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This framework is based on five criteria: viral infection in children receiving breast milk from infected mothers; the presence of virus, viral antigen, or viral genome in the breast milk of infected mothers; the evidence for the virus in breast milk being infectious; the attempts to rule out other transmission modalities; and the reproduction of viral transmission by oral inoculation in an animal model. We searched for evidence in published reports to determine whether the 5 criteria are fulfilled for 16 human viruses that are suspected to be transmissible by breast milk. We considered breast milk transmission is proven if all 5 criteria are fulfilled, as probable if 4 of the 5 criteria are met, as possible if 3 of the 5 criteria are fulfilled, and as unlikely if less than 3 criteria are met. Only five viruses have proven transmission through breast milk: human T\u2010cell lymphotropic virus 1, human immunodeficiency virus, human cytomegalovirus, dengue virus, and Zika virus. The other 11 viruses fulfilled some but not all criteria and were categorized accordingly.<\/jats:p>\n                  <jats:p>Our framework analysis is useful for guiding public health recommendations and for identifying knowledge gaps amenable to original experiments.<\/jats:p>","DOI":"10.1111\/pai.13473","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T19:36:10Z","timestamp":1613590570000},"page":"835-842","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Revisiting Koch's postulate to determine the plausibility of viral transmission by human milk"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3912-0427","authenticated-orcid":false,"given":"Philippe","family":"Van de Perre","sequence":"first","affiliation":[{"name":"Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM Etablissement Fran\u00e7ais du Sang Antilles University Montpellier France"},{"name":"CHU Montpellier Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-6350","authenticated-orcid":false,"given":"Jean\u2010Pierre","family":"Mol\u00e8s","sequence":"additional","affiliation":[{"name":"Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM Etablissement Fran\u00e7ais du Sang Antilles University Montpellier France"},{"name":"CHU Montpellier Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Nagot","sequence":"additional","affiliation":[{"name":"Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM Etablissement Fran\u00e7ais du Sang Antilles University Montpellier France"},{"name":"CHU Montpellier Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Tuaillon","sequence":"additional","affiliation":[{"name":"Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM Etablissement Fran\u00e7ais du Sang Antilles University Montpellier France"},{"name":"CHU Montpellier Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre\u2010Emmanuel","family":"Ceccaldi","sequence":"additional","affiliation":[{"name":"Unit\u00e9 Epid\u00e9miologie et Physiopathologie des Virus Oncog\u00e8nes CNRS UMR 3569 Institut Pasteur Universit\u00e9 de Paris Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameena","family":"Goga","sequence":"additional","affiliation":[{"name":"HIV Prevention Research Unit South African Medical Research Council Cape Town South Africa"},{"name":"Department of Paediatrics and Child Health University of Pretoria Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Prendergast","sequence":"additional","affiliation":[{"name":"Blizard Institute Queen Mary University of London UK"},{"name":"Zvitambo Institute for Maternal and Child Health Research Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Rollins","sequence":"additional","affiliation":[{"name":"Department of Maternal, Newborn, Child and Adolescent Health and Ageing World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)00040-1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-2251-8_9"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(19)30024-0"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3003327"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1091\/mbc.E05-03-0192"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/v8020040"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pai.12841"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16362"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31181-8"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15495"},{"key":"e_1_2_10_12_1","first-page":"277","article-title":"Untersuchungen \u00fcber Bakterien: V. 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