Ebola virus disease and breastfeeding: time for attention
Research snapshot1
Over 2,800 cases of Ebola virus disease (EVD) have been confirmed in the ongoing outbreak in the Democratic Republic of Congo (DRC); most cases are adults and 56% of cases are women. Ample information is available on the presence of EVD in bodily fluids such as blood, urine, and semen, and on the prevention of transmission from these fluids. However, information on EVD and breastmilk is limited. The current recommendation of testing breastmilk only in mothers who are known EVD survivors might be insufficient, because asymptomatic lactating mothers in households affected by EVD have also been shown to have Ebola virus-positive breastmilk. In DRC, current guidance on breastfeeding issued by the Ministry of Health and supported by the United Nations Children's Fund recommends that, in EVD-affected households, mothers and infants who have symptoms but are Ebola virus blood-negative should continue breastfeeding.
The authors of this correspondence are concerned about these guidelines, because Ebola virus blood negativity does not necessarily equal safe breastmilk. Health practitioners and policy-makers are in desperate need of more information on EVD and breastmilk. Systematic research is needed on EVD appearance and duration in breastmilk; transmissibility through breastmilk, taking into account the effect of factors such as infant saliva on the virus; and the provision of evidence-based advice for asymptomatic lactating mothers in EVD-affected households. The repercussions of a lack of clarity on these questions are potentially enormous for DRC. If breastfeeding is wrongly discouraged, years of public health efforts to promote breastfeeding could be lost. Conversely, if breastfeeding is wrongly encouraged, many infants could be put at risk. The authors conclude that it is time to give as much attention to Ebola virus in breastmilk as we do in semen.
Endnote
1Ververs, M. and Arya, A. (2019) Ebola virus disease and breastfeeding: time for attention. Correspondence. The Lancet, published online: August 27, 2019 http://dx.doi.org/10.1016/S0140-6736(19)32005-7