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Breastfeeding and Vertical Exposure to Zika Virus: A Literature Review

Review Article | Open Access Volume 2 | Issue 2 |

  • 1. Department of Speech-Language Pathologist, Instituto Nacional de Saúde da Mulher, Brazil
  • 2. Department of Biomedical engineering, Instituto Nacional de Saúde da Mulher, Brazil
  • 3. Department of Child and Adolescent Health, Instituto Nacional de Saúde da Mulher, Brazil
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Corresponding Authors
Marinatti T, Department of Speech- Language, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Oswaldo Cruz Foundation, FIOCRUZ, Av. Rui Barbosa - Flamengo, Rio de Janeiro - RJ, 20021-140, Brazil, Tel : 552102-5541739;
Abstract

The Zika virus has been affecting a large part of the Brazilian population since 2014, and its pathology has raised questions on the transmission route, symptoms ,prevention, and treatment, as well as on neurological changes, which were previously not associated with the disease. To clear doubts on the transmission of the virus during breastfeeding, this study aimed to review and analyze studies, published from January 2014 to April 2017, regarding the relationship between breastfeeding and Zika virus exposure and focusing on the importance of breastfeeding. A search was performed in main databases, resulting in 85 articles, of which 38 were selected based on search criteria. All articles reported on the presence of Zika virus RNA in human milk. Among them, 34.21% had no stance on breastfeeding, 28.94% supported it, 18.42% did not recommend it, while 18.42% explained the need for further studies on the subject. The World Health Organization recommends breastfeeding for all mothers infected with Zika virus because the benefits of breastfeeding outweigh the risks of disease transmission, and there is no scientifically proven case of transmission through this route.

Keywords

Breastfeeding, Nursing, Newborn, Infant

Citation

Marinatti T, Bartha M, Gomes Junior SC, Lopes Moreira ME (2017) Breastfeeding and Vertical Exposure to Zika Virus: A Literature Review. JSM Women’s Health 2(2): 1007.

ABBREVIATIONS

ZIKAV: Zika virus; PCR: polymerase chain reaction; WHO: World Health Organization

INTRODUCTION

In November 2014 and early 2015, the Zika virus (ZIKAV), a new virus transmitted by the Aedes aegypti mosquito, started to spread in Brazil. The manifestations were similar to those of dengue fever, with low fever, itching exanthema in the body, and conjunctivitis. Other symptoms included myalgia and mild joint pain [1,2]. A higher prevalence of microcephaly cases and central nervous system abnormalities was observed, associating cases of neurological changes with the virus [3,4].\

ZIKAV originated from Asia and Africa and spread throughout French Polynesia in 2013, with some cases in Chile [5]. In May 2015, 1.5 million people were affected by ZIKAV in the northeastern region of Brazil. The virus spread throughout South America, Central America, and the Caribbean, alarming the Pan American Health Organization. More than 4,500 microcephaly cases were confirmed in February 2016, and a worldwide epidemic of ZIKAV was announced, with confirmed cases in Europe [6]. The idea of correlating ZIKAV with microcephaly began as a result of a surge in the number of infected cases and newborns with reduced cephalic perimeter with no apparent cause, which initiated research and notification

The viral transmission can either be vectored or non-vectored. The vectored route occurs through the bite of Aedes aegypti or other mosquitoes of the same species, which reproduce in clean standing water in unsealed water tanks, plant dishes, and tires, among other places [7]. The non-vectored form occurs without direct contact with the agent, such as sexual transmission through semen [7-9] and perinatal transmission, or transmission of the virus from the mother to the newborn during childbirth [4,10,11]. Blood transfusion is also a form of transmission [7,12]; asymptomatic blood donors with ZIKAV were detected, with 80% not showing clinical alterations [13]. Transplacental transmission can also occur through a pregnant woman affected by ZIKAV, transmitting the virus to the fetus through the placenta at any time during pregnancy [14].

Diagnosis is through polymerase chain reaction (PCR) and virus segregation in blood samples. The PCR technique allows to accurately identify the causative agent’s DNA in the patient’s blood samples. It operates by amplifying a specific fragment of the DNA molecule thousands of times in just a few hours [5,13]. 

