The World Health Organization (WHO) recommends that babies be breastfed for at least the first six months of life and that breastfeeding continue, like the slow arrival of complementary foods, for two years or more.
Breastfeeding is associated with short- and long-term effects against several diseases. For example, the duration and exclusivity of breastfeeding is associated with a lower threat of respiratory tract infections in infants.
Human breast milk is composed of several factors, such as enzymes, cytokines, antibodies, extracellular vesicles, and immune cells that provide antiviral coverage to the infant. In addition, the breast itself also provides passive immunity in the form of immunoglobulin G (IgG), IgM and IgA to the infant, even if it has a direct mucosal surface.
The secretory form of IgA (sIgA) is the main antibody discovered in human breast milk, while levels of IgG, which are found in its monomeric form, are lower than those of IgA and IgM.
Several studies have reported the presence of antibodies opposing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in breast milk after breastfeeding gained two doses of messenger ribonucleic acid (mRNA) against coronavirus disease 2019 (COVID-19) vaccines. Specifically, IgG and IgA opposed to the SARS-CoV-2 spike protein were detected in breast milk after vaccination and infection.
It should be noted that the dynamics of antibodies are different depending on the infection or vaccination. IgG levels, for example, appear to accumulate after receiving the current dose of vaccine, while sIgA levels increase after SARS-CoV-2 infection.
More data are needed on the duration and potency of antibody responses in breast milk beyond the time of vaccination and on the effect of hybrid immunity achieved through infections that crossed the Omicron era.
Young infants have a higher threat of severe COVID-19 and hospitalization than older children. To date, COVID-19 vaccines have not been approved for infants younger than six months in the United States; However, vaccination during pregnancy would possibly be offering some coverage to babies.
However, knowledge about symptomatology and immune coverage occurring after infection and vaccination is limited for breastfed and breastfed infants. Therefore, more data are needed to determine coverage versus vulnerable early months of COVID-19 formation, the point at which antibodies are transferred to infants, and the patience of SARS-CoV-2 antibodies in milk after vaccination.
A new preliminary study from The Lancet evaluates SARS-CoV-2 antibody levels in breast milk from breastfeeding others after two to three doses of COVID-19 vaccine and after infections in vaccinated mothers. To this end, the researchers analyzed the symptomatology of infants and mothers after vaccination or infection, as well as the duration and presence of passively transferred antibodies to the saliva of breastfed babies.
The existing test included other people who were breastfeeding or pregnant who received the COVID-19 vaccine from December 2020 to April 2022. All participants answered questions about years of training and maternal symptomatology after the vaccine dose. In addition, examining participants with a history of recurrent infections also answered questions about formative years and maternal symptoms after infection.
Milk samples were collected at six other time points, adding before the vaccine, after the current dose, before the 3rd dose, after the 3rd dose, five months after the 3rd dose, and after infection. In addition, maternal blood samples were taken at the same time as the milk collection.
Evaluation of the duration of antibody patience in infants’ saliva after breastfeeding by taking saliva samples without delay after breastfeeding, 30 minutes after, 60 minutes after and before the next breastfeeding session.
Matching samples of breast milk and saliva were also collected on the day of the baby’s extraction. Finally, the anti-spike enzyme-linked immunosorbent assay (ELISA) was used to measure IgA and/or IgG in milk, blood and saliva samples.
A total of 33 people breastfeeding others who had received two doses of the COVID-19 vaccine provided milk samples. Of those, 26 received a third dose of the vaccine, 19 of which provided samples for antibody evaluation.
Of those 19 participants, 10 reported an advance of infection with the Omicron wave. In addition, another 14 participants provided saliva and/or milk samples and infant saliva samples after their timing or third dose of vaccine.
No participants reported severe symptoms after receiving the third dose of the vaccine. Common maternal symptoms included pain at the injection site, fatigue or exhaustion.
Fewer symptoms were reported after the third dose than after the current dose of vaccine. In addition, general symptoms were basically reported after infection compared to the third dose.
All of the swollen babies had at least one symptom of COVID-19, and one required emergency department evaluation. In addition, seven out of 8 babies had to see their doctor regarding their COVID-19 diagnosis.
The average age of the babies 8 months, and not all were exclusively breastfed. Antibodies to peak milk were seen six to 8 months after receiving the dose at the time of vaccination.
In particular, anti-spike IgG levels in breast milk particularly decreased over time, while anti-spike IgA levels remained at detectable levels after receiving the current dose of vaccine. After the third dose of the vaccine, IgG levels were higher than those reported after the time of the vaccine dose; however, the accumulation of IgA is not significant.
IgG and IgA levels decreased five months after receiving a third dose of the vaccine. People with a history of recurrent infections had higher levels of IgA in breast milk than after the third dose of the vaccine.
In addition, anti-spike IgA levels were higher in the plasma of nursing mothers after infection compared to after the third dose of the vaccine. The correlation between IgA levels in blood and milk was stronger after infection than after the third dose of the vaccine.
A positive correlation was observed between peak anti-IgA and peak anti-IgG antibodies in breast milk and maternal saliva. In addition, anti-peak IgA levels were particularly higher over time in infant saliva after infancy than in IgG.
The existing study reports that antibody levels in breast milk accumulate after receiving the current dose of COVID-19 vaccine and are maintained for up to 8 months in some people. IgG levels also accumulate after a third dose of the vaccine, while accumulation in IgA increases after advanced infection. In addition, IgA has been shown to be more solid in the baby’s mouth after breastfeeding, which would possibly be imperative for infant protection.
However, more large-scale studies are needed to understand the role of milk antibodies in protecting babies against COVID-19.
Preprints with The Lancet/SSRN First Look publishes initial clinical reports that are not peer-reviewed and therefore not considered conclusive, clinical practice consultants/health behaviors, nor treated as established information.
Written by
Suchandrima holds a Bachelor of Science (B. Sc. ) in Microbiology and a Master of Science (M. Sc. ) in Microbiology from the University of Calcutta, India. The examination of physical condition and illness has been very important to her. In addition to microbiology, he also acquired extensive wisdom in biochemistry, immunology, medical microbiology, metabolism and biotechnology as part of his master’s degree.
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