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LACTNET  February 2003, Week 2

LACTNET February 2003, Week 2

Subject:

Re: HIV transmission and sub-clinical mastitis, and pasteurized breastmilk

From:

Lara Hopkins <[log in to unmask]>

Reply-To:

Lactation Information and Discussion <[log in to unmask]>

Date:

Wed, 12 Feb 2003 17:26:22 +0800

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (132 lines)

On Tuesday, Feb 11, 2003, at 02:40 Australia/Perth, Pamela Morrison
wrote:

> Lara - I see the point you make about the need for screening of milk
> donors
> in spite of pasteurization - because of human error, or failures in the
> pasteurization process, mentioning the occasional errors that are made
> with
> screening blood and sterilizing instruments and suggesting that we
> need to
> be realistic about the limits of technology.  The thing is, does this
> prevent donated blood being used at all, or surgery taking place,
> "just in
> case"?  No, it doesn't.

Like anything else, it's a risk-benefit analysis - not just by the
medical staff, but by the patients themselves (much of the time,
anyway).

>  Donated breastmilk is not the same as donated
> blood which cannot be pasteurized, and should we accept that sloppy
> practices in handling and pasteurizing it should prevent us using it at
> all?

Not at all! I'm sorry if you thought I was suggesting that.  The post I
was responding to seemed (maybe I read it wrong) to say that there was
no need to screen donors at all if the milk was being pasteurised. I
disagree with this - I can't imagine our current society accepting
completely unscreened donor milk. Relying on one process only to make
the milk "safe"[1] - pasteurization - puts all the eggs in one basket,
as it were. Having a donor screening process as well as pasteurization
reduces the risk by requiring multiple points of failure for
transmission to occur.

[1] The assumption being made here is that it is possible to transfer
HIV via breastmilk. I think it's a reasonable assumption in the case of
a real-life milk bank, as you have no way of knowing whether the donor
has active mastitis/subclinical mastitis/cracks/fissures/etc.

>   It just seems that the need for screening is put up as one more
> obstacle to the use of donated breastmilk, making it more difficult to
> obtain for those who might benefit from it.

Do you think screening donors for HIV & hepatitis would dramatically
reduce donor numbers? Does anyone have any data on this? On the other
hand, do you think having only unscreened donor milk available would
reduce acceptance by the parents of children who need donor milk?

I'll put myself in the shoes of a parent of a potential recipient here
and say: I wouldn't accept it. Like many people, no matter how low
authorities tell me the risk is - it could be one in a hundred thousand
for all I know - it's not a risk I'm prepared to take. Maybe that's
irrational in the face of ABM risks, but that's the way people are.
They'd rather take a higher risk of diarrhoeal illnesses, ear
infections, and the many other diseases associated with ABM, for their
child than even a tiny risk of HIV. We as statisticians or
epidemiologists might find that hard to accept, but we as
mothers/fathers... it can be a very different story.

> For several years I have been trying to suggest the use of the
> HIV-infected
> mother's own home-pasteurized breastmilk - not as a replacement for
> breastfeeding, but as a replacement for formula for those women might
> be
> coerced into not breastfeeding.

I think this is a fantastic idea, and support you in it. I believe it
is a different situation from mass donor milk in countries with safe
water supplies, however. (and I'm presuming the pasteurisation
education comes with information on how to wash bottles safely, etc
despite a contaminated water supply).

>  The resistance to this logical,
> physiological, free, healthy alternative is almost pathological.
> Responses
> have ranged from:
>
> - "It's not possible to express breastmilk long-term"

(sheesh)

> (so I collected from
> Lactnetters 48 separate testimonies showing that this IS, indeed,
> possible)

Make that 49.

> - "It's not possible to manually express breastmilk for long, mothers
> might
> get mastitis" (please come and see mothers doing this for days, weeks
> or
> months in neonatal units in Nairobi and Harare)

Is there a reason the milk must be manually expressed (cracked
nipples?), or is this because the families you're talking about might
not have access to good quality breast pumps?

> - "It's not safe" (studies in Puerto Rico and South Africa show that
> there
> are two methods of killing the virus in breastmilk by
> home-pasteurization;  flash-boiling, and Pretoria pasteurization - but
> now
> I'm receiving third-hand responses about the latter method that suggest
> that the author herself might be retracting her findings because if the
> size of the pot holding the boiling water is different, or if the
> thickness
> of the glass in the jar containing the milk is different then this
> might
> invalidate the findings).
> - "Oh, but it's not cultural".  (we had someone who came to Zimbabwe
> and
> found that there was *not* a lot of resistance to this idea amongst
> women
> themselves, particularly if communities were to receive education about
> this possibility).

Is ABM "cultural"?

Lara

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November 2003, Week 5
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March 2003, Week 2
March 2003, Week 1
February 2003, Week 4
February 2003, Week 3
February 2003, Week 2
February 2003, Week 1
January 2003, Week 5
January 2003, Week 4
January 2003, Week 3
January 2003, Week 2
January 2003, Week 1
December 2002, Week 5
December 2002, Week 4
December 2002, Week 3
December 2002, Week 2
December 2002, Week 1
November 2002, Week 5
November 2002, Week 4
November 2002, Week 3
November 2002, Week 2
November 2002, Week 1
October 2002, Week 5
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October 2002, Week 3
October 2002, Week 2
October 2002, Week 1
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April 2002, Week 3
April 2002, Week 2
April 2002, Week 1
March 2002, Week 5
March 2002, Week 4
March 2002, Week 3
March 2002, Week 2
March 2002, Week 1
February 2002, Week 4
February 2002, Week 3
February 2002, Week 2
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January 2002, Week 5
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January 2002, Week 3
January 2002, Week 2
January 2002, Week 1
December 2001, Week 5
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December 2001, Week 3
December 2001, Week 2
December 2001, Week 1
November 2001, Week 5
November 2001, Week 4
November 2001, Week 3
November 2001, Week 2
November 2001, Week 1
October 2001, Week 5
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October 2001, Week 3
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October 2001, Week 1
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April 2001, Week 3
April 2001, Week 2
April 2001, Week 1
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March 2001, Week 4
March 2001, Week 3
March 2001, Week 2
March 2001, Week 1
February 2001, Week 4
February 2001, Week 3
February 2001, Week 2
February 2001, Week 1
January 2001, Week 5
January 2001, Week 4
January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
December 2000, Week 4
December 2000, Week 3
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December 2000, Week 1
November 2000, Week 5
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November 2000, Week 3
November 2000, Week 2
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April 2000, Week 3
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February 2000, Week 3
February 2000, Week 2
February 2000, Week 1
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January 2000, Week 4
January 2000, Week 3
January 2000, Week 2
January 2000, Week 1
December 1999, Week 5
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November 1999, Week 5
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November 1999, Week 3
November 1999, Week 2
November 1999, Week 1
October 1999, Week 5
October 1999, Week 4
October 1999, Week 3
October 1999, Week 2
October 1999, Week 1
September 1999, Week 5
September 1999, Week 4
September 1999, Week 3
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August 1999, Week 3
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April 1999, Week 1
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March 1999, Week 4
March 1999, Week 3
March 1999, Week 2
March 1999, Week 1
February 1999, Week 4
February 1999, Week 3
February 1999, Week 2
February 1999, Week 1
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January 1999, Week 4
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December 1997, Week 5
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March 1997, Week 2
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February 1997, Week 3
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December 1996, Week 5
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December 1995, Week 5
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