SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

Perl, Sivan; Uzan-Yulzari, Atara; Klainer, Hodaya; Asiskovich, Liron; Youngster, Michal; Rinott, Ehud; Youngster, Ilan

doi:10.1001/jama.2021.5782

Cited by 263 publications

(281 citation statements)

References 2 publications

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“…While levels of anti-SARS-CoV-2 IgG were maintained at the final time point of the follow-up, IgA levels decreased 3-4 weeks after the 2 nd dose. These results are in accordance with previous studies focused on the presence of SARS-CoV-2 antibodies in breast milk 11,20 . Indeed, we found that all samples remained positive for anti-SARS-CoV-2 IgG at the end of the vaccination course, while only 50-60% of the samples were classified as positive for IgA, which is in agreement with previously reported data 12 .…”

Section: Discussionsupporting

confidence: 93%

“…Despite this lack of information, main organizations including the Centers for Disease Control and Prevention have recommended lactating women to be immunized 9,10 . Preliminary studies showed that mRNA-based vaccines induced anti-SARS-CoV-2 antibodies in breast milk [10][11][12] . However, several questions remain still open including the extend of the vaccination effect, whether there is a differential response depending on the vaccine type, and the impact of vaccination on women with past SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

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Anti-Sars-Cov-2 IgA And IgG In Human Milk After Vaccination Is Dependent On Vaccine Type And Previous Sars-Cov-2 Exposure: A Longitudinal Study

Selma‐Royo

Bäuerl

Mena‐Tudela

et al. 2021

Preprint

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Importance: Limited data are available on COVID-19 vaccine impact in lactating women. Objective: To evaluate the impact of different COVID-19 vaccines on specific anti-SARS-CoV-2 IgA and IgG levels in human milk. Design, Settings and Participants: In this prospective observational study in Spain, 75 lactating women from priority groups receiving vaccination against SARS-CoV-2 were included (January to April 2021). Human milk samples were collected at seven-time points. A group with confirmed SARS-CoV-2 infection (n=19) and a group of women from prepandemic time (n=13) were included. Exposure: mRNA vaccines (BNT162b2 and mRNA-1273) and adenovirus-vectored vaccine (ChAdOx1 nCoV-19). Main Outcome(s) and Measure(s): Presence of IgA and IgG against RBD SARS-CoV-2 in breast milk. Results: Seventy-five vaccinated lactating women [mean age, 34.9±3.7 years] of whom 96% were Caucasic and 92% were health care workers. A total of 417 milk samples were included and vaccine distribution was BioNTech/Pfizer (BNT162b2, n=30), Moderna (mRNA-1273, n=21), and AstraZeneca (ChAdOx1 nCoV-19, n=24). For each vaccine, 7 time points were collected from baseline up to 25 days after the 1st dose and same points were collected for mRNA vaccines 30 days after 2nd dose. A strong reactivity was observed for IgG and IgA after vaccination mainly after the 2nd dose. Presence and the persistence of specific SARS-CoV-2 antibodies in breast milk were dependent on the vaccine-type and, on previous virus exposure. High inter-variability was observed, being relevant for IgA antibodies. IgG levels were significantly higher than those observed in milk from COVID-19 women while IgA levels were lower. Women with previous COVID-19 increased the IgG levels after the 1st dose to a similar level observed in vaccinated women after the 2nd dose. Conclusions and Relevance: Breast milk from vaccinated women contains anti-SARS-CoV-2 IgA and IgG, with highest after the 2nd dose. Levels were dependent on vaccine type and previous exposure to SARS-CoV-2. Previous COVID-19 influenced the vaccine effect after a single dose, which could be especially relevant in the design of vaccination protocols . Further studies are warranted to demonstrate the potential protective role of these antibodies against COVID-19 in infants from vaccinated and infected mothers through breastfeeding.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Anti-Sars-Cov-2 IgA And IgG In Human Milk After Vaccination Is Dependent On Vaccine Type And Previous Sars-Cov-2 Exposure: A Longitudinal Study

Selma‐Royo

Bäuerl

Mena‐Tudela

et al. 2021

Preprint

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“…Other groups have also found SARS-CoV-2 spike and RBD-specific IgG [11][12][13][14] in human milk after vaccination in addition to IgA. Here, we showed that SARS-CoV-2 spike and RBD-specific IgG are found at significantly higher levels in T4 compared to T1.…”

Section: Discussionsupporting

confidence: 58%

“…9 However, such measures may disrupt mother-child bonding and may result in premature cessation of breastfeeding. 10 There is emerging evidence that SARS-CoV-2 specific antibodies are detectable in human milk post vaccination; [11][12][13][14] however, the amount of immunoglobulin G (IgG) and immunoglobulin A (IgA) have not been clearly quantified. It is also unknown whether vaccine components such as mRNA are transferred in human milk; preliminary studies purportedly detect no vaccine mRNA in human milk.…”

