Please read the case in it's entirety - the transfusions were given AFTER the
delivery. They could not have been the cause of the transmission to the
infant. IgM is made BY the infant in response to infection. Instead of
trying to deny the infant got the WNV from the milk - we should be praising
the CDC for coming out clearly in favor of continuing to breastfeed.
Below is the text of a 2 page "Information for Clinicians" that is being
circulated to every Peds/FP/Ob-Gyn.
Centers for Disease Control and Prevention
West Nile Virus (WNV) Infection and Breastfeeding
Information for Clinicians
On October 4, 2002, CDC's MMWR published a report entitled "Possible West
Nile Virus Transmission to an Infant through Breast-Feeding - Michigan,
2002." CDC and the Michigan Department of Community Health continue to
investigate West Nile virus (WNV) infection in a woman and possible
transmission to her newborn child. Following is a summary.
o In early September 2002, a woman gave birth to a healthy infant.
Post-delivery, the mother required transfusion with 2 units of packed red
blood cells for anemia.
o The second blood transfusion, given one day after delivery, was derived
from the same donation as a unit given to a liver transplant recipient who
subsequently developed WNV meningoencephalitis. A retained blood specimen
from the donation was PCR-positive for WNV.
o The mother began breast-feeding her child on the day of delivery. She was
discharged from the hospital 2 days later.
o The mother developed severe, persistent headache and high fever (102.8°F)
and was readmitted to the hospital 15 days after delivery.
o A cerebrospinal fluid (CSF) sample was positive for WNV-specific IgM, and
the mother was diagnosed with WNV meningoencephalitis.
o A sample of the mother's breast milk obtained 16 days after delivery
tested positive for WNV-specific IgM.
o The infant remained afebrile and healthy, although a serum sample from
the infant at age 25 days tested positive for WNV-specific IgM. Virus
culture is pending.
o Neither WNV nor WNV nucleic acids have been identified previously in
human breast milk.
o Because the infant had minimal outdoor exposure, it is unlikely WNV
infection was acquired from a mosquito. Therefore, breast milk must be
considered a likely source of infection.
o Currently, both mother and child are healthy.
Recommendations for Patients: Because the health benefits of breast-feeding
are well established, and the risk for WNV transmission through
breast-feeding is unknown, these findings do not suggest a change in
breast-feeding recommendations. Lactating women who are ill or who are
having difficulty breastfeeding for any reason, as always, are advised to
consult their physicians.
Following are questions and answers developed by CDC to assist clinicians who
may receive inquiries from their patients regarding WNV and breastfeeding.
Q. Can West Nile virus be transmitted through breast milk?
A. Based on a recent case in Michigan, it appears that West Nile virus can be
transmitted through breast milk. A new mother in Michigan contracted West
Nile virus from a blood transfusion shortly after giving birth. Laboratory
analysis showed evidence of West Nile virus in her breast milk. She breastfed
her infant, and three weeks later, her baby's blood tested positive for West
Nile virus. Because of the infant's minimal outdoor exposure, it is unlikely
that infection was acquired from a mosquito. The infant was most likely
infected through breast milk. The child is healthy, and does not have
symptoms of West Nile virus.
Q. Should I continue breast-feeding if I am symptomatic for West Nile virus?
A. Because the health benefits of breast-feeding are well established, and
the risk for West Nile virus transmission through breast-feeding is unknown,
the new findings do not suggest a change in breast-feeding recommendations.
The American Academy of Pediatricians and the American Academy of Family
Physicians recommend that infants be breastfed for a full year of life.
Lactating women who are ill or who are having difficulty breast-feeding for
any reason, as always, should consult their physicians.
Q. Should I continue breast-feeding if I am not symptomatic for West Nile
virus?
A. Yes. Because the health benefits of breast-feeding are well established,
and the risk for West Nile virus transmission through breast-feeding is
unknown, the new findings do not suggest a change in breast-feeding
recommendations.
Q. If I am breast-feeding, should I be tested for West Nile virus?
A. No. There is no need to be tested just because you are breast-feeding.
Q. Is there any evidence that West Nile virus is transmitted from mother to
child during pregnancy or during birth?
A. There is no evidence that West Nile virus can be transmitted during
pregnancy or birth.
Q. Are infants at higher risk than other groups for illness with West Nile
virus?
A. No. West Nile virus illnesses in children younger than 1-year-old are
infrequent. During 1999-2001, no cases in children younger than one year of
age were reported to CDC. Of the over 2500 total West Nile Virus cases in
2002, only four were less than one year of age. We know that one of these
infants was not breast-feeding, and investigation of the other infants is
underway.
Q. If I am breast-feeding, should I use insect repellent containing DEET?
A. Yes. Insect repellents help people reduce their exposure to mosquito bites
that may carry potentially serious viruses such as West Nile virus, and allow
them to continue to play and work outdoors. There are no reported adverse
events following use of repellents containing DEET in pregnant or
breast-feeding women.
For additional information regarding WNV, please see http://www.cdc.gov
Questions can be directed to CDC Public Information at 1-888-246-2675
(English), 1-888-246-2857 (Spanish), and 1-866- 874-2646 (TTY).
For the full published case report, please see CDC Possible West Nile Virus
Transmission to an Infant through Breast-Feeding - Michigan 2002. MMWR 2002;
51:877-878.
Also available online at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5139a1.htm
October 4, 2002 www.cdc.gov
Nancy
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital & Sharp Mary Birch Hospital For Women
Medical Director, Sharp HealthCare Lactation Services
San Diego, California, USA
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