Ebola Hemorrhagic Fever

Ebola virus has shown to be present in the breast milk. Mechanism of transmission to the infant is unknown, whether it occurs through the milk or the close contact with other body fluids of infected mother is uncertain. Although most mothers and breastfed infants died during the current and previous outbreaks in West Africa, there have been reported cases of survival among breastfed infants of infected mothers and others who were not infected at all.

A high proportion of infected pregnant women suffered abortion and died. No survivors are known among those women who could reach to birth. Nor infants survived for longer than 2-3 weeks.

In the context of Ebola outbreak the UNICEF, WHO, CDC, ENN recommendations are:

EVIDENCE to date indicates that the mortality rates of Ebola infection far outweighs the morbility and mortality associated with not breastfeeding in the West Africa context.

BREASTFED INFANT WITH A MOTHER INFECTED BY EBOLA. ASYMTOMATIC INFANT: separate the infant from the mother. Offer replacement feeding. Keep mother's breast pumping and throw away the milk (pump-and-dump). Psychological support to the mother. Follow-up the infant as a “healthy contact” for 21 days.

BREASTFED INFANT WITH A MOTHER INFECTED BY EBOLA. SUSPICIOUS OR SYMTOMATIC INFANT: continue breastfeeding if the mother still asymptomatic. Take a confirmatory test from the infant.

NEWBORN INFANT WITH A MOTHER INFECTED BY EBOLA: support and initiate breastfeeding whenever the mother is on stable condition.

ORFAN INFANTS YOUNGER THAN 24 MONTHS: replacement feeding is recommended. In the context of current Ebola outbreak, the safest replacement feeding for infants younger than 6 months is Ready-to-Use infant formula.

Wet nursing is not recommended since the transmission risk of infection is high (from a wet-nurse to infant and vice versa)

Mothers who should not breastfeed their babies because of high risk of transmission, expression of breast is mandatory in order to prevent plethora and keep milk production.

When to resume breastfeeding? There is evidence on persistence of virus in the milk beyond disappearance in the serum. Checking the milk every 2-3 days after disappearance of virus in the blood should be done. Two consecutive negative tests in the milk are required before resuming breastfeeding.

If testing is not possible, waiting for 8 weeks after recovering of the mother is recommended.