Dear Anthony! Thanks for idea!

In an interesting problem a few questions. I will dwell on two issues. To take into account that the mother's milk feeding carefully observe hygiene. In this case the possible ingress of pathogenic viruses and bacteria from mother to infant (lactoferrin, milk and other assembles the immune status of women evolutionarily perfect). There is a second aspect. He is dual. On the one hand, the child's skin, airways, digestive system does not have to be sterile. It is necessary for "training" the immune system and training of the child. On the other hand, it is necessary to take into account the functional condition of the child. If the immune status of the child is weakened, it is necessary to stimulate the immune system by natural means (hardening). At this point, observe basic hygiene.

"it will help to keep in mind that it's not just that human milk is protective against infection"

I realise this is held as a fundamental truth, but there is abundant evidence to show that this is not generally so.  Certainly it is the case that many, but not all, infections are less common in the breastfed, but even where this is so, there is rarely a dose effect.  If breastmilk were good for the baby, the more the better, but the dose effect is often absent after about 6 months of age.

See for example Howarth's prospective study of feeding and mortality in 9189 births Lancet 1905;2:210-3:

---Unlike for example gastrointestinal and respiratory deaths, there was no consistent dose effect for breastfeeding and other diseases, including non-intestinal tuberculosis.  Death rates for all 8 foods in the hand-fed were at least double the rate in the breastfed, the highest rate being for condensed milk.   This suggests that it is the fact of not being breastfed that matters, not what is fed.

Dear Anthony, we have different arguments trying to discuss the problem of infections in childhood. Conciliation, the essence of the conversation is how to efficiently prevent these infections. I accept your arguments.

"(it is well established that breastmilk IS good for babies)"

It has been well established for at least a century that breastfeeding is good for babies, although this is misleading way to express the situation.  Breastfeeding is the natural process that has stood the test of time through evolution.   Breathing is also good for us, but rather than stressing this it makes much more sense to concentrate on classifying, diagnosing and explaining breathing disorders.  I know of no evidence that breastmilk in practice, rather than theory, is good for babies, compared to the alternatives.  Some of the evidence that what matters is not what is fed, but how it is fed, is given in my publications in Lancet (1981), JAMA (1987), Nature (1992), Int J Epidem (1986), BMJ 2010, etc.   Specifically, if infants are fed or left on their backs, from propped bottles or breastfeeding in bed for example, food and debris accumulates and festers in the ears, leading eventually to fatal lung and stomach infections.

"... breastmilk often contains harmful organisms (eg in breastmilk banks). " This is an egregious misstatement. At least in North America , there are NO harmful organisms in milk from banks. All milk from HMBANA banks has been Holder Pasteurized for decades, and no cases of disease related to milk from those banks has been reported. On the contrary, CMV transmission by mother's own milk has been reported from many NICU. Holder kills all known viruses studied to date, and all donors are pre-screened for Hepatitis viruses, HIV, etc. FYI: 41.      Cohen RS. Current issues in human milk banking. NeoReviews 2007; 8:e289-95. http://neoreviews.aappublications.org/cgi/content/full/neoreviews;8/7/e289 . 

Readers might find useful this NPR Animation of the Human Microbiome:

http://microbe.net/2013/11/24/microbe-video-of-the-week-npr-animation-of-the-human-microbiome/

"... breastmilk often contains harmful organisms (eg in breastmilk banks). " This is an egregious misstatement. At least in North America , there are NO harmful organisms in milk from banks. All milk from HMBANA banks has been Holder Pasteurized for decades, and no cases of disease related to milk from those banks has been reported. On the contrary, CMV transmission by mother's own milk has been reported from many NICU.

I was thinking more of expressed milk in general.  See Risks of the Unregulated Market in Human Breast Milk BMJ 2015;350:h1485:

Steele et al. cited one study showing that 21% of the samples bought online were positive for CMV, compared with only(!) 5% of bank samples.   Online samples also showed higher overall bacterial growth, only 9% having no detectable growth.

However, this editorial did not identify any studies in practice that linked infections to this contaminated breast milk.  So, as I surmised above, it seems possible that babies fed at the breast are catching little, if anything, via the milk itself.

Absolutely true that online & peer-to-peer milk transfer is not without risk! That is completely different from "breastmilk banks". All banks in North America test the donors, and more importantly, Holder Pasteurize the milk with kills CMV. Getting milk off the web is certainly dangerous - the incidence of CMV in the general population is at least 21%. But comparing "breastmilk banks" to online milk transfer is like comparing the Federal Reserve to a loan shark :)

See: Cohen RS, Xiong SC, Sakamoto P. Retrospective review of serologic testing of potential human milk donors. Arch Dis Child Fetal Neonatal Ed 2010; 95:F118-20.  

