Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk

dc.contributor.authorVan de Perre, Philippe
dc.contributor.authorMoles, Jean-Pierre
dc.contributor.authorNagot, Nicolas
dc.contributor.authorTuaillon, Edouard
dc.contributor.authorCeccaldi, Pierre-Emmanuel
dc.contributor.authorGoga, Ameena Ebrahim
dc.contributor.authorPrendergast, Andrew J.
dc.contributor.authorRollins, Nigel
dc.date.accessioned2022-07-26T08:13:24Z
dc.date.available2022-07-26T08:13:24Z
dc.date.issued2021-07
dc.description.abstractAs breastfeeding is of utmost importance for child development and survival, identifying whether breast milk is a route of transmission for human viruses is critical. Based on the principle of Koch's postulate, we propose an analytical framework to determine the plausibility of viral transmission by breast milk. This framework is based on five criteria: viral infection in children receiving breast milk from infected mothers; the presence of virus, viral antigen, or viral genome in the breast milk of infected mothers; the evidence for the virus in breast milk being infectious; the attempts to rule out other transmission modalities; and the reproduction of viral transmission by oral inoculation in an animal model. We searched for evidence in published reports to determine whether the 5 criteria are fulfilled for 16 human viruses that are suspected to be transmissible by breast milk. We considered breast milk transmission is proven if all 5 criteria are fulfilled, as probable if 4 of the 5 criteria are met, as possible if 3 of the 5 criteria are fulfilled, and as unlikely if less than 3 criteria are met. Only five viruses have proven transmission through breast milk: human T-cell lymphotropic virus 1, human immunodeficiency virus, human cytomegalovirus, dengue virus, and Zika virus. The other 11 viruses fulfilled some but not all criteria and were categorized accordingly. Our framework analysis is useful for guiding public health recommendations and for identifying knowledge gaps amenable to original experiments. KEY MESSAGE : This report will inform pediatricians and immunologists on the existence of viral transmission by breast milk, alleviate public anxiety regarding potential transmission, identify knowledge gaps amenable to original experiments, and enrich the debate on how to encourage best practice of infant feeding while preventing breastfeeding transmission of human viruses.en_US
dc.description.departmentPaediatrics and Child Healthen_US
dc.description.librarianhj2022en_US
dc.description.urihttp://www.wileyonlinelibrary.com/journal/paien_US
dc.identifier.citationVan de Perre P, Molès J-P, Nagot N, et al. Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk. Pediatric Allergy and Immunology 2021;32:835–842. https://doi.org/10.1111/pai.13473.en_US
dc.identifier.issn0905-6157 (print)
dc.identifier.issn1399-3038 (online)
dc.identifier.issn10.1111/pai.13473
dc.identifier.urihttps://repository.up.ac.za/handle/2263/86449
dc.language.isoenen_US
dc.publisherWileyen_US
dc.rights© 2021 The Authors. Pediatric Allergy and Immunology published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License.en_US
dc.subjectAnalytical frameworken_US
dc.subjectBreast milken_US
dc.subjectKoch's postulateen_US
dc.subjectPlausibilityen_US
dc.subjectViral transmissionen_US
dc.titleRevisiting Koch's postulate to determine the plausibility of viral transmission by human milken_US
dc.typeArticleen_US

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