Chair & Medical Director, MMBC
Professor Richard Banati, MD, PhD
Richard Banati is an internationally recognised for his work on the innate immune system of the brain and the nervous system. He has pioneered advanced medical imaging to detect acute or chronic brain injury, inflammation and subtle changes during development as well as ageing. The tracer principle, on which this medical research is based, has applications far beyond neuroscience, such as the measurement of naturally occurring isotopes (‘isotopic signatures’) as well as the detection of hazardous trace contaminants due to human activity as they bio-accumulate in water, food and aerosols.
Prior to his academic career, Richard Banati has served for ten years as a medical doctor in the Red Cross Emergency and Civil Protection service and has since maintained an active interest in Nutrition in Emergencies: Infant and Young Child Feeding in Emergencies. Since 2015, in the wake of the Syrian refugee crisis, that saw many young infants inadequately fed with infant formula, he has been investigating safe storage and pathogen control methods for the establishment of a Human Milk Emergency Reserve as the foundation for improving the security of supply and equity of access to safe donor human milk.
The research of Professor Banati and his colleagues has received recognition through the bi-annual Award of the German league for Research into Alzheimer's Disease, in addition to many more international accolades.
Richard Banati is Professor and Foundation Chair of Medical Radiation Sciences, Faculty of Medicine and Health at the University of Sydney, Inaugural Director of the Ramaciotti Centre for Brain Imaging at the Brain & Mind Research Center (BMC) and University of Sydney node of the National Imaging Facility.
In 2008, Professor Banati joined the Australian Nuclear Science and Technology Organisation (ANSTO) as a Distinguished Research Fellow in 2008, supporting the organisation in strategic research and national and international collaborations and partnerships.
If you wish to get in direct contact with Professor Banati please email him here: firstname.lastname@example.org
Emergency Reserve Fund
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Mothers Milk Bank
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COVID-19 update for breastfeeding mothers
13th March 2020
COVID-19 Update and Call for Donations
to the Human Milk Emergency Reserve
Professor Richard Banati, MD
Mothers Milk Bank Charity (Chair & Medical Director, MMBC)
Review of the current expert advice for breastfeeding mothers during the COVID-19 pandemic based on recent statements by
Word Health Organisation (WHO)
Centres for Disease Control and Prevention, USA (CDC)
UN Population Fund (UNFPA)
Human Milk Banking Association of North America (HMBANA)
European Milk Bank Association (EMBA)
Academy of Breastfeeding Medicine
La Leche League International
Royal College of Obstetricians and Gynaecologists, UK
American College of Obstetricians and Gynecologists (ACOG)
The Lancet (weekly peer-reviewed general medical journal).
(excerpts from the various statements issued by above institutions are listed below under Sources & References)
There is no evidence that the corona virus COVID-19 can be transmitted through breastmilk. Breastfeeding women infected with COVID-19 should, therefore, not be separated from their newborns. Breastfeeding mothers with COVID-19 should wear a mask when close to their baby, wash hands before and after feeding, and disinfect contaminated surfaces.
Mother who are too unwell to breastfeed can express milk for the baby, and take the aforementioned general precautions.
Pasteurisation inactivates COVID-19 and renders pasteurised donor human milk safe in the event of contamination during expressing or handling of the milk.
Mothers who currently source donor milk informally can ask Mothers Milk Bank Charity’s secure cold-chain-transport service to pick up, pasteurise and deliver human milk from screened donors https://www.mothersmilkbank.com.au
Karleen Gribble and Nina Jane Chad have summarised what parents and carers need to know to prepare and respond. Where grandparents or carers over 60 help with childcare, alternative arrangements are recommended, as older individuals tend to be more seriously affected by the coronavirus.
URGENT: Donations for the Human Milk Emergency Reserve
Mothers Milk Bank Charity urgently calls for donations to establish a human milk emergency reserve. This reserve is of particular relevance for vulnerable communities, where the feeding of infant formula in the presence of pathogen exposure leads to a 5-6 times higher mortality in infants under 2 months (Lancet 2008, see below).
