








key: cord-308501-z3eiac25
authors: Zhu, Chengliang; Liu, Weiyong; Su, Hanwen; Li, Sitong; Shereen, Muhammad Adnan; Lv, Zhihua; Niu, Zhili; Li, Dong; Liu, Fang; Luo, Zhen; Xia, Yuchen
title: nBreastfeeding Risk from Detectable Severe Acute Respiratory Syndrome Coronavirus 2 in Breastmilk
date: 2020-06-04
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.001
sha: 
doc_id: 308501
cord_uid: z3eiac25

nan

An emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19) pandemic, imposes a great threat to global public health 1 . The transmission and pathophysiology of SARS-CoV-2 gradually known among various populations, but public health effects of COVID-19 on women and their outcomes should not be ignored 1, 2 . In pregnant and perinatal women, vertical transmission of SARS-CoV-2 from infected mother to her newborn is a controversial issue [2] [3] [4] . SARS-CoV-2 was not detected in vaginal fluid from a women with COVID-19 5 , however, no clear evidence regarding optimal delivery timing and safety of vaginal or cesarean delivery preventing SARS-CoV-2 vertical transmission has been reported 6 . Thus, the management of in pregnancy based on obstetrical indications and maternal-fetal status is highly concerned.

Here, we represent clinical characteristics of COVID-19 pneumonia in puerperal women and evidence of SARS-CoV-2 shedding in her breastmilk. Between February 1 and March 25, 2020, five pregnant patients with COVID-19 were included to analyze this study ( Table 1 ). The mean age of five mothers was 32 years (range 27 to 34 years), with mean gestational age of 38 weeks plus 1 week (range 35 weeks to 40 weeks plus 1 week). All mother's main onset symptoms were fever (40%), cough (20%), nasal congestion (20%), rhinorrhea (20%), poor appetite (20%), chest distress (40%), dyspnea (40%), and diarrhea (20%), that is consistent with clinical signs and symptoms, as previously described 7 . Chest CT scan of all patients (except Patient 4) before delivery showed typical viral pneumonia, such as patchy and scattered ground-glass opacities, and blurred borders. Table 1) . None of the patients had co-infection with other common respiratory viruses (enlisted in Table 1 ).

Five (100%) nasopharyngeal swab samples from patients were tested positive for SARS-CoV-2 RT-PCR. All the available vaginal secretion samples were negative for SARS-CoV-2 RT-PCR test, that is similar as previously reported 5 . During follow-up, three of four (75%) available serum samples from patients had significant elevated concentrations of SARS-CoV-2 IgM and IgG (Table 1) . More importantly, four out of five (80%) patient`s breastmilk samples were negative for SARS-CoV-2 RT-PCR, which is similar to previous observations 2, 8 , while one (20%) patient`s (Patient 3) breastmilk showed SARS-CoV-2 RNA test positive (Table 1) . Additionally, the breastmilk samples from Patient 3 after delivery for two and three days, still remained positive for SARS-CoV-2 ( Figure 1B) . Of note, Ct value of RT-PCR test results were relatively high as 38.2 and 38.5 ( Figure 1B, a and Collectively, we reported detectable SARS-CoV-2 in human breastmilk from a puerperal woman with COVID-19. Although our conclusions are limited by the small sample size, we believe our findings are important for the concern of SARS-CoV-2 infection risk in breastfeeding of mother with COVID-19 to her neonate.

The study was approved by the Ethics Committee and Institutional Review Board of the Renmin Hospital of Wuhan University (file no. WDRY2020-K066), and the Tongji Hospital of Huazhong University of Science and Technology (file no. TJ-IRB20200201). Written informed consent was obtained from each enrolled patient.

The data in this study can be provided after the Article is published with the permission of the corresponding authors. We can provide participant data without names and identifiers, but not the study protocol, statistical analysis plan, or informed consent form though an appointed email address for communication. The corresponding authors have the right to decide whether to share the data or not regarding to the research objectives and plan provided. 

Coronavirus disease 2019 (COVID-19): we don't leave women alone. International journal of public health

Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

Clinical infectious diseases: an official publication of the Infectious Diseases Society of America

SARS-CoV-2 is not detectable in the vaginal fluid of women with severe COVID-19 infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America

Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Clinical features and obstetric and NA=not available; +=positive

CRP=C-reactive protein; PCT=Procalcitonin

ALT=Alanine aminotransferase

PCR, short for Real-time PCR against SARS-CoV-2 nucleic acid; Ct=Curve threshold value of SARS-CoV-2 N gene

HCOV=Human seasonal coronavirus; HMPV=Human metapeumovirus; HPIV=Human parainfluenza virus; HRSV=Human respiratory syncytial virus

We declare no competing interests.

