Humoral and cellular immune responses to mRNA-based coronavirus disease 2019 (COVID-19) vaccination are present in the breast milk of most women and confer passive immunity to the nursing infant. OBJECTIVE: To evaluate immune responses to coronavirus disease 2019 (COVID-19) mRNA-based vaccines present in breast milk and transfer of the immune responses to breastfeeding infants. METHODS: We enrolled 30 lactating women who received mRNA-based COVID-19 vaccines from January through April 2021 in this cohort study. Women provided serial milk samples, including milk expressed before vaccination, across 2–3 weeks after the first dose, and across 3 weeks after the second dose. Women provided their blood, spotted on cards (dried blood spots), 19 days after the first dose and 21 days after the second dose. Stool samples from the breastfed infants were collected 21 days after mothers’ second vaccination. Prepandemic samples of milk, dried blood spots, and infant stool were used as controls. Milk, dried blood spots, and infant stool were tested by enzyme-linked immunosorbent assay for receptor-binding domain (RBD)–specific immunoglobulin (Ig)A and IgG. Milk samples were tested for the presence of neutralizing antibodies against the spike and four variants of concern: D614G, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1). Levels of 10 cytokines were measured in milk samples. RESULTS: Milk from COVID-19-immunized women neutralized the spike and four variants of concern, primarily driven by anti-RBD IgG. The immune response in milk also included significant elevation of interferon-γ. The immune response to maternal vaccination was reflected in breastfed infants: anti-RBD IgG and anti-RBD IgA were detected in 33% and 30% of infant stool samples, respectively. Levels of anti-RBD antibodies in infant stool correlated with maternal vaccine side effects. Median antibody levels against RBD were below the positive cutoffs in prepandemic milk and infant stool samples. CONCLUSION: Humoral and cellular immune responses to mRNA-based COVID-19 vaccination are present in most women’s breast milk. The milk anti-RBD antibodies can neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike and variants of concern. Anti-RBD antibodies are transferred to breastfed infants, with the potential to confer passive immunity against SARS-CoV-2.
【초록키워드】 COVID-19, coronavirus disease, neutralizing antibody, SARS-CoV-2, IgG, Breastfeeding, Vaccine, coronavirus, immune response, vaccination, antibody, B.1.351, Cellular immune response, variant, passive immunity, variants of concern, cytokine, cohort study, Infant, Dried blood spots, Infants, Stool, COVID-19 vaccination, Immunoglobulin, B.1.1.7, RBD, P.1, breast milk, Gamma, D614G, Beta, women, Side effects, Blood, mother, Anti-RBD antibody, Anti-RBD IgG, interferon-γ, acute respiratory syndrome, second vaccination, second dose, first dose, domain, transfer, Cutoff, milk, positive, mRNA-based vaccine, controls, lactating women, anti-RBD IgA, neutralize, enzyme-linked immunosorbent, neutralized, mRNA-based COVID-19 vaccine, enrolled, tested, collected, evaluate, provided, reflected, were used, expressed, correlated, driven by, Level, were measured, Stool sample, mRNA-based, transferred, 【제목키워드】 COVID-19, Breast, mRNA, milk,