Section: Introductionmentioning

confidence: 99%

BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA

Low

et al. 2021

Preprint

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Importance: To examine the impact of SARS-CoV-2 vaccination of lactating mothers on human milk Objective: (1) To quantify SARS-CoV-2-specific immunoglobulin A (IgA) and immunoglobulin G (IgG) in human milk of lactating mothers who received the BNT162b2 vaccine, with reference to a cohort convalescent from antenatal COVID-19, and healthy lactating mothers. (2) To detect and quantify vaccine mRNA in human milk after BNT162b2 vaccination. Design: Gestational Immunity For Transfer 2 (GIFT-2) is a prospective cohort study of lactating mothers who were due to receive two doses of BNT162b2 vaccine, recruited between 5th February 2021 and 9th February 2021. Setting: Lactating healthcare workers living in Singapore Participants: Convenience sample of ten lactating healthcare workers. Human milk samples were collected at four time points: pre-vaccination, 1 to 3 days after dose one, 7 to 10 days after dose one, and 3 to 7 days after dose two of the BNT162b2 vaccine. Exposure: Two doses of the BNT162b2 vaccine 21 days apart. Main Outcome and Measure: (i) SARS-CoV-2-specific IgA and IgG in human milk of lactating mothers who received BNT162b2 vaccine, (ii) Detection and quantification of vaccine mRNA in human milk after BNT162b2 vaccination. Results: Ten lactating healthcare workers aged 32.5 years (range 29 to 42) were recruited, with 40 human milk samples collected and analysed. SARS-CoV-2-specific IgA was predominant in human milk of lactating mothers who received BNT162b2 vaccine. The sharpest rise in antibody production was 3 to 7 days after dose two of the BNT162b2 vaccine, with medians of 1110 picomolar of anti-SARS-CoV-2 spike and 374 picomolar of anti-Receptor Binding Domain IgA. Vaccine mRNA was detected only on rare occasions, at a maximum concentration of 2 ng/mL. Infants had no reported adverse events, up to 28 days after ingestion of post-vaccination human milk. Conclusions and Relevance: In this cohort of ten lactating mothers following BNT162b2 vaccination, nine (90%) produced SARS-CoV-2 IgA, and ten (100%) produced IgG in human milk with minimal amounts of vaccine mRNA. Lactating individuals should continue breastfeeding in an uninterrupted manner after receiving mRNA vaccination for SARS-CoV-2.

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“…These observations are consistent with another study that was recently published. This study found the robust secretion of SARS-CoV-2-specific IgA and IgG antibodies in breast milk for 6 weeks after vaccination [ 7 ]. Moreover, antibodies against SARS-CoV-2 found previously in the breast milk of women infected with COVID-19 showed strong neutralizing effects, suggesting a potential protective effect against infection in the infants [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers

et al. 2021

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Background: Initially, there were no data on the safety of COVID-19 vaccines in lactating women. The aim of our study was to evaluate the immune response to COVID-19 vaccinations in breastfeeding women. Methods: The study included 32 breastfeeding women who, regardless of the study, had decided to be vaccinated. Maternal serum and breast milk samples were simultaneously collected on days 8 ± 1, 22 ± 2, 29 ± 3, and 43 ± 4 after the first dose of the vaccine. The immune response was assessed by determining the presence of anti-SARS-CoV-2 IgG and IgA. Results: The breast milk IgG level was detectable (6.50 ± 6.74, median 4.7, and maximum 34.2 BAU/mL) and highly correlated to serum IgG level (rS 0.89; p < 0.001). The breast milk ratio of IgA to the cut-off value was higher in serum IgA-positive (4.18 ± 3.26, median 2.8, and maximum >10) than in serum IgA-negative women (0.56 ± 0.37, median 0.5, and maximum 1.6; p < 0.001). The highest concentrations of serum and breast milk antibodies were observed on day 29 ± 3 with a decrease on day 43 ± 4. Conclusion: The immune response to the vaccination against SARS-CoV-2 is strongest 7 ± 3 days after the second dose of the vaccine. Lactating mothers breastfeeding their children after vaccination against SARS-CoV-2 may transfer antibodies to their infant.

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SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women

Abstract: This prospective study investigated whether antibodies from SARS-CoV-2 immunization of nursing mothers transferred to infants as a potentially protective effect.

Cited by 263 publications

References 2 publications

Anti-Sars-Cov-2 IgA And IgG In Human Milk After Vaccination Is Dependent On Vaccine Type And Previous Sars-Cov-2 Exposure: A Longitudinal Study

Anti-Sars-Cov-2 IgA And IgG In Human Milk After Vaccination Is Dependent On Vaccine Type And Previous Sars-Cov-2 Exposure: A Longitudinal Study

BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA

Immune Response to Vaccination against COVID-19 in Breastfeeding Health Workers

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