Last update July 15, 2023

Zika (flavivirus), Maternal Zika Virus Infection

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Flaviviruses are mainly transmitted by the bite of Aedes mosquitoes (Ae. aegypti and Ae. albopictus or Tiger mosquito) from infected reservoirs that are mostly humans but may also be various animals. The viral infection is asymptomatic in 75% of cases. Only one out of four infected persons generally develop benign symptoms with few complications in adults and children and even infants, with rare admission of patients. (Red Book 2021-24 p.114).

It has been documented sporadically transmission by sexual intercourse (Musso 2015, Foy 2011) and vertically from the mother to the child, transplacental and perinatal (AAP 2018 p894). Also of concern is a possible transmission by blood transfusion. (Musso 2014)

Two infants had positive test for the virus, presumably after perinatal transmission, one remained asymptomatic and the other one with mild symptoms that doubtfully were due to the virus. Both, as well as their mothers evolved favorably. (Besnard 2014)

Four infants breastfed by mothers with Zika infection (viral RNA in breast milk from one of them) did not become infected with Zika. (Cavalcanti 2017)

Zika virus RNA has been detected in breast milk from two mothers with confirmed Zika virus infection, but no replicative virus was identified in cell culture (WHO 2016, Besnard, 2014). Transmission of the infection through breastfeeding has not been documented. (Red Book 2021-24 p.114, Runge 2019, WHO 2016, CDC 2016)

Breast milk (colostrum, transitional milk, and mature milk) has antiviral activity against Zika virus, making it difficult for flavivirus to bind to cells. (Francese 2020)

Since the health benefits of breastfeeding from breastfeeding are considered greater than the unproven potential risk of transmission, experts, expert committees and the World Health Organization recommend that mothers with possible or confirmed infection or exposure to Zika virus continue to breastfeed, even in endemic areas. (Red Book 2021-24 p.114, Mann 2018, WHO 2016, CDC 2016).

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.


Zika (flavivirus), Maternal Zika Virus Infection belongs to this group or family:


  1. Van de Perre P, Molès JP, Nagot N, Tuaillon E, Ceccaldi PE, Goga A, Prendergast AJ, Rollins N. Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk. Pediatr Allergy Immunol. 2021 Jul;32(5):835-842. Abstract Full text (link to original source)
  2. (Red Book). AAP. Kimberlin DW, Barnett ED, , Lynfield R, Sawyer MH eds. Red Book: 2021-2024. Report of the Committee on Infectious Diseases. 32th ed. Elk Grove Village, - 2021
  3. Francese R, Civra A, Donalisio M, Volpi N, Capitani F, Sottemano S, Tonetto P, Coscia A, Maiocco G, Moro GE, Bertino E, Lembo D. Anti-Zika virus and anti-Usutu virus activity of human milk and its components. PLoS Negl Trop Dis. 2020 Oct 7;14(10):e0008713. Abstract Full text (link to original source)
  4. Runge-Ranzinger S, Morrison AC, Manrique-Saide P, Horstick O. Zika transmission patterns: a meta-review. Trop Med Int Health. 2019 May;24(5):523-529. Abstract Full text (link to original source) Full text (in our servers)
  5. Mann TZ, Haddad LB, Williams TR, Hills SL, Read JS, Dee DL, Dziuban EJ, Pérez-Padilla J, Jamieson DJ, Honein MA, Shapiro-Mendoza CK. Breast milk transmission of flaviviruses in the context of Zika virus: A systematic review. Paediatr Perinat Epidemiol. 2018 Jul;32(4):358-368. Abstract Full text (link to original source) Full text (in our servers)
  6. Cavalcanti MG, Cabral-Castro MJ, Gonçalves JLS, Santana LS, Pimenta ES, Peralta JM. Zika virus shedding in human milk during lactation: an unlikely source of infection? Int J Infect Dis. 2017 Apr;57:70-72. Abstract Full text (link to original source)
  7. World Health Organization. Breastfeeding in the context of Zika virus. Interim guidance, 25 February 2016 Full text (link to original source) Full text (in our servers)
  8. CDC. Questions and Answers for Pediatric Healthcare Providers: Infants and Zika Virus Infection. HC-Providers-01/26. 2016 Full text (in our servers)
  9. CDC. Zika Virus Transmission. 2016-02-03. 2016 Full text (in our servers)
  10. CDC. Preguntas y respuestas para proveedores de atención médica pediátrica: Los bebés y la infección por el virus del Zika. HC-Proveedores-02/02. 2016 Full text (in our servers)
  11. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis. 2015 Abstract Full text (link to original source)
  12. Musso D, Nhan T, Robin E, Roche C, Bierlaire D, Zisou K, Shan Yan A, Cao-Lormeau VM, Broult J. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill. 2014 Abstract Full text (link to original source)
  13. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014 Apr 3;19(13). pii: 20751. No abstract available. Abstract Full text (link to original source) Full text (in our servers)
  14. Foy BD, Kobylinski KC, Chilson Foy JL, Blitvich BJ, Travassos da Rosa A, Haddow AD, Lanciotti RS, Tesh RB. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis. 2011 Abstract Full text (link to original source)
  15. Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Abstract Full text (link to original source)
  16. Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, Lanciotti RS, Pretrick M, Marfel M, Holzbauer S, Dubray C, Guillaumot L, Griggs A, Bel M, Lambert AJ, Laven J, Kosoy O, Panella A, Biggerstaff BJ, Fischer M, Hayes EB. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009 Abstract Full text (link to original source)

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