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Infection caused by the Western Nile Virus (WNV), which is an flavivirus transmitted by mosquito bite.
Reservoir: birds. Vector: mosquitoes from the genus Culex. Host: horses and humans.
The disease has an incubation period from 5 to 15 days and usually appears asymptomatic (80% of cases) or with mild flu symptoms. Less than 1% of affected patients develop meningoencephalitis and other serious features. (AAP 2018, p888).
There has been a possible documented case of transmission through breastfeeding (positive RNA and specific IgM antibodies in the milk with positive plasma IgM antibody in the infant), but the child remained asymptomatic (CDC 2002).
Among six breastfed infants whose mothers were diagnosed as positively infected, who subsequently had serologic tests for West Nile virus that were negative, only one of them exhibited a slight skin rash (Hinckley 2007).
Because the health advantages of breast feeding are considered greater than the potential risk of transmission, experts and expert committees recommend breastfeeding even in areas where there is the presence of Zika virus recommends that mothers with possible or confirmed WNV infection or exposure continue to breast feed, even from endemic areas (AAP 2018 p119, Lawrence 2016 p469 & 790, Hayes 2005).