This figure is close to that seen following the 2009 swine flu pandemic when Indigenous Australians, made up 11% of all identified cases and had a “six-fold death rate compared with non-Indigenous Australians [across all age groups]”and recently drawn attention to by Dawn Casey, the deputy CEO of the National Aboriginal Community Controlled Health Organisation. (NACCHO)
There is currently no provision for infants in the community. ‘…NSW Health [as is the case in all other states] is focussed on providing pasteurised donor human milk to vulnerable premature babies, those born less than 32 weeks gestational age or of a very low birth weight (i.e. <1500 grams)’.
The human milk emergency reserve gives food security to newborn infants in need of breastmilk.
The stock needs to be accrued BEFORE the emergency.
Figure: Relative risk of not breastfeeding for infections and mortality compared to exclusive breastfeeding from 0-5 months
[Source: Lancet 2008, Nutrition Series]
Donated human milk actively protects non-breastfed newborns and avoids risks due to infant formula feeding.
The current advice to continue breastfeeding or to feed expressed human milk reflects better understanding that human milk provides active protection to the infant. “…Human milk contains free fatty acids and monoglycerides, which are also generated by milk lipase activity , and these have potent antiviral activity against enveloped viruses including HIV [and coronaviruses, such as COVID-19] [21, 22].”(https://jmm.microbiologyresearch.org/content/journal/jmm/10.1099/0022-1317-49-8-719?crawler=true&mimetype=application/pdf)
Infant formula feeding increases the risks of diarrhoea and respiratory disease in young infants. (https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1693-2 https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-014-0020-7), Claimed immune benefits of newer formula preparations containing milk oligosaccharides remain problematic (https://www.nature.com/articles/pr2008136 https://www.nature.com/articles/pr2008141).
Annually 770000 people die of HIV infection. Increasing breastfeeding to near-universal levels for infants and young children could save over 800,000 children’s lives a year worldwide, equivalent to 13% of all deaths in children under two, and prevent an extra 20,000 deaths from breast cancer every year. (https://www.who.int/gho/hiv/epidemic_status/deaths_text/en/ https://www.unicef.org.uk/babyfriendly/lancet-increasing-breastfeeding-worldwide-prevent-800000-child-deaths-every-year/
The latter is relevant across the globe, including high income countries, since the health risks associated with infant formula is not only due to contaminated water as may be the case in developing countries or certain vulnerable populations.
Human milk is in itself actively protective AND avoids health risks due to infant formula feeding. Importantly, donor human milk is a solution that closes a gap in supply. It is ‘bridging milk’ that does not replace breastfeeding but is associated with reduced durations of hospital stay and higher or maintained maternal breastfeeding rates. (https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-019-0233-x https://journals.sagepub.com/doi/10.1177/0890334416632203
Sources & References
Clinical management of severe acute respiratory infection when Novel coronavirus (2019-nCoV) infection is suspected: Interim Guidance1Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected
CDC (Centre for Disease Control, USA):
Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19
Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.
Transmission of COVID-19 through breast milk
Much is unknown about how COVID-19 is spread. Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however we do not know whether mothers with COVID-19 can transmit the virus via breast milk.
Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy
Coronavirus disease (COVID-19): What parents should know
There’s a lot of information online. What should I do?
There are a lot of myths and misinformation about coronavirus being shared online – including on how COVID-19 spreads, how to stay safe, and what to do if you’re worried about having contracted the virus.
So, it’s important to be careful where you look for information and advice. This explainer contains information and recommendations on how to reduce the risk of infection, whether you should take your child out of school, whether it’s safe for pregnant women to breastfeed, and precautions to take when traveling. In addition, the World Health Organization has a useful section addressing some of the most frequently asked questions.
It’s also advisable to keep up to date on travel, education and other guidance provided by your national or local authorities for the latest recommendations and news.
