Recommendations for Breastfeeding/Infant Feeding in the Context of Ebola Virus Disease

Key Points

When a lactating woman is sick with Ebola virus disease (EVD), her breast milk can have Ebola virus in it, just as any other body fluids. Breastfeeding is often the best choice for feeding an infant, particularly in settings where resources are limited. However, when safe alternatives to breastfeeding and infant care exist, a mother with confirmed or suspected Ebola virus infection should not have close contact with her infant (including breastfeeding) to reduce the risk of transmitting Ebola virus to her child.

If a mother is suspected to have EVD or has confirmed Ebola virus infection, decisions about how she should feed her baby must be made on a case-by-case basis by weighing the risk of transmitting Ebola virus to the baby through breastfeeding against the risk of stopping breastfeeding for the baby.

• A mother (whether in quarantine or not) who is a contact to another individual who is sick with confirmed Ebola virus infection should continue breastfeeding unless she begins to show signs and symptoms consistent with EVD;
• If a breastfeeding mother exhibits signs and symptoms consistent with EVD, she should discontinue close contact (including breastfeeding) with her infant until she can be confirmed not to have Ebola virus infection.
• Donor breast milk or Ready to Use Infant Formula (RUIF), if available, may be an acceptable substitute.

In resource-limited settings where safe alternatives do not exist, breastfeeding may be the only option for providing the nutrition a baby needs even after a mother is confirmed to have EVD.

• If a mother with EVD is able to breastfeed, decisions about how she should feed her baby may depend on:
  • the age of the infant
  • the availability and feasibility of safe nutrition and infant care
  • the overall sanitary conditions
  • access to care for the mother

These risks must be balanced against the risk of Ebola virus transmission through close contact (including breastfeeding) with the ill mother.

Ebola virus has been detected in breast milk while a woman had EVD and shortly after she recovered^{1, 2}. It is not known whether Ebola virus can be transmitted from a mother to her infant through breast milk. However, given what is known about the transmission of Ebola virus, regardless of breastfeeding status, an infant whose mother has EVD is at high risk of getting Ebola virus infection from close contact with the mother, and consequently is at high risk of death overall^{3, 4}.

There is not enough evidence to provide guidance on precisely when it is safe to resume breastfeeding after recovery. In a few situations where breast milk was tested after recovery from EVD, Ebola virus genetic material was identified in the breast milk of two different lactating women from 6 to 26 days after disease onset^{2, 3}.

It is best for a mother who has recently survived EVD not to breastfeed if she has other safe ways to feed her baby.

• Where available, testing of breastmilk for the presence of Ebola virus genetic material can help to guide decisions about when breastfeeding can be safely resumed.

There is no known risk of transmission of Ebola virus via breast milk for infants born to women who became pregnant after recovering from EVD⁵.

• Breastfeeding is safe and should be recommended for women who, after recovering from EVD, become pregnant and give birth.

¹ Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. The Journal of Infectious Diseases. 2007;196 Suppl 2:S142-7.
² Nordenstedt H, Bah IE, de la Vega M-A, et al. Ebola Virus in Breast Milk in an Ebola Virus–Positive Mother with Twin Babies, Guinea, 2015. Emerging Infectious Diseases. 2016;22(4):759.
³ WHO. Ebola haemorrhagic fever in Zaire, 1976. Bulletin of the World Health Organization. 1978;56(2):271-93.
⁴ Nelson J, Griese S, Goodman A, Peacock G. Live neonates born to mothers with Ebola virus disease: a review of the literature. Journal of Perinatology. 2015; doi: 10.1038/jp.2015.189. [Epub ahead of print].
⁵ Kamali A, Jamieson DJ, Kpaduwa J, et al. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States. Emerg Infect Dis. 2016;22(7). [Epub ahead of print.] DOI: 10.3201/eid2207.160269. http://dx.doi.org/10.3201/eid2207.160269. Accessed June 8, 2016.

More guidance can be found here: http://files.ennonline.net/attachments/2176/DC-Infant-feeding-and-Ebola-further-clarification-of-guidance_190914.pdf