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Titres and neutralising capacity of SARS-CoV-2-specific antibodies in human milk: a systematic review
  1. Jia Ming Low1,2,
  2. Yue Wey Low3,
  3. Youjia Zhong2,4,
  4. Cheuk Yiu Charlotte Lee5,
  5. Ming Chan5,
  6. Nicholas Beng Hui Ng2,4,
  7. Zubair Amin1,2,
  8. Yvonne Peng Mei Ng1,2
  1. 1 Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore
  2. 2 Paediatrics, National University Singapore, Yong Loo Lin School of Medicine, Singapore
  3. 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4 Khoo Teck Puat – National University Children's Medical Institute, National University Health System, Singapore
  5. 5 Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
  1. Correspondence to Dr Zubair Amin, Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, 119228, Singapore; paeza{at}nus.edu.sg

Abstract

Objective Synthesise evidence on production of SARS-CoV-2 antibodies in human milk of individuals who had COVID-19, and antibodies’ ability to neutralise SARS-CoV-2 infectivity.

Design A systematic review of studies published from 1 December 2019 to 16 February 2021 without study design restrictions.

Setting Data were sourced from PubMed, MEDLINE, Embase, CNKI, CINAHL and WHO COVID-19 database. Search was also performed through reviewing references of selected articles, Google Scholar and preprint servers. Studies that tested human milk for antibodies to SARS-CoV-2 were included.

Patients Individuals with COVID-19 infection and human milk tested for anti-SARS-CoV-2 neutralising antibodies.

Main outcome measures The presence of neutralising antibodies in milk samples provided by individuals with COVID-19 infection.

Results Individual participant data from 161 persons (14 studies) were extracted and re-pooled. Milk from 133 (82.6%) individuals demonstrated the presence of anti-SARS-CoV-2 immunoglobulin A (IgA), IgM and/or IgG. Illness severity data were available in 146 individuals; 5 (3.4%) had severe disease, 128 (87.7%) had mild disease, while 13 (8.9%) were asymptomatic. Presence of neutralising antibodies in milk from 20 (41.7%) of 48 individuals neutralised SARS-CoV-2 infectivity in vitro. Neutralising capacity of antibodies was lost after Holder pasteurisation but preserved after high-pressure pasteurisation.

Conclusion Human milk of lactating individuals after COVID-19 infection contains anti-SARS-CoV-2-specific IgG, IgM and/or IgA, even after mild or asymptomatic infection. Current evidence demonstrates that these antibodies can neutralise SARS-CoV-2 virus in vitro. Holder pasteurisation deactivates SARS-CoV-2-specific IgA, while high-pressure pasteurisation preserves the SARS-CoV-2-specific IgA function.

  • neonatology
  • COVID-19
  • virology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. The data were extracted from the published literature. The details of all such literature used are included in the manuscript.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/archdischild-2021-322156

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information. The data were extracted from the published literature. The details of all such literature used are included in the manuscript.

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    Footnotes

    • Contributors JML and YWL designed, analysed and interpreted the data. CYCL, MC and NBHN drafted the work and contributed to the design and conception of the study. JML, ZA, YPN and YZ analysed and revised the manuscript critically for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.