Is it safe for a mother to breastfeed if she is infected with coronavirus?
All mothers in affected and at-risk areas who have symptoms of fever, cough or difficulty breathing, should seek medical care early, and follow instructions from a health care provider.
Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.
For symptomatic mothers well enough to breastfeed, this includes wearing a mask when near a child (including during feeding), washing hands before and after contact with the child (including feeding), and cleaning/disinfecting contaminated surfaces – as should be done in all cases where anyone with confirmed or suspected COVID-19 interacts with others, including children.
If a mother is too ill, she should be encouraged to express milk and give it to the child via a clean cup and/or spoon – all while following the same infection prevention methods.
UNFPA (UN Population Fund)
As COVID-19 continues to spread, pregnant and breastfeeding women advised to take precautions
Breastfeeding women who become ill should not be separated from their newborns, the statement adds. There is no evidence that the illness can be transmitted through breastmilk. However, breastfeeding mothers who are infected should wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces. If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions.
Human Milk Banking Association of North America (HMBANA)
Milk Banking and COVID-19
The Human Milk Banking Association of North America (HMBANA) is closely monitoring the evolving situation regarding the outbreak of the 2019 Novel Coronavirus. As always, HMBANA remains dedicated to providing safe donor human milk to infants in need. Screening criteria for milk donors are rigorous, and designed to protect the incoming milk supply.
For more details, please read our full statement on milk banking and COVID-19.
The CDC has now provided interim guidance for women who are confirmed to have COVID-19 or are persons-under-investigation (PUI) for COVID-19 and are currently breastfeeding.
For additional details and the latest information, including tips on how to stay healthy, please visit cdc.gov/coronavirus/2019-ncov.
Transmission and Breastmilk or Human Milk.
“Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread.” (Center for Disease Control and Prevention [CDC], 2020)
In limited studies including women with SARS, the virus has not been detected in breastmilk, however, it is not known whether mothers with COVID-19 can transmit the virus via breastmilk.
In a recent, but small study in China, a group of six mothers testing positive for COVID-19 were studied after giving birth. No evidence of the virus was found in their samples of breastmilk, cord blood, amniotic fluid or throat swabs of their newborns (Chen et al., 2020).
COVID-19 and Genetically Similar Viruses
Research specific to COVID-19 is still emerging as the current outbreak evolves. While COVID-19 is a novel (new) virus and data is limited, characteristics of similar viruses such as SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) are significantly relevant and applicable to milk banking.
On February 11, 2020, the International Committee on Taxonomy of Viruses (ICTV) named this newly identified virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, now called “COVID-19” because of its genetic similarities to the SARS coronavirus responsible for the outbreak in 2003 (World Health Organization [WHO], 2020). Existing SARS and MERS research provide valuable information when evaluating virus transmission and inactivation.
Heat Inactivation of the Virus
Studies have documented complete heat inactivation of genetically similar viruses such as SARS and MERS, specifically heat treatment of 60°C for 30 minutes (Miriam & Taylor, 2006; Rabenau et al., 2005; van Doremalen, 2014). All donor milk dispensed by HMBANA member banks undergo heat treatment using the Holder pasteurization method of 62.5°C for 30 minutes.
European Milk Bank Association
Academy of Breastfeeding Medicine:
News Release 4-Mar-2020; Coronavirus treatment and risk to breastfeeding women
New Rochelle, NY, March 4, 2020--Little data is available about the ability of antiviral drugs used to treat COVID-19, coronavirus, to enter breastmilk, let alone the potential adverse effects on breastfeeding infants. A new perspective article reviewing what is known about the most commonly used drugs to treat coronavirus and influenza is published in Breastfeeding Medicine, the official journal of the Academy of Breastfeeding Medicine published by Mary Ann Liebert, Inc., publishers. Click here to read the protocol free on the Breastfeeding Medicine website.
