 2020. An additional group of 23 breastfeeding mothers who had no previously documented infection and had not been vaccinated against SARS-CoV-2 were included as a control group. The antibodies in blood and breast milk and their evolution at 6 months post-vaccination were analysed. RESULTS One hundred ten breastfeeding mothers were included; 70 women (63.6%) were vaccinated with two doses of BNT162b2, 20 women (18.2%) received two doses of mRNA-1273, and 20 women (18.2%) received a single dose of ChAdOx1-S. No evidence of differences between concentrations of antibodies was found according to the type of vaccine, with the exception of serum IgA antibodies, which was higher in women vaccinated with mRNA-1273: mean [95%CI]: 0.05 AU/mL [0.03,0.06] with mRNA-1273, 0.02 AU/mL [0.01,0.03] with BNT162b2 and 0.01 AU/mL [0.00,0.03] with ChAdOx1-S, ANOVA p value = 0.03. The lack of difference between vaccines was also found when anti-S1 specific IgG in serum and breast milk were measured. CONCLUSIONS In lactating women vaccinated against COVID-19, anti-SARS-CoV-2 antibodies can be detected in both serum and breastmilk 6 months after receiving the second dose, although their concentrations decreased when compared with concentrations reached immediately after vaccination.
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Affiliation(s)
- Carolina Lechosa-Muñiz
- grid.7821.c0000 0004 1770 272XDepartamento de Enfermería, Universidad de Cantabria, Santander, Spain ,grid.411325.00000 0001 0627 4262Breastfeeding Coordinator, IBCLC, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain. .,IDIVAL- Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Cantabria, Spain.
| | - Juan Irure-Ventura
- grid.411325.00000 0001 0627 4262Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jose Manuel Mendez-Legaza
- grid.411325.00000 0001 0627 4262Department of Microbiology, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain
| | - Rocío Cuesta González
- grid.411325.00000 0001 0627 4262Department of Pediatrics, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain
| | - Inés Gómez-Acebo
- grid.7821.c0000 0004 1770 272XDepartamento de Ciencias Médicas y Quirúrgicas. Universidad de Cantabria, Santander, Spain ,grid.484299.a0000 0004 9288 8771IDIVAL, Cantabria, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marcos López-Hoyos
- grid.411325.00000 0001 0627 4262Department of Immunology, Hospital Universitario Marqués de Valdecilla, Santander, Spain ,grid.484299.a0000 0004 9288 8771IDIVAL, Cantabria, Spain ,grid.7821.c0000 0004 1770 272XLaboratory, Molecular Biology Department, University of Cantabria, Santander, Spain
| | - Javier Llorca
- grid.7821.c0000 0004 1770 272XDepartamento de Ciencias Médicas y Quirúrgicas. Universidad de Cantabria, Santander, Spain ,grid.466571.70000 0004 1756 6246CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Jesús Cabero-Pérez
- grid.411325.00000 0001 0627 4262Department of Pediatrics, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain ,grid.7821.c0000 0004 1770 272XDepartamento de Ciencias Médicas y Quirúrgicas. Universidad de Cantabria, Santander, Spain ,grid.484299.a0000 0004 9288 8771IDIVAL, Cantabria, Spain ,grid.413448.e0000 0000 9314 1427Red de Salud Materno Infantil y del Desarrollo – SAMID. Instituto de Salud Carlos III, Madrid, Spain
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12
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Novillo B, Martínez-Varea A. COVID-19 Vaccines during Pregnancy and Breastfeeding: A Systematic Review. J Pers Med 2022; 13:jpm13010040. [PMID: 36675701 PMCID: PMC9864310 DOI: 10.3390/jpm13010040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Pregnant and breastfeeding women received unclear recommendations regarding COVID-19 vaccination at the beginning of the pandemic, as they were not included in the initial clinical trials. This systematic review aims to provide an update regarding COVID-19 vaccines during pregnancy and breastfeeding. Methods: The systematic review was carried out through a literature search in Medline/Pubmed. Studies were selected if they included information regarding COVID-19 vaccination during pregnancy and breastfeeding. The PRISMA guidelines for systematic reviews were followed. Results: A total of 33 studies were included. The main adverse effect is pain at the injection site, as in the general population. Adverse effects are more frequent after the second dose, being slightly more frequent after the Moderna vaccine. COVID-19 vaccination reduces the risk of severe COVID-19 in pregnant women. Additionally, COVID-19 vaccination induces artificial active immunogenicity in the mother and natural passive immunogenicity in the child. Breastmilk straddles both immediate antibody-mediated and long-lived cellular-mediated immune protection. Regarding neonatal benefits, vaccination is associated with a larger and more stable Immunoglobulin G response, while COVID-19 Infection is associated with a rapid and long-lasting Immunoglobulin A response. Conclusions: COVID-19 vaccines are not only suggested but strongly recommended for pregnant and breastfeeding populations to protect mothers and newborns.
