Background: Existing recommendations on whether mothers with COVID-19 should continue breastfeeding are still conflicting. We aimed to conduct a rapid review of mother-to-child transmission of COVID-19 during breastfeeding.

Background: Existing recommendations on whether mothers with COVID-19 should continue breastfeeding are still conflicting. We aimed to conduct a rapid review of mother-to-child transmission of COVID-19 during breastfeeding. Methods:We systematically searched Medline, Embase, Web of Science, Cochrane library, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang, and preprint articles up to March 2020. We included studies relevant to transmission through milk and respiratory droplets during breastfeeding of mothers with COVID-19, SARS, MERS and influenza. Two reviewers independently screened studies for eligibility, extracted data, assessed risk of bias and used GRADE to assess certainty of evidence.Results: A total of 4481 records were identified in our literature search. Six studies (five case reports and one case series) involving 58 mothers (16 mothers with COVID-19, 42 mothers with influenza) and their infants proved eligible. Five case reports showed that the viral nucleic acid tests for all thirteen collected samples of breast milk from mothers with COVID-19 were negative.A case series of 42 influenza infected postpartum mothers taking precautions (hand hygiene and wearing masks) before breastfeeding showed that no neonates were infected with influenza during one-month of follow-up. Conclusions:The current evidence indicates that SARS-CoV-2 viral nucleic acid has not been detected in breast milk. The benefits of breastfeeding may outweigh the risk of SARS-CoV-2 infection in infants. Mothers with COVID-19 should take appropriate precautions to reduce the All rights reserved. No reuse allowed without permission.

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Background Andrographolide sulfonate is a proprietary Traditional Chinese Medicine used for the treatment of childhood respiratory tract infections. However, its effective role in respiratory syncytial virus (RSV) infection remain unclear.Methods BALB/c mice were infected with RSV and inoculated intraperitoneally or intranasally with andrographolide sulfonate daily for 5 days. Lung damage was measured using hematoxylin and eosin staining. Bronchoalveolar lavage fluid (BALF) was used for total cell counts and interferon-γ (IFN-γ) detection based on enzyme-linked immunosorbent assay (ELISA). The expression levels of the RSV N gene and Toll-like receptor (TLR) mRNA were detected by quantitative real-time polymerase chain reaction (qRT-PCR), and the expression levels of the N protein, TLR2/3, and TRIF were detected by western blot analysis.Results Intraperitoneal injection of andrographolide sulfonate did not suppress RSV-induced inflammation, whereas intranasal administration reduced the total number of inflammatory cells in the BALF and pathological damage in the lungs. Furthermore, IFN-γ production was significantly decreased in the BALF, as were the N gene and protein expression levels. The RSV N gene was positively correlated with lung inflammation. After intranasal treatment with andrographolide sulfonate, lung TLR3 and TRIF expression were also reduced compared to the the RSV group.Conclusions Intranasal administration of andrographolide sulfonate reduces RSV replication and RSV infection-induced substance inflammation via TLR3-TRIF. Andrographolide sulfonate aerosol inhalation may be a better treatment for viral respiratory diseases.

Respiratory syncytial virus (RSV), the most common viral pathogen causing acute lower respiratory tract infection among children under five years old worldwide, still lacks specific therapeutic drugs. Andrographolide has been found efficacious in various virus infections, however, its effects on RSV infection remains unknown. Herein, in this study we quantified RSV virus load, IL-6 and IL-8 in A549 cell supernatant, and found andrographolide decreased the viral load and attenuated RSV-induced inflammation. Then, using online databases, we discovered 25 potential targets of andrographolide in the treatment of RSV-infected airway epithelial cells. Subsequently, GO and KEGG enrichment analysis led to the identification of CASP1, CCL5, JAK2, STAT1 as significant players. We verified the mRNA expression change of the potential target genes, which showed that andrographolide noticeably suppressed the increase of CASP1, CCL5, JAK2 and STAT1 post RSV infection. IL-1β, which is downstream of CASP1, was also up-regulated after RSV infection and down-regulated by andrographolide. Furthermore, we conducted Annexin V-FITC/PI apoptosis assay and Western blotting to determine whether andrographolide has an impact on the death pattern of RSV-infected cells. Interestingly, RSV infection decreased the protein levels of caspase-1, cleaved caspase-1, cleaved IL-1β, N terminal of GSDMD and Bcl-2, while andrographolide elevated them. These results suggested that andrographolide might attenuate RSV-induced inflammation by suppressing apoptosis and promoting pyroptosis of infected epithelial cells and thus inducing effective viral clearance.