The ZIKAV epidemic has raised questions about the transmission, prevention, and consequences of the disease, including some questions about breastfeeding and reproduction planning. Due to the extent and diversity of the cases, infected infants need to undergo an interdisciplinary follow-up by neurologists, pediatricians, speech therapists, physiotherapists, occupational therapists, psychologists, and social workers, to address different issues. Moreover, early evaluation and stimulation of neuropsychomotor function are essential to provide a better prognosis [5,15].

Considering the increased incidence of ZIKAV in Brazil and the association of swallowing disorders in newborns with congenital ZIKAV syndrome, a speech pathologist is necessary to evaluate the baby’s feeding problems and stomatognathic functions, stimulate these functions, and design an appropriate intervention plan for each case, following the recommendation of the World Health Organization (WHO) [16], which is exclusive breastfeeding in the first 6 months of life for the overall development of the newborn and food security.

Considering the controversy surrounding the pathology of ZIKAV with unknown means of transmission, this literature review was conducted to build knowledge for action, allowing a stance on breastfeeding in ZIKAV cases and providing basis for both professional recommendations and performance of the mother regarding breastfeeding.

METHODOLOGY

This literature review aimed to group knowledge about breastfeeding and ZIKAV exposure in articles published between January 2014 and April 2017. The following combined keywords in English, Portuguese, and Spanish were used to identify articles on the topic in the Medline, SciELO, Bireme, Cochrane, and Embase databases: fonoaudiologia “Zika e amamentação”, “Zika e aleitamento materno”, “Zika e alimentação”, “Zika and breastfeeding”, “Zika and feeding”, “Zika y lactancia materna”, and “Zika y alimentacion”.

We found 85 studies published in English and Portuguese in Medline, Bireme, and Embase, as shown in Figure 1. No studies were found in SciELO and Cochrane. Furthermore, no studies on ZIKAV related to speech therapy were found in any of these scientific databases. Among the 85 articles, the following were excluded: duplicate articles (13), nonscientific publications (9), articles not related to the subject (20), and unavailable articles (5). Thus, 47 articles were excluded, and the remaining 38 articles that addressed the subject of ZIKAV and breastfeeding were selected (Figure 1).

Exclusion and selection criteria.

Figure (1): Exclusion and selection criteria.

We established a guiding question, “What is the stance of the existing literature on breastfeeding in cases of ZIKAV exposure?” After article selection, we observed and analyzed the 38 articles, and classified the approach of each study based on the guiding question, as follows: has no stance on breastfeeding, is in favor, is against, and explains the need for further studies on the subject.

RESULTS

Among the analyzed studies are shown in Table 1, 34.21% [5,10,14,17-26] investigated the presence of ZIKAV RNA in breast milk but had no stance on breastfeeding or lactation.

However, 28.94% [16,27-36] were in favor of breastfeeding and explained that despite the presence of ZIKAV in human milk, there is no scientific evidence of infants being infected through breastfeeding. Meanwhile, 18.42% [6,37-42] affirmed the possibility of contamination and were against breastfeeding, whereas 18.42% [43-49] explained the importance of further studies in this area (Figure 2).

Evidences found in articles selected.

Figure 2: Evidences found in articles selected.

DISCUSSION

In this literature review, a large proportion of the articles reported that breastfeeding is essential in all nations and should be treated as a public policy based on the benefits it brings in the short, medium, and long term, being advantageous to both the baby and the mother [16,27,36,50,51].

The WHO guidelines on breastfeeding reinforce that even in cases of suspected or confirmed ZIKAV infection, breastfeeding should be supported and encouraged. Exclusive breastfeeding is recommended from 1 hour after childbirth up to 6 months of age, to be continued with complementary foods up to 2 years of age or more [16,17,36]. Mothers and infants may need help in the breastfeeding process, and newborns with congenital ZIKAV syndrome may have swallowing disorders, requiring speech therapy to start and continue breastfeeding.

One study analyzed the milk of a mother with confirmed ZIKAV infection [18] and showed virus replication in breast milk. However, the newborn was not infected even though it was breastfed. Due to this study, some authors [6,37-42] supposed that breastfeeding may be a transmission vector, knowing that some diseases caused by flaviviruses of the same family with ZIKAV, such as dengue fever and other diseases, can be transmitted through breastfeeding [46]. However, until recently, there is no scientific evidence of this transmission route for ZIKAV.

