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Recommendations for Breastfeeding/Infant Feeding in the Context of Ebola

Page Summary

Who this is for: Field and partner organizations.

What this is for: To provide recommendations about breastfeeding if a mother is under investigation for Ebola, has confirmed Ebola, or has survived Ebola.

How to use: Use this document to advise a mother who is under investigation for Ebola, has confirmed Ebola, or has survived Ebola.

Key Points

  • When safe alternatives to breastfeeding and infant care exist, a mother under investigation for Ebola or with confirmed Ebola should not have close contact with her infant (including breastfeeding).
  • In resource-limited settings where safe alternatives do not exist, breastfeeding may be the only option for providing the nutrition a baby needs.
  • Ebola can stay in breast milk even after recovery. It is best for a mother who has survived Ebola not to breastfeed if she has other safe ways to feed her baby.

In most situations, breastfeeding is the best choice for feeding an infant, particularly in settings where resources are limited. However, if a mother is under investigation for Ebola or has confirmed Ebola, decisions about how she should feed her baby must be made on a case-by-case basis by weighing the risk of transmitting the virus to the baby through breastfeeding against the risks of stopping breastfeeding.

A mother with Ebola may be critically ill and unable to breastfeed. If a mother with Ebola is able to breastfeed, decisions about how she should feed her baby may depend on the age of the infant, the availability and feasibility of safe nutrition and infant care, and overall sanitary conditions. These risks must be balanced against the likely high risk of Ebola virus transmission through breastfeeding, the act of suckling, and close contact with the ill mother.

Although Ebola virus has been detected in breast milk1, it is not known whether the virus can be transmitted from a mother to her infant through breastfeeding. However, given what is known about the transmission of Ebola virus, regardless of breastfeeding status, an infant whose mother has Ebola is already at high risk of getting infected from close contact with the mother, and is at high risk of death overall2. When safe replacements to breastfeeding and infant care exist, a mother under investigation or with confirmed Ebola should not have close contact with her infant (including breastfeeding). In resource-limited settings where safe alternatives do not exist, breastfeeding may be the only option for providing the nutrition the baby needs.

There is not enough evidence to provide guidance on when it is safe to resume breastfeeding after a mother's recovery, unless her breast milk can be shown to be Ebola virus-free by laboratory testing. In the one case in which breast milk was tested, Ebola virus was identified in the breast milk of a lactating woman 7 and 15 days after disease onset.1 It is best for a mother who has survived Ebola not to breastfeed if she has other safe ways to feed her baby.

  1. Bausch et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. Journal of Infectious Diseases 2007;196:S142-7.
  2. Bulletin of the World Health Organization, Ebola Haemorrhagic Fever in Zaire 1976 56 (2): 271-291 (1978).

More guidance can be found here: http://files.ennonline.net/attachments/2176/DC-Infant-feeding-and-Ebola-further-clarification-of-guidance_190914.pdf

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