Mija Ververs’s research while affiliated with Centers for Disease Control and Prevention and other places

The discovery that the Oropouche virus (OROV) can be transmitted vertically from an infected pregnant mother to the fetus, resulting in fetal and placental OROV infection, miscarriage, stillbirth, and congenital malformations including microcephaly, has emphasized its public health significance. Because of the importance of breastfeeding in those areas affected by the Oropouche fever outbreak, public health agencies have continued to encourage nursing among mothers who have had OROV infection or who reside or travel in endemic regions. However, the basis for this recommendation has not been stated. At the present time, there have been no reports of the OROV being transmitted from mothers having had Oropouche fever during pregnancy to their infants through breast milk. To further evaluate the potential risk of OROV transmission through breastfeeding, we have examined the peer-reviewed literature to determine if related Orthobunyavirus species infecting humans and animals are transmissible via breast milk. Bibliographic search engines, including PubMed, Scopus, and Google Scholar, were extensively reviewed using keywords, MeSH terms, and other sources cited in the articles examined. Studies investigating Orthobunyavirus species that infect humans and animals, including reassortant strains of OROV and viruses within the Simbu serogroup, were reviewed. We found that there have been no reported events of vertical transmission of any Orthobunyavirus through breast milk. Based on these results, we believe that the advantages of breastfeeding following maternal OROV infection outweigh any negligible risk for vertical transmission.

Background: Pregnancy induces physiological decline in maternal immunity. Ebola virus disease (EVD) in pregnancy is associated with obstetrical complications, and vaccination in early pregnancy is recommended, but may not be without risk. Case Presentation: We described neonatal survival after spontaneous maternal EVD recovery. This neonate was born to a 25‐year‐old mother admitted to an Ebola Treatment Unit (ETU) in July, 2020, after 11 days of symptoms. She was vaccinated with rVSV‐ZEBOV three days before symptom onset and her real‐time polymerase chain of reaction (RT‐PCR) results confirmed EVD and malarial infection two days after, but she refused hospitalization. She was treated at home with PO ASAQ, amoxicillin, paracetamol, albendazole, omeprazole, and papaverine. Eleven days later, due to clinical deterioration and onset of vaginal hemorrhage, she finally accepted to be transferred in ETU. She was Parity 2, fetal age at admission was 5 weeks and 3 days. Upon admission, her EVD PCR measured NP 26.3 and GP 32.9. She did not receive monoclonal therapy against Ebola infection due to stock shortage. She received intravenous, artesunate, ceftriaxone, and papaverine. She experienced spontaneous resolution of EVD 18 days after symptom onset and was discharged. At 40 weeks gestation, seven and a half months after EVD recovery, she delivered a healthy female infant, APGAR 10/10/10, weighing 3450 g. Maternal blood, adnexal, and newborn blood samples were RT‐PCR negative, and the mother and the baby were discharged after 14 days. At our last follow‐up, in June 2023 (2 years, 3 months after delivery), the mother and the baby were in good health. Conclusion: Neonatal survival following spontaneous maternal recovery from EVD in the first trimester of gestation is rare but possible, even in the context of limited clinical resources for treatment.

Background Ebola-HIV and malaria co-infection is one of the rare clinical situations that remains complex to manage even in the context of unlimited resources. In pregnancy, each of these infections can compromise maternal and fetal outcomes. The synergy of their effects on maternal immunity are often fatal, and survival is an exception, especially in a context of limited resources, such as in Ebola Treatment Units (ETUs). Case presentation Our 22-year-old patient, weighing 56 kg and nine weeks pregnant was admitted to the ETU during the 10th outbreak in DRC. She had HIV and had abandoned antiretroviral treatment (ART) seven months before. One month before her admission, her HIV viral load was high with a low CD4⁺ T cell count. She was vaccinated against EVD with rVSV-ZEBOV four days before her symptoms. She appeared generally in ill-health but her vital signs were within normal range. Without ultrasound, the fetal vitality could not be assessed. Laboratory tests confirmed malaria, pregnancy, HIV, and Ebola infection through RT-PCR. She received supportive treatment and a neutralizing monoclonal antibody (mAb114). On the 2nd day, we observed a significant decrease in Ebola viral load. Her clinical evolution improved with no disturbance in many biological parameters. She was negative for Ebola infection on 13th day and was discharged from the ETU after three weeks of admission. After referral to a health facility an ultrasound revealed 12 weeks of gestation and lab results showed a decrease of 47% in HIV viral load with 44% CD4⁺ T cell count increase. She began ART treatment and at 38 weeks gestation, the HIV viral load was undetectable and gave birth by caesarian section to a healthy male newborn. The mother and newborn’ s blood, buccal swab and adnexal samples tested negative for Ebola virus and both were discharged 10 days after the delivery. Conclusion In case of Ebola, HIV and malaria co-infection, maternal and fetal survival remains possible even in the context of resources limited-setting. This case raises questions about the effects of the interactions of these co-infections and/or their antibodies, treatment during immune adaptation of the gravid organism.

Ebola virus outbreaks causing viral haemorrhagic fever occur predominantly in regions with high fertility, where breastfeeding is the only safe infant feeding option. Yet, there is a dearth of evidence to inform recommendations and decision making for breastfeeding mothers. Specific gaps in knowledge include whether or for how long replicable virus is present in breastmilk, whether mother-to-infant viral transmission can occur through breastmilk, and whether the interruption of breastfeeding would be beneficial if both mother and infant are infected. Furthermore, despite vaccine availability, there is no evidence regarding safety in mother-infant pairs. This inadequacy of evidence is long recognised, but a pathway to necessary knowledge has not previously been outlined. This Health Policy summarises existing data and delineates research priorities and methods to provide a research roadmap to protect breastfeeding women and their infants through research, rather than systematically excluding them, with the desire to protect them from theoretical risks of research in the context of Ebola.

Background On 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies. Methods Data was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding. Results A total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities. Conclusions These incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies.

Introduction During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. Methods We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Results Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Conclusion Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.

In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.