Detection of SARS-CoV-2 specific IgA in the human milk of COVID-19 vaccinated, lactating health care workers

ImportanceIn 2019, a deadly virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for COVID-19, emerged. In December 2020, two mRNA-based COVID-19 vaccines were approved for use in the United States (US) which provide immunity to those receiving the vaccine. Maternally derived antibodies are a key element of infants immunity. Certain vaccines given to pregnant and lactating mothers provide immunity to infants through transmission across the placenta, umbilical cord (IgG) and human milk (IgA). Human milk produced by mothers with a history of COVID-19 infection contains SARS-CoV-2 IgA and IgG. ObjectiveTo determine whether SARS-CoV-2 specific immunoglobulins are found in human milk after the COVID-19 vaccination, and to characterize the types of immunoglobulins present. Design, setting, and participantsThis is a prospective observational study conducted at Shands Hospital, University of Florida from December 2020 to March 2021. Twenty-two lactating healthcare workers who received the SARS-CoV-2 mRNA vaccine (Pfizer/BioNtech or Moderna) made up the sample group. Plasma and human milk were collected at three-time points (pre-vaccination, post-first vaccine dose, and post-second vaccine dose). SARS-CoV-2 specific IgA and IgG in human milk and in plasma were measured by ELISA. Maternal demographics was compiled. ExposuresPfizer/BioNtech or Moderna vaccination. Main outcome and measureLevels of SARS-CoV-2 IgA and IgG in human milk and plasma. ResultsWe found significant secretion of SARS-CoV-2 specific IgA and IgG in human milk and plasma after SARS-CoV-2 vaccination. Conclusions and relevanceOur results show that the mRNA-based COVID-19 vaccines induce SARS-CoV-2 specific IgA and IgG secretion in human milk. Further studies are needed to determine the duration of this immune response, its capacity to neutralize the COVID-19 virus, the transfer of passive immunity to breastfeeding infants, and the potential therapeutic use of human milk IgA to combat SARS-CoV-2 infections and COVID-19. KEY POINTSO_ST_ABSQuestionC_ST_ABSIs there SARS-CoV-2 specific IgA in the human milk of lactating women after COVID-19 vaccination? FindingsIn this prospective observational study that included 22 lactating women, we found SARS-CoV-2 specific IgA in the human milk in response to the COVID-19 vaccination series. There is statistically significant secretion of SARS-CoV-2 IgA in human milk after mRNA COVID-19 vaccination series completion (p < 0.0001). MeaningNewborn immunologic defense is present but immature. SARS-CoV-2 IgA secreted in the human milk could potentially provide COVID-19 protection to nursing infants. These results could guide a strategy for SARS-CoV-2 vaccination among lactating women.