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COVID-19: EMBA Position Statement

February, 25th 2020

COVID-19 is an emerging acute respiratory disease caused by the novel coronavirus SARS CoV-2. Current knowledge is evolving rapidly and is largely based on what is known about similar coronaviruses. Questions arise concerning breastmilk donors and the treatment of breastmilk in human milk banks.

SARS CoV-2 coronavirus transmission:

The virus spreads mainly from person to person by close contact (0-2 meters) and it is transmitted via respiratory droplets produced when an infected person sneezes or coughs. It may be possible that a person can get COVID-19 by touching a surface or object contaminated by infected respiratory secretions and then touching his or her own mouth, nose, or eyes, but, so far, this is not thought to be the main way the virus spreads. Infected people are thought to be most contagious when they are most symptomatic. However, as with other respiratory infections, some spread might be possible before symptoms appear.

This justifies all the precautions which are recommended by the health authorities in order to limit the transmission of the virus (http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19).

Regarding human milk donation:

Human milk is essential for premature infants, as it significantly reduces the risk of serious complications related to prematurity, in the short and long term.

Human milk donation is organized and supported by EMBA according to the common rules concerning the selection of donors based on a health questionnaire and on blood sampling as well as the handling and treatment of milk by pasteurisation, in accordance with the EMBA documents1,2.

Regarding breastmilk and SARS CoV-2:

It is not yet known whether SARS CoV-2 can be found in human milk, and if found, it could be contagious.

Other coronaviruses are destroyed by thermal inactivation3. In particular, MERS-coronavirus is inactivated in camel, goat and cow’s milk at 63°C for 30 min4. However, it should be pointed out that the few available studies simulated pasteurisation in small aliquots, a procedure that does not follow human milk bank protocols. Based on the available data on other coronaviruses it is likely that, even if SARS CoV-2 is present in breastmilk, it could also be destroyed by pasteurisation, but solid data is needed.

Taking into account the available information, EMBA recommends to add to the health questionnaires utilised to screen human milk donors, specific questions concerning the risk of being a suspected or probable case (refer to the “Case” definition on the World Health Organization website: https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)).

For example:

  • Having stayed or transited in a risk zone during the previous 14 days
  • Close contact with a confirmed or probable case of SARS CoV-2 infection during its symptomatic phase
  • Person who worked in or attended a health care facility in which a case of SARS CoV-2 infection has been confirmed.

This makes it possible to temporarily suspend the recruitment of these mothers for 2 weeks, in order to ensure that they do not become ill during this period of time.

If an already established donor develops signs of possible SARS-CoV2 infection (severe acute respiratory infection: cough, fever, sore throat etc.) with no other etiology that fully explains the clinical presentation, and/or reports a risk exposure in the 14 days preceding the milk donation,  a rhinopharyngeal swab is recommended. Donation should be temporary discontinued until the result of the swab. If the culture is positive for SARS CoV-2, donation should be interrupted until a negative culture is found. If the culture is negative for SARS CoV-2, donation can be continued.

Regarding hygiene in human milk banks

EMBA recommends strict observation of the hygienic rules regarding collection, storage and handling of donated human milk1.

 

References

  1. Weaver G et al. Recommendations for the Establishment and Operation of Human Milk Banks in Europe: A Consensus Statement From the European Milk Bank Association (EMBA). Front. Pediatr. 7:53 (2019).
  2. Moro GE et al. Processing of Donor Human Milk: Update and Recommendations From the European Milk Bank Association (EMBA). Front. Pediatr. 7:49 (2019).
  3. Duan SM et al. Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. Biomed Environ Sci. 16(3):246-55 (2003).
  4. van Doremalen N et al. Stability of Middle East Respiratory Syndrome Coronavirus in Milk. Emerg Infect Dis. 20(7):1263-1264 (2014).

 

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