Mann Taylor Z, Haddad Lisa B, Williams Tonya R, Hills Susan L, Read Jennifer S, Dee Deborah L, Dziuban Eric J, Pérez-Padilla Janice, Jamieson Denise J, Honein Margaret A, Shapiro-Mendoza Carrie K
Division of Congenital and Developmental Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Oak Ridge Institute for Science and Education (ORISE) Research Participation Program, Atlanta, GA, USA.
Paediatr Perinat Epidemiol. 2018 Jul;32(4):358-368. doi: 10.1111/ppe.12478. Epub 2018 Jun 8.
Since the Zika virus epidemic in the Americas began in 2015, Zika virus transmission has occurred throughout the Americas. However, limited information exists regarding possible risks of transmission of Zika virus and other flaviviruses through breast feeding and human milk. We conducted a systematic review of the evidence regarding flaviviruses detection in and transmission through milk, specifically regarding Zika virus, Japanese encephalitis virus, tick-borne encephalitis virus, Powassan virus, West Nile virus, dengue virus, and yellow fever virus.
Medline, Embase, Global Health, CINAHL, Cochrane Library, Scopus, Popline, Virtual Health Library, and WorldCat were searched through June 2017. Two authors independently screened potential studies for inclusion and extracted data. Human and nonhuman (animal) studies describing: 1) confirmed or suspected cases of mother-to-child transmission through milk; or 2) the presence of flavivirus genomic material in milk.
Seventeen studies were included, four animal models and thirteen observational studies. Dengue virus, West Nile virus, and Zika virus viral ribonucleic acid was detected in human milk, including infectious Zika virus and dengue virus viral particles. Human breast-feeding transmission was confirmed for only yellow fever virus. There was evidence of milk-related transmission of dengue virus, Powassan virus, and West Nile virus in animal studies.
Because the health advantages of breast feeding are considered greater than the potential risk of transmission, the World Health Organization recommends that mothers with possible or confirmed Zika virus infection or exposure continue to breast feed. This review did not identify any data that might alter this recommendation.
自2015年寨卡病毒在美洲流行以来，寨卡病毒已在整个美洲传播。然而，关于寨卡病毒和其他黄病毒通过母乳喂养及人乳传播的潜在风险的信息有限。我们对有关黄病毒在乳汁中的检测及通过乳汁传播的证据进行了系统综述，特别关注寨卡病毒、日本脑炎病毒、蜱传脑炎病毒、波瓦桑病毒、西尼罗河病毒、登革病毒和黄热病毒。
检索了截至2017年6月的Medline、Embase、全球卫生、护理学与健康领域数据库、考克兰图书馆、Scopus、Popline、虚拟健康图书馆和WorldCat。两位作者独立筛选潜在的纳入研究并提取数据。纳入描述以下内容的人类和非人类（动物）研究：1）通过乳汁发生母婴传播的确诊或疑似病例；或2）乳汁中存在黄病毒基因组物质。
共纳入17项研究，包括4项动物模型研究和13项观察性研究。在人乳中检测到了登革病毒、西尼罗河病毒和寨卡病毒的病毒核糖核酸，包括具有传染性的寨卡病毒和登革病毒病毒颗粒。仅确认黄热病毒存在通过母乳喂养传播的情况。在动物研究中有证据表明登革病毒、波瓦桑病毒和西尼罗河病毒存在与乳汁相关的传播。
由于母乳喂养对健康的益处被认为大于潜在的传播风险，世界卫生组织建议可能感染或已确诊感染寨卡病毒的母亲继续进行母乳喂养。本综述未发现任何可能改变这一建议的数据。