Philip Anderson, PharmD, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, is the author of "Breastfeeding and Respiratory Antivirals: Coronavirus (COVID-19) and Influenza." The short answer to questions regarding drug therapy for COVID-19 is that currently there is no antiviral agent proven to be effective against this new infection. However, one investigational drug so far, remdesivir, appears promising to treat COVID-19, and it is in phase 3 clinical trials in patients. Dr. Anderson notes: "Nothing is known about the passage of remdesivir into breastmilk."
Arthur I. Eidelman, MD, Editor-in-Chief of Breastfeeding Medicine, states: "Given the reality that mothers infected with coronavirus have probably already colonized their nursing infant, continued breastfeeding has the potential of transmitting protective maternal antibodies to the infant via the breast milk. Thus, breastfeeding should be continued with the mother carefully practicing handwashing and wearing a mask while nursing, to minimize additional viral exposure to the infant."
La Leche League International
Continuing to Nurse Your Baby Through Coronavirus (2019-nCoV; COVID-19) and Other Respiratory Infections (19 February 2020)
The novel Coronavirus (COVID-19) currently in the news is a rapidly evolving global medical situation with limited information available at this time. La Leche League International (LLLI) respects the efforts of international health and medical organizations and associations to maintain up-to-date information and recommendations as understanding of the virus is developed. LLLI will continue to track the development of the current global health crisis.
With over 60 years of breastfeeding experience, La Leche League International stands firm in encouraging all families to recognize the importance of breastfeeding in providing immunological protections to the breastfed child. Most often, babies who are being nursed remain healthy even when their parents or other family members fall ill with an infectious illness. There is a growing body of research showing babies benefit from multiple and diverse immunologic proteins, including antibodies, provided in human milk, particularly through direct breastfeeding.
Those who become infected shortly before giving birth and then begin breastfeeding, and those who become infected while breastfeeding, will produce specific secretory IgA antibodies and many other critical immune factors in their milk to protect their nursing infants and enhance their infants’ own immune responses. At this time, these immunologic factors will aid their infants’ bodies to respond more effectively to exposure and infection. Following good hygiene practices will also help reduce transfer of the virus.
If someone who is breastfeeding becomes ill, it is important not to interrupt direct breastfeeding. The baby has already been exposed to the virus by the mother and/or family and will benefit most from continued direct breastfeeding.
Disruption of breastfeeding may lead to several issues:
significant emotional trauma for the nursing baby or toddler,
a drop in milk supply due to the need to express milk,
later breast refusal by the infant due to the introduction of bottles,
a decrease in protective immune factors due to lack of direct breastfeeding and expressed milk not matching the infant’s needs at a particular time, and
an increased risk of the infant becoming ill due to lack of immune support from direct breastfeeding.
The last point is of critical importance: when any member of the family has been exposed, the infant has been exposed. Hence, any interruption of breastfeeding may actually increase the infant’s risk of becoming ill and even of becoming severely ill.
Anyone who believes they may have COVID-19 (also known as novel coronavirus; 2019-nCoV; SARS-CoV-2) is encouraged to follow good hygiene practices, such as thoroughly washing their hands and wearing a protective mask to prevent spread of the virus. If someone becomes ill enough to require hospitalization, the baby should be allowed to continue breastfeeding if at all possible, keeping in mind the above list of possible results from any separation or disruption of breastfeeding. In an extreme circumstance, if an interruption of breastfeeding is deemed medically necessary, hand expressing or pumping the milk is encouraged. In such cases, the expressed milk, which contains multiple immune factors, may be fed to the baby to help prevent the baby from getting the infection or to help reduce the severity and duration of an infection if the baby does get sick.
The World Health Organization (WHO) offers guidance and other information on coronavirus in multiple languages on the WHO website. UNICEF also provides information for breastfeeding through COVID-19 infection. Links are included in the references below.
All of the information above also applies to families at risk of or experiencing influenza and other respiratory viruses.
