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FW: [pronut-hiv] Flash heat inactivation of HIV-1 in human milk: details of this method

  • From: "Kiersten Israel-Ballard" <>
  • Date: Thu, 21 Jun 2007 16:24:10 -0700


Thank you for contacting me about the recent JAIDS publication. Here are
some clarifications -

The Flash-heat method involves manually expressing 50mL of breastmilk into
an uncovered glass peanut butter jar, which is then placed in 450mL of water
in an aluminum pan. The water and milk are then heated together over a high
flame until the water first reaches a rolling boil. We have found that many
mothers are used to this way of heating since using a water bath is how they
commonly heat their cow's milk. The concept of heating but not destroying
the protective elements in the milk is not a new one, even to mothers in
rural Africa. The breastmilk is immediately removed from the water, covered,
and allowed to cool and then cup or spoon-fed to the infant. Field
observations using local stoves, utensils, pans, and jars and varying water
and milk volumes in South Africa, Kenya and Tanzania have shown that this
protocol can be adapted as long the water is approximately two finger-widths
above the level of the milk. Flash-heat is a quick method, typically
reaching temperatures above 56.0°C for over 6 minutes and peaking around
73°C. This is similar to the high temperature, short time (HTST) heat
treatment method used commercially, which heats to 72°C for 15 seconds.
Studies have shown that commercial HTST methods effectively kill bacteria
and cytomegalovirus and has limited impact on vitamins, lactoferrin, total
IgA concentrations and secretory IgA activity and thus is viewed as the
preferable heating technique for human milk. (There is a short video at this
link if that would be helpful...

One of the heating mechanisms we had hoped to pursue was solar heating. I
have met with a microfinance group of women near Lake Victoria in Kenya who
are making simple "Cook-Its" (Solar Cookers Int'l) for pasteurizing cow's
milk and water and even for cooking meals. This was the same solar cooker we
had used in our only experiment using solar heat - unfortunately the weather
did not cooperate and our methodology was compromised. We have since had to
focus all of our energy into the Flash-heat methodology and determining its
safety. Hopefully we can expand our focus to include solar heat again in the
near future - certainly in areas where sunny days dominate this is an option
to explore as it saves resources, etc.

It's important to clarify that heat treatment of breast milk has been a WHO
recommended infant feeding option for years. Our acceptability data tells us
that some mothers (not all) would try this method, if indeed there was a
practical method that they could realistically use. Actually it was mothers
in Zimbabwe who initially inspired this work when they asked what they could
do to their breast milk to make it safe.

There is much recent data that show the risks associated with the transition
from exclusive breastfeeding (EBF) to complementary/replacement feeds.
Inadequate feeding practices due to lack of appropriate replacement feeds
often result in malnutrition and growth faltering. Additionally, an increase
in breast milk viral load or mixed feeds may increase the risk of
transmission. It seems that heat-treated breast milk could have a special
niche here - it could be used during these high-risk times and could be
viewed as a replacement food; it is HIV-free, nutritious, affordable and
available. Milk production would be well established after months of EBF,
and other complementary foods would then be an additional source of infant
nutrition. If a mother fed heat-treated breast milk to her infant several
times each day while introducing complementary foods it could significantly
impact the infant?s nutritional intake as well as provide immune protection
unique to breast milk, thus lowering risk of morbidity from non-HIV
diseases. While some mothers may provide heated milk only for weeks and
others for months, the contribution to the infant?s health outcomes during
this transition phase could still be substantial.

Given heat treatment is a WHO recommendation, we know there are areas where
mothers are attempting to heat-treat their milk. Regardless, more research
is needed to understand what mothers need to successfully and safely do so.
There are several feasibility studies currently being planned so hopefully
we'll have answers soon!

Please let me know if you have any other questions. Thank you -

Kiersten Israel-Ballard, MPH
Doctorate of Public Health Candidate
Scientific Coordinator - HIV and Breast Milk Study
School of Public Health
140 Warren Hall
University of California, Berkeley CA 94720
510.381.6335(office) 510.849.4832(fax)

"It is better to light a candle than to complain about the darkness?"


From: Ruth Hope []
Sent: Wednesday, June 13, 2007 11:01 PM
Subject: RE: [pronut-hiv] Flash heat inactivation of HIV-1 in human milk:
details of this method

Thanks for getting touch, Kiersten.

The PDF that you forwarded is the one that I have ? given to me by Ted
Greiner. We cannot post it on a listserv as it is traceable to the computer
it was downloaded onto by the codes on the top, and posting it on a listserv
is breaking the copyright. I shared it with Ann Burgess privately.

Safe travels back to CA

Yours, Ruth


From: Kiersten Israel-Ballard []
Sent: Thursday, June 14, 2007 1:41 AM
To: 'Ruth Hope'
Cc: 'Ann Burgess'
Subject: RE: [pronut-hiv] Flash heat inactivation of HIV-1 in human milk:
details of this method


Thank you for contacting me. I was forwarded some of the communication but
haven't had a chance to respond - I've been working in the rural area of
Kenya but will be back to CA next week and will reply to you then if that is

In the meantime, attached is the pdf of the article - can it be posted to
the site? Regardless I will respond in full. Thank you for your interest -

Kiersten Israel-Ballard, MPH
Doctorate of Public Health Candidate
Scientific Coordinator - HIV and Breast Milk Study
School of Public Health
140 Warren Hall
University of California, Berkeley CA 94720
510.381.6335(office) 510.849.4832(fax)

----- Ruth Hope wrote:

Dear Kiersten

We talked on the telephone a couple of years when I was at the Synergy
project. I was pleased to see your paper with Anna Coutsoudis in J. Acquir.
Immune Defic. Syndr.

I shared the abstract with the PMTCT forum -- a listserv concerned with
prevention of mother to child transmission of HIV and it was cross-posted to
ProNut-HIV. Now Ann Burgess is asking if the authors could describe the
process in full. Many of the ProNut audience do not have access to the
journal article. (see below)

Are you a member of the ProNut listserv? If you are might you be able to
respond to the enquiry? If not, I would be willing to post a response for

I will also send Ann, who is cc?d on this email, a copy of the full paper
but I cannot send it to the listserv as I would be infringing copyright.

On the PMTCT listserv several members were wondering what happened about
your interest in using sunlight to treat human milk ? along the lines of the
solar treatment for contaminated drinking water? Are you still pursuing
that lie of research?

Best personal wishes,

Yours, Ruth Hope
----- Ann Burgess wrote:

It would be useful if the authors of the latest article on heat treating
breastmilk could tell pronut-hiv the exact details of this method - so that
we are able to share it, when relevant, with other nutritionists/health
workers and perhaps mothers. Many of us do not have easy access to published


Flash-Heat Inactivation of HIV-1 in Human Milk: A Potential Method to
Reduce Postnatal Transmission

in Developing Countries

Kiersten Israel-Ballard, MPH, Richard Donovan, PhD, Caroline Chantry, MD,
Anna Coutsoudis, PhD, Haynes Sheppard, PhD, Lindiwe Sibeko, MSc, and Barbara
Abrams, DrPH


Ann Burgess

Nutrition Consultant