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CMV Infection from Breast Milk
Epidemiology of Transmission of Cytomegalovirus from Mother to Preterm infant by Breastfeeding. Hamprecht K, et al. Lancet 2001; 357:513-18.
Few data are available on transmission of infection from mothers to pre-term infants during breast feeding. 151 mothers and their 176 pre-term infants ( gestational age < 32 weeks or birthweight < 1500 gms. ) were prospectively screened for cytomegalovirus infection by serology, virus culture and PCR.
Findings: Of the 69 seronegative breastfeeding control mothers, none had detectable cytomegalovirus DNA in breastmilk and none of their 80 infants shed the virus in urine.
The proportion of cytomegalovirus reactivation in seropositive breastfeeding mothers was 96% ( 73 of 76 ). The early appearance of viral DNA in milk whey ( median 3-5 days post-partum in transmitters; 8 days in non-transmitters; p 0.025 ) and infectious virus in milk whey ( 10 days and 16 days, respectively; p = 0.005 were risk factors for transmission.
The cumulative rate of transmission was 37 % ( 27 of 73 mothers; 33 infants ). The infection of the neonates had a mean incubation time of 42 days ( 95 % CI 28-69 ). About 50 % of the infected infants had no symptoms, but four had sepsis-like symptoms.
Interpretation: The proportion of cyto-megalovirus reactivation during lactation almost equals maternal seroprevalence. Breast feeding as a source of postnatal cytomegalovirus infection in pre-term infants has been underestimated and may be associated with a symptomatic infection.
Reviewed by: Ernesto Valdes, MD