Centers for Disease Control and Prevention (CDC; 28 January 2020). About 2019 Novel Coronavirus (2019 – nCoV). Accessed 29 January 2020 and 12 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
Centers for Disease Control and Prevention (CDC; 17 February 2020). Frequently Asked Questions and Answers: Coronavirus Disease 2019 (COVID-19) and Pregnancy. Accessed 18 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
Centers for Disease Control and Prevention (CDC; 15 February 2020). Coronavirus Disease 2019 (COVID-19): Frequently Asked Questions and Answers. Accessed 19 February 2020 from https://www.cdc.gov/coronavirus/2019-ncov/faq.html
Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; published online Feb 12 2020 at https://doi.org/10.1016/S0140-6736(20)30360-3
China National Health Commission. Transcript of Press Conference on Feb 7, 2020 in Chinese. Available at http://www.nhc.gov.cn/xcs/s3574/202002/5bc099fc9144445297e8776838e57ddc.shtml
Lam, C.M., Wong, S.F., Leung, T.N., Chow, K.M., Yu, W.C., Wong, T.Y., Lai, S.T. and Ho, L.C. (2004), A case‐controlled study comparing clinical course and outcomes of pregnant and non‐pregnant women with severe acute respiratory syndrome. BJOG: An International Journal of Obstetrics & Gynaecology, 111: 771-774.
Scientific American (12 February 2020). Disease Caused by the Novel Coronavirus Officially Has a Name: COVID-19. Accessed 12 February 2020 from https://www.scientificamerican.com/article/disease-caused-by-the-novel-coronavirus-officially-has-a-name-covid-19/
Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003; 112: e254.
UNICEF (February 2020). Coronavirus disease (COVID-19): What parents should know. Accessed 18 February 2020 from https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know
Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292–97.
World Health Organization (WHO; 20 January 2020). Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts: Interim guidance 20 January 2020. Accessed 29 January 2020 from https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
World Health Organization (WHO, 2020). Novel coronavirus (2019-nCoV). Accessed 12 February 2020 from https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; published online Feb 10 2020. DOI:10.21037/tp.2020.02.06.
Royal College of Obstetricians and Gynaecologists, UK
Will I be able to breastfeed my baby?
Yes. At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.
The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.
A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team.
This guidance may change as knowledge evolves.
If you choose to breastfeed your baby, the following precautions are recommended:
Wash your hands before touching your baby, breast pump or bottles
Wear a face-mask for feeding at the breast
Follow recommendations for pump cleaning after each use
Consider asking someone who is well to feed expressed breast milk to your baby.
If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.
American College of Obstetricians and Gynecologists (ACOG)
Breastfeeding: The CDC has developed Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation for COVID-19. There are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care practitioners. Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding. A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while breastfeeding. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.
In limited case series reported to date, no evidence of virus has been found in the breast milk of women infected with COVID-19; however, it is not yet known if COVID-19 can be transmitted through breast milk (ie, infectious virus in the breast milk).
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records
Huijun Chen*, Juanjuan Guo*, Chen Wang*, Fan Luo, Xuechen Yu, Wei Zhang, Jiafu Li, Dongchi Zhao, Dan Xu, Qing Gong, Jing Liao, Huixia Yang,
Wei Hou, Yuanzhen Zhang
Lancet 2020; 395: 809–15
February 12, 2020
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical recordsThe clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.
Volume 395, ISSUE 10226, P760-762, March 07, 2020
What are the risks of COVID-19 infection in pregnant women?
We need to further strengthen our capacity to deal with emergent infectious disease outbreaks, through laws and regulations to prevent and control the spread of infectious diseases and to avoid outbreak clusters in families, communities, and other public places, and to do so with transparency and solidarity.
We thank Dr Nina Jane Chad (Infant and Young Child Feeding in Emergencies Consultant) for her advice on emergency preparedness for mothers and carers of young infants (https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026)