The Critical Need for Research on Breastfeeding During Ebola Outbreaks

Breastfeeding plays a vital role in ensuring the health and well-being of infants, as emphasized by global health authorities like the World Health Organization (WHO) and Unicef. Their guidelines advocate for mothers to initiate breastfeeding within an hour of childbirth, exclusively breastfeed for the first six months, and continue breastfeeding alongside solid foods for up to two years or more.

However, the emergence of infectious disease outbreaks, such as Ebola, poses significant challenges to breastfeeding, potentially jeopardizing the health of both mothers and their infants. The transmission of infections, whether through close contact or, albeit rarely, through breastmilk, raises considerable concerns. Additionally, the administration of medications or vaccinations to mothers may further complicate breastfeeding practices.

During an Ebola outbreak, it is crucial for mothers to receive clear and accurate guidance on how to proceed with breastfeeding. The Ebola virus presents severe symptoms, including fever, fatigue, muscle pain, headaches, sore throats, and can escalate to more critical conditions such as vomiting, diarrhea, rashes, and bleeding. The high contagiousness of the virus, coupled with a significant mortality rate, particularly affects vulnerable populations like pregnant women and infants.

Countries that have experienced Ebola outbreaks typically rely heavily on breastfeeding, making it all the more pressing to understand the implications of the virus on this practice. Uganda recently declared another outbreak of Ebola, further highlighting the urgency for appropriate breastfeeding guidance during such crises.

Breastmilk is rich in essential nutrients and antibodies that help bolster an infant's immune system. Discontinuing breastfeeding in favor of alternative feeding methods, including infant formulas, could diminish this protective factor, increasing the risk of serious illness among infants.

It is imperative to discern which actions may either safeguard or jeopardize the health of mothers and infants during Ebola outbreaks. Recommendations regarding the management of infectious diseases should carefully balance the risks associated with the disease, medical interventions, and the consequences of ceasing breastfeeding.

The WHO has issued guidelines on managing breastfeeding in the context of Ebola; however, these directives are primarily based on limited evidence and expert opinions rather than comprehensive research findings. Historically, research focused on Ebola has largely overlooked the effects on breastfeeding, leaving significant gaps in knowledge.

A recent publication in The Lancet Global Health has called attention to the need for a structured research agenda focusing on the intersection of Ebola and breastfeeding, which is critical for protecting the health of mothers and their infants during outbreaks.

While it is understood that Ebola can be transmitted through close contact, there are numerous unanswered questions regarding the implications for breastfeeding:

• Is breastmilk infectious, and if so, for how long?
• Can expressed breastmilk be treated to eliminate the risk of infection?
• If both mother and baby are infected, is continued breastfeeding beneficial for the infant?
• Does vaccinating mothers against Ebola provide any protective effects for breastfed infants?
• What risks do breastfed infants face if their mothers are infected?

The absence of clear answers to these questions can lead to decisions that might inadvertently increase risks for mothers and children. For instance, a mother might decline vaccination due to fears for her infant's safety, leaving herself vulnerable to the virus. Conversely, a mother who chooses to vaccinate may stop breastfeeding, exposing her baby to other serious health risks.

Separation of mothers and babies during outbreaks, along with the cessation of breastfeeding, could significantly diminish survival chances for both parties. A concerted effort is required to ensure that mothers and infants receive the support and information they need during such critical times.

The lack of attention to breastfeeding in Ebola research has been a long-standing issue that must be addressed. A comprehensive plan is needed to rectify this gap, which includes identifying various groups of breastfeeding mothers affected by Ebola who should be involved in research initiatives:

• Mothers who have received vaccinations
• Women suffering from Ebola
• Mothers recovering from the virus
• Asymptomatic mothers who are infected
• The broader community of breastfeeding mothers in Ebola-affected areas

This roadmap will outline essential research questions and methodologies to fill existing knowledge voids. Collaboration among governments, pharmaceutical companies, researchers, and health organizations is crucial to drive this research agenda forward.

Closing the gaps in data concerning women and breastfeeding during Ebola outbreaks is imperative for ensuring that mothers can receive the necessary societal, familial, and health support to continue breastfeeding safely. The Universal Declaration of Human Rights underscores the need for special care for motherhood and childhood, highlighting the urgency of committing to this vital area of research.