title: Breast Milk as a Potential Source of Epstein-Barr Virus Transmission Among Infants Living in a Malaria-Endemic Region of Kenya.
abstract: BACKGROUND
  We previously reported that infants in Kenya were infected with Epstein-Barr virus (EBV) at <6 months of age, suggesting that mothers were the likely source of transmissible virus to the infant. In this study, we investigated whether breast milk contained infectious EBV and the role of malaria in EBV shedding in breast milk.
  
  
  METHODS
  Breast milk samples were obtained from Kenyan mothers at postpartum weeks 6, 10, 14, and 18 and analyzed for presence of infectious EBV.
  
  
  RESULTS
  We found that the prevalence of EBV DNA and the mean EBV load were significantly higher at 6 weeks and decreased through postpartum week 18 (P < .0001). High EBV load in breast milk correlated with mothers who had Plasmodium falciparum malaria at delivery. To determine whether viral DNA was encapsidated, breast milk samples were treated with DNAse before DNA extraction. Sixty percent of samples were DNAse resistant, suggesting that the viral DNA in breast milk was encapsidated. Next, we exposed peripheral blood mononuclear cells to breast milk supernatant, which resulted in the generation of EBV-positive lymphoblastoid cell lines, indicating that the virus in breast milk was infectious.
  
  
  CONCLUSIONS
  Our data suggest that breast milk contains infectious EBV and is a potential source of viral transmission to infants living in malaria-endemic regions.
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology.
authors.forename: Ibrahim I
authors.initials: II
authors.lastname: Daud
authors.affiliation: SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Carrie B
authors.initials: CB
authors.lastname: Coleman
authors.affiliation: SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Smith
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute Maseno University, Kisumu.
authors.forename: Sidney
authors.initials: S
authors.lastname: Ogolla
authors.affiliation: SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Simbiri
authors.affiliation: Center for Microbiology Research, Kenya Medical Research Institute, Nairobi.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology.
authors.forename: Zipporah W
authors.initials: ZW
authors.lastname: Ng'ang'a
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Sumba
authors.affiliation: Center for Global Health Research, Kenya Medical Research Institute.
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.affiliation: Universities Space Research Association, Houston, Texas.
authors.forename: Robert
authors.initials: R
authors.lastname: Ploutz-Snyder
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Arlene E
authors.initials: AE
authors.lastname: Dent
authors.affiliation: SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Rochford
mesh_terms: D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria; D008895:Milk, Human / Q000821:virology*; D015995:Prevalence; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: EBV transmission; Kenya; breast milk; malaria