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First Ebola-related death from breast milk transmission reported in Guinea
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Genomic analysis confirmed that the 2015 death of a 9-month-old Guinean infant from Ebola virus was the result of transmission through the breast milk of her asymptomatic mother, according to a recent case study.
In August 2015, the infant developed fever, diarrhea, vomiting and cough, which stabilized following administration of erythromycin, paracetamol, amodiaquine, albendazole and metopimazine. However, 6 days later, her condition rapidly deteriorated with increased diarrhea and vomiting. The infant later developed respiratory distress and died while en route to the hospital.
A buccal swab of the infant’s RNA tested positive for Ebola virus using reverse transcription PCR, yet an epidemiological investigation could not identify a known source of infection.
“Contact with known Ebola virus disease patients or survivors could not be identified,” Daouda Sissoko, MD, MSc, a senior infectionologist in the division of infectious and tropical diseases at the University Hospital of Bordeaux, France, and colleagues wrote. “The child was the first [Ebola virus disease] case in over 42 days in the area where the family was living. She had never presented at a health care facility and did not receive routine vaccinations, as the mother feared contact with [Ebola virus disease] patients in health centers.”
To determine the source of infection, the researchers sequenced the viral genome of the Ebola-positive RNA using MinION technology (Oxford Nanopore Technologies) in Guinea. Phylogenetic analysis determined that the virus was of the Sierra-Leone lineage, clustered with Conakry-Dubréka sublineage that circulated within the child’s living area between May and July 2015.
The child’s parents underwent testing for Ebola virus in bodily fluids. Of note, the mother’s breast milk tested positive through sequencing, and the virus was closely related to her child’s virus. In addition, phylogenetic analysis demonstrated two shared unique single nucleotide polymorphisms that indicated the virus from the breast milk was ancestral to the virus in the child’s RNA.
“The closely related [Ebola virus] sequences in mother and child, the ancestral position of the mother’s virus relative to the child’s virus in the phylogram, the epidemiological link between mother and child and the absence of contact of the child to other [Ebola virus] cases in the community or the hospital suggest that the mother transmitted the virus to the child via breastfeeding,” Sissoko and colleagues wrote. “Our findings are in line with the [separate] case of an asymptomatic mother, whose breast milk tested positive and who may have transmitted [Ebola virus] to her 13-month-old child.” – by Kate Sherrer
Disclosure: One of the researchers reports receiving travel fees from Oxford Nanopore Technologies.
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