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Pérez-Bernal M, Hernández C, Ibargollín R, Martínez M, Soria M, Delgado M, Valdivia O, Dorta D, Domínguez A, Pérez E, Cabrera Y. SARS-CoV-2 spike RBD-specific IgA and IgG antibodies in breast milk after vaccination with the protein subunit vaccine Abdala. INFECTIOUS MEDICINE 2022; 1:253-261. [PMID: 38013910 PMCID: PMC9671870 DOI: 10.1016/j.imj.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Background COVID-19 vaccines that trigger a strong secretory antibody response in breast milk may achieve effective passive protection of vulnerable newborns and breastfed infants of immunized mothers. The aim of this work was to investigate the presence of SARS-CoV-2 spike RBD-specific IgA and IgG antibodies in breast milk, 5 and 9 weeks after vaccination with 3 doses of the protein subunit vaccine Abdala, compared to those found in breast milk from COVID-19-recovered women, collected at least 40 days after the infection. Methods SARS-CoV-2 spike RBD-specific IgA and IgG antibodies were semi-quantified by indirect ELISA, using a homemade standard generated by pooling twenty breast milk samples with high absorbance values according to preliminary data. The validity of the standard curves was proved following the European Medicines Agency Guideline. Two breast milk samples from 2 unvaccinated women who had not been infected with COVID-19 were included as negative controls. Potentially neutralizing antibodies was assessed by a SARS-CoV-2 surrogate virus neutralization test. Results High levels of anti-RBD IgA antibodies were detected in breast milk samples 9 weeks after vaccination and anti-RBD IgG antibodies rise from the fifth to the ninth week. In the post-COVID-19 time that was evaluated, the IgG-type response was notably higher compared to both post-vaccination periods. Neutralizing antibody titers were similar in breast milk from vaccinated and COVID-19 recovered women. Conclusions This is the first report about the immune response in breast milk after the administration of a COVID-19 protein subunit vaccine, which could provide analogous protection to that conferred by SARS-CoV-2 infection. This implies a potential passive immunity that breastfed infants receive from their mothers vaccinated with Abdala.
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Affiliation(s)
- Maylin Pérez-Bernal
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Carlos Hernández
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Rafael Ibargollín
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Midalis Martínez
- Neonatology Service, General Hospital "Camilo Cienfuegos", 128 Bartolome Maso, Sancti Spiritus, Cuba
| | - Migdiala Soria
- Neonatology Service, General Hospital "Camilo Cienfuegos", 128 Bartolome Maso, Sancti Spiritus, Cuba
| | - Magali Delgado
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Onel Valdivia
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Dayamí Dorta
- Production Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Andy Domínguez
- Production Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Enrique Pérez
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
| | - Yeosvany Cabrera
- Research & Development Department, Center for Genetic Engineering and Biotechnology, Circunvalante Norte, Olivos III, Sancti Spiritus, Cuba
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Bender JM, Lee Y, Cheng WA, Marentes Ruiz CJ, Pannaraj PS. Coronavirus Disease 2019 Vaccine Booster Effects Are Seen in Human Milk Antibody Response. Front Nutr 2022; 9:898849. [PMID: 35685893 PMCID: PMC9171392 DOI: 10.3389/fnut.2022.898849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022] Open
Abstract
Infants remain at high risk for severe coronavirus disease 2019 (COVID-19). Human milk contains high levels of protective SARS CoV-2 specific antibodies post-infection and primary vaccine series, but levels decline over time. We hypothesized that the COVID-19 booster vaccine augment antibody production and the protection afforded to human milk-fed infants. We prospectively enrolled pregnant or lactating mothers planning to receive COVID-19 vaccination. We measured human milk IgG, IgA, and IgM antibodies targeting the SARS CoV-2 receptor binding domain within the spike protein and human milk neutralization activity against SARS CoV-2 in 10 lactating mothers from pre-COVID-19 primary series vaccine to post-booster dose. Human milk SARS CoV-2 specific IgG increased significantly from pre- to post-booster levels (median OD 0.33 vs. 2.02, P = 0.002). The IgG levels post-booster were even higher than the peak level after the primary series (2.02 vs. 0.95, P = 0.03). The increase in SARS CoV-2 specific IgA levels was not significant (0.10 vs. 0.33, P = 0.23). There was a strong correlation between paired maternal blood and milk IgG and IgA levels (IgG rho 0.52, P < 0.001, IgA rho 0.31, P = 0.05). Post-booster neutralizing activity was elevated compared to pre-booster levels (66% vs. 12% inhibition, P = 0.002). COVID-19 vaccine booster elicits SARS CoV-2 specific antibodies in human milk at higher levels compared to the initial primary series. This finding suggests that three doses of COVID-19 mRNA vaccination leads to improved mucosal response in human milk and reinforces current guidance recommending all pregnant or lactating mothers receive full COVID-19 vaccine courses with a booster dose.
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Affiliation(s)
- Jeffrey M. Bender
- Department of Pediatrics, Pediatric Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Pediatric Immunization Advancement Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Yesun Lee
- Pediatric Immunization Advancement Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Wesley A. Cheng
- Pediatric Immunization Advancement Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Carolyn J. Marentes Ruiz
- Pediatric Immunization Advancement Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Pia S. Pannaraj
- Department of Pediatrics, Pediatric Infectious Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Pediatric Immunization Advancement Laboratory, Children's Hospital Los Angeles, Los Angeles, CA, United States
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15
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Domenici R, Vierucci F. Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052973. [PMID: 35270666 PMCID: PMC8910000 DOI: 10.3390/ijerph19052973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health.
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