LAUSR

the expressed milk should be discarded. Criteria 1 is therefore not fully satisfied. 2. Vaccinia virus DNA and viral particle shedding have been demon-strated in the milk of infected cow, and this virus has been shown to be infectious. 8 However, similar observations in humans for any of the human orthopoxviruses are presently lacking. Criteria 2 and 3 are therefore not satisfied either. 3. No data are available that could validate criteria 4. However, a robust murine model involving non- traumatic inoculation of murine pups with contaminated milk exists that reproduces vaccinia virus trans mission by breastfeeding, confirming therefore the fifth criteria. 9 Based on the conceptual framework described above and noting that more than two criteria are undocumented, there is insufficient ev idence to infer that transmission of MPXV and/or of human orthopoxviruses takes place thought breastfeeding. More research is needed to determine possible routes and risks of mother- to- child transmission of human orthopoxviruses through breast milk and breastfeeding. However, even if the occurrence of breast milk transmission of MPX is unknown, there is a high risk of mother- to- child (or child- to-mother) transmission while breastfeeding, due to direct contact with infectious skin or mucocutaneous lesions, including face- to- face, skin- to- skin, mouth- to- mouth, or mouth- to- skin contact. These con-siderations support the current WHO recommendations on infant feeding in the context of maternal MPXV infection that include case-by- case assessment of transmission risk and, when there is active maternal MPXV infection, the possibility of isolation of the mother from the infant to prevent transmission of the virus. 10 Administration of expressed breast milk from a MPXV- infected woman to the infant may be hazardous because of the risk of contamination by mucocu taneous viral shedding during milk collection.