Note again, milk from donors like this is Holder Pasteurized, tool 

Quick comment - remember that most often, if there is a virus in the milk, there may well be antibodies to it transferred both in utero & via the milk. Thus, except for premature infants who do not receive as much transplacental antibody, the risk to term babies might be small. On the other hand, if that milk is "shared", then the recipient might not have transplacental immunity to the virus! Also, if mom is infected primarily either at delivery or postpartum, then the baby will not have been protected in utero. Of course, these antibodies may provide only partial protection, too. 

Peer-to-peer milk transfer is most assuredly not without risk, but we should never lose sight of the multiple inherent risks for the health and development of children who are denied access to human milk.

It would of course be entirely unacceptable to gloss over the inherent risks of milk sharing. However, it is also essential to place these risks in perspective. Thus, using Cohen et al. as an example:

 A 3.3% positive serology is indeed significant in terms of the specific viral agents detected. Nevertheless, while a percentage was calculated, no statistical significance testing was done.

 Positive serology does not automatically mean virus in the milk. It can also indicate previous infection that has been successfully treated.

 The review omits any reference to the multiple statistically significant inherent risks for the health and development of children who are denied access to human milk.

Despite its conclusion concerning possible risk with peer-to-peer milk distribution, the San José study provides a useful, even reassuring, backdrop to the milk sharing that is the focus of this presentation. I say this for three reasons:

 First, the probable health-profile similarities – subject to verification of course – between two all-volunteer subpopulations: potential donors to a human milk bank and mothers prepared to donate their unpasteurized milk directly for the babies of other mothers

 Second, the study’s determination that in fact nearly 97% of potential donors tested negative for exclusionary viral agents. This result not only validates the approach to responsible milk sharing that the networks have persistently promoted since their foundation

 Third, it also signals an obvious entry point for collaboration between donor mothers and healthcare professionals to reduce the level of risk further still

Let us recall that here, as elsewhere in public health, it is not a question of absolute protection. It is rather a matter of relative risk for children who are receiving donated milk compared to children with no access to breast milk; and managing risk, minimizing potential harm, and maximizing benefit. In place of reflex condemnation, I propose that we first do the epidemiological risk/benefit arithmetic.

Readers may care to refer to a number of on-line resources in this connection:

http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-6-8.pdf

http://online.liebertpub.com/doi/10.1089/bfm.2015.0009

I also attach the participant handout for an on-line presentation - Human-milk sharing: a timeless practice goes mainstream - made in May 2012.

Hard to do statistical significance with a survey like this. An important point to remember is that this was a population of pre-screened women, already approved by their Obstetricians. Thus, it is reasonable to assume that the seropositivity rate amongst unscreened women would be quite a bit higher. The risk/benefit study would be hard to do in the USA - who would randomize their child?

Please take a look at the following PDF attachments.

Dear : Arvind Singh

Is there a possibility that breastfeeding may cause the transfer of toxins acquired by the mother from the surrounding environment and her baby. Thus breastfeeding is stopped. Breast milk contains antioxidant substances that reduce the negative effects of these harmful substances on the baby.

@ Elham Hamid Al Rawee

Is there any evidence that infants get viral infections from contaminated breast milk?

In reply to the above question, I have attached three published articles to prove that yes infants get viral infections from contaminated breast milk. The question is on transmission of viruses, not on the transfer of harmful substances or toxins. You must know the difference between harmful substances/toxins and viruses. Can diseases like AIDS and encephalitis in children be treated by breast milk?

Thanks!

Some viruses can pass through breast milk. HIV, the virus causing AIDS, is one of them. ... Women with hepatitis C may also be able to transmit the virus through breast milk.

There is a difference between expressed breast milk having a virus load when testing and the baby developing the virus. As said in earlier responses the milk may also contain factors reducing the rate of transmission.

With some viruses that are predominately spread by droplet it can be difficult to determine if the baby acquired the virus by routes other than the milk - e.g. mother coughing, sneezing, poor hand hygiene etc. or if the virus was initially in the milk or transferred during milk expression or feeding.

Studies on human milk generally show associations as ethically babies are not randomised to receive or not receive human milk.

The number 1 source of CMV in the NICU now is from the baby's mother's milk. Of note, milk from HMBANA milk banks in North America is pasteurized and has never been found to pass along any pathogen, viral or otherwise. Also note that testing can find viral DNA or RNA in milk but that does NOT mean that the milk can transmit the virus. Hep B does not seem to be transmitted orally, and non-functioning viral particles can be found in non-infectious milk.