Abstract

Objectives: Breastfeeding and human milk (HM) improve maternal and infant morbidities and mortality. Therefore, monitoring the safety of breastfeeding and access to HM is of critical importance. In this study, we assessed tools to monitor the presence of monkeypox virus (MPXV) in HM and whether standard Holder pasteurization inactivates MPXV.
Materials and Methods: Heat-inactivated MPXV was added to HM or viral transport media (VTM) and analyzed using both research and clinical MPXV quantitative polymerase chain reaction (qPCR) tests. Infectious MPXV was added to HM and was exposed to 1 cycle of freeze–thaw, incubation for 1 hour at room temperature, or conditions of Holder pasteurization (62.5°C for 30 minutes) followed by infectious unit quantification by plaque assay.
Results: Research and clinical nucleic acid tests detect MPXV that was added to HM but with reduced sensitivity compared with equivalent samples in VTM at low virus inoculum. MPXV added to HM to achieve a starting concentration of 225,000 plaque forming units (pfu)/mL remains infectious after freeze–thaw or 1 hour storage at room temperature. However, Holder pasteurization reduced infectious virus below the limit of detection, >2,000-fold reduction in viral titer.
Conclusion: MPXV can be detected when added to HM using a clinical laboratory-developed qPCR test without modification, but the detection limit is reduced compared with equivalent samples in VTM. MPXV remains viable in HM should the virus ever gain access to HM, but Holder pasteurization reduces infectious MPXV to below detection limits and can be used to reduce the risk of MPXV transmission to infants who receive pasteurized (donor) HM.

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Information & Authors

Information

Published In

cover image Breastfeeding Medicine
Breastfeeding Medicine
Volume 18Issue Number 10October 2023
Pages: 785 - 789
PubMed: 37733262

History

Published online: 17 October 2023
Published in print: October 2023
Published ahead of print: 21 September 2023

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    Authors

    Affiliations

    Alex E. Clark
    Department of Medicine, University of California, San Diego, La Jolla, California, USA.
    Annalee Furst
    Department of Pediatrics, and University of California, San Diego, La Jolla, California, USA.
    Kristija Sejane
    Department of Pediatrics, and University of California, San Diego, La Jolla, California, USA.
    Lisa Stellwagen
    UC Health Milk Bank, University of California, San Diego, La Jolla, California, USA.
    Human Milk Institute (HMI), University of California, San Diego, La Jolla, California, USA.
    Marissa Proost
    Department of Pathology, University of California, San Diego, La Jolla, California, USA.
    David Pride
    Department of Pathology, University of California, San Diego, La Jolla, California, USA.
    Davey M. Smith
    Department of Medicine, University of California, San Diego, La Jolla, California, USA.
    VA San Diego Healthcare System, San Diego, California, USA.
    Aaron F. Carlin*
    Department of Medicine, University of California, San Diego, La Jolla, California, USA.
    Department of Pathology, University of California, San Diego, La Jolla, California, USA.
    Department of Pediatrics, and University of California, San Diego, La Jolla, California, USA.
    Human Milk Institute (HMI), University of California, San Diego, La Jolla, California, USA.
    Larsson-Rosenquist Foundation Mother-Milk-Infant Center of research Excellence (MOMI CORE), University of California, San Diego, La Jolla, California, USA.

    Notes

    *
    These authors contributed equally as cosenior authors.
    Address correspondence to: Lars Bode, PhD, Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0715, USA [email protected]

    Authors' Contributions

    A.E.C. conceptualized and designed the study, conducted experiments, and analyzed data. A.F., K.S., and M.P. conducted experiments and analyzed data. L.S., D.P., and D.S. conceptualized and designed the study. A.F.C. and L.B. conceptualized and designed the study, and wrote the initial article. All authors approved the final article as submitted and agree to be accountable for all aspects of the study.

    Disclosure Statement

    No competing financial interests exist.

    Funding Information

    This study was supported by UCSD PREPARE and Human Milk Institutes, NIH grants AI036214 and AI131385 to D.S.; San Diego Center for AIDS Research (CFAR) AI100665, the Department of Veterans Affairs, the John and Mary Tu Foundation, and the James B. Pendleton Charitable Trust. A.F.C. was supported by an NIH grant K08 AI130381 and a Career Award for Medical Scientists from the Burroughs Wellcome Fund. L.B. is UC San Diego Chair of Collaborative Human Milk Research endowed by the Family Larsson-Rosenquist Foundation (FLRF), Switzerland.

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