Sudan Ebola virus persistence in breastmilk: A systematic mixed-studies review of viral shedding and transmission risk.

Allan  Komugisa; Micheal Jackson  Asingwire; Vivian  Namboga

doi:10.51168/sjhrafrica.v7i4.2437

Authors

Allan Komugisa Makerere University, School of Public Health, Kampala, Uganda.
Michael Jackson Asingwire Marwadi University, Faculty of Pharmacy, Department of Health Sciences, Rajkot, India.
Vivian Namboga Kyambogo University, Department of Nutritional Sciences, Kampala, Uganda.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i4.2437

Keywords:

Ebola Virus, Breast Milk, Breastfeeding, Ready-to-use Infant Formula

Abstract

Introduction

Ebola virus disease (EVD) poses significant risks to pregnant and breastfeeding women, with viral persistence in breastmilk potentially enabling mother-to-child transmission. This systematic mixed-studies review synthesizes evidence on Sudan ebolavirus (SUDV) in breastmilk, transmission risks, and implications for infant feeding during outbreaks.

Methodology

This searched Google Scholar, WHO, and global databases (January 2015–December 2024; English only) for peer-reviewed articles, reviews, and grey literature using terms like "Ebola Virus Disease" and "Persistence of Ebola Virus in Breast Milk." Inclusion: studies on EVD-positive women intending to breastfeed; exclusion: non-comprehensive case identification. Secondary data from Uganda's 2022 SUDV outbreak (89 cases) used RT-PCR for breastmilk. Two reviewers independently screened/extracted data; disagreements were resolved by consensus. Risk of bias assessed via narrative synthesis (no formal tool); certainty via GRADE (low-moderate due to observational data)

Results

The earliest viral clearance was observed on day 54, and the latest clearance occurred 223 days after discharge from the hospital. Overall clearance occurred faster in the left breast (average 80 days) than in the right breast (average 115 days). Older survivors cleared slower than their younger counterparts. While mothers were eager to re-lactate, their fears lay in re-infection and loss of breast milk due to viral clearance. Additionally, (Ready-to-use Infant Formula) RUIF nourished the babies beyond the need for breast milk. Food insecurity and post-traumatic stress disorder did not spare the milk letdown reflex, perhaps even struggling to get a sample to test.

Conclusion

Sudan Ebola Virus (SUDV) persists in breastmilk with clearance rates significantly influenced by maternal age and anatomical asymmetry. Beyond these biological risks, survivors face a "double burden" of PTSD and food insecurity post-recovery.

Recommendation

Formulate guidelines on utilization of RUIF and re-lactation for comprehensive survivor care with trauma-informed psychosocial support to address the complex emotional and physiological barriers to safe infant feeding.

Author Biographies

Allan Komugisa, Makerere University, School of Public Health, Kampala, Uganda.

A public health researcher and corresponding author focused on strengthening East African health systems and infectious disease dynamics. He specializes in bridging clinical data with public health policy.

Michael Jackson Asingwire, Marwadi University, Faculty of Pharmacy, Department of Health Sciences, Rajkot, India.

A health sciences researcher specializing in the clinical pharmacology of infectious diseases and biochemical markers of recovery. His work facilitates international collaboration between Indian and African institutions.

Vivian Namboga, Kyambogo University, Department of Nutritional Sciences, Kampala, Uganda.

A nutritional sciences specialist focusing on clinical nutrition and maternal-infant health. Her expertise includes breastfeeding practices and food security in vulnerable populations, specifically evaluating how psychosocial distress and socio-demographic factors impact nutritional outcomes during public health emergencies.

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