This research shows that 28.94% of the studies analyzed [16,28-37] agreed with the recommendation of exclusive breastfeeding. Although ZIKAV RNA was detected in human milk, there was no virus replication in the culture, and the virus did not infect infants [9]. Nevertheless, this remains a controversial subject.

Breastfeeding helps in cognitive, affective, and social development, besides being a species/specific food, that is, “a living substance of great complexity, with specific composition for human species, containing fats, proteins, vitamins, water, sugar, enzymes, iron, antibodies and iron in exact proportions for the nutritional needs of the human baby” [52], which is easily digested and absorbed. Breastfeeding also contributes to the reduction of infant mortality and has prevented 823,000 deaths annually from children under 5 years of age by increasing their immunity and preventing diseases such as diarrhea and respiratory problems, otitis, and malocclusions [50,51] Breastfeeding is also an economic policy that is sustainable, since it does not generate expenses or pollute the environment. It is renewable, natural, and free [50,51]. Current evidence suggests that the benefits of breastfeeding outweigh the risks of ZIKAV transmission through breast milk.

During breastfeeding, mothers and babies require assistance, as they commonly have difficulties establishing this practice [53]. Speech therapists have the competence to accompany the mother and baby in their feeding mishaps, evaluate their stomatognathic functions, encourage them, and tailor the intervention plan for each case [54]. Because of these findings, we searched the databases for any correlation between the work of speech therapists, breastfeeding, and ZIKAV infection; however, the search showed no studies focused on this correlation. Although this area is a “recent” subject, the search result encourages further research.

In Brazil, the region most affected by ZIKAV has been the southeast, followed by the northeast, midwest, south, and north [55]. The recommended/performed approaches throughout Brazil encourage breastfeeding, multidisciplinary follow-up, and early neuropsychomotor stimulation. The innovations in this pathology has promoted the search for new knowledge and approaches.

The institution of a ZIKAV epidemic protocol became a crucial step to foster research funding and enable clarification on the infection, forms of transmission, and whether breastfeeding is a possible transmission vector, providing information for the population of pregnant women and newborns with congenital ZIKAV syndrome.

Table 1: Summary of the results of studies related to breastfeeding and Zika Virus.
Authors/ Year of Results
Publication  
Chan JF, Choi GK, Yip CC, Cheng VC, Yuen KY5 /2016 ZIKAV particles were detected in breast milk, but virus replication was not detected
Besnard M, Lastère S, Teissier A, CaoLormeau VM, Musso D10/2016 Collected breast milk from two infected and active mothers, and tested resulting in the presence of virus RNA. However, there was no replication of ZIKAV
Possas C14/2016 There is no research confirming the transmission of ZIKAV by breastfeeding
Russell K, Oliver SE, Lewis L, Barfield WD, Cragan J, Meaney-Delman D, et al.17/2016 Although the Zika virus has been found in breast milk, there are no cases associating breastfeeding with ZIKAV infection
Dupont-Rouzeyrol M, Biron A, O’Connor O, Huguon E, Descloux E18/2016 Tested samples of mother's milk from infected and active mother of ZIKAV and was found infectious particles of the virus. However the child was not infected.
Ghebreyesus A, Hungary MS19/2016 Detected ZIKAV in human milk, and consider a possible transmission vetor. But there is no publication about infection per breastfeeding
Hennessey M, Fischer M, Staples JE20/2016 Zika virus RNA was detected in breast milk, but there is no evidence of the relationship between infection and breastfeeding
Sampathkumar P, Sanchez LJ21/2016 The virus was detected in breast milk but was not associated with a form of transmission
Malone RW, Homan J, Callahan MV, GlasspoolMalone J, Damodaran L, Schneider Ade B, et al22/2016 Zika virus sequences were identified in breast milk by polymerase chain reaction (PCR), but reports did not indicate microcephaly as a complication
Boeuf P, Drummer HE, Richards JS, Scoullar MJL, Beeson JG23/2016 Was detected RNA do ZIKAV, in breast milk,urine, saliva and semen.
Klase ZA, Khakhina S, Schneider Ade B, Callahan MV, Glasspool-Malone J, Malone R24/2016 ZIKV RNA can be detected in breast milk, urine, semen, and sputum from infected individuals, replication-competent virions have been most readily cultured from semen samples.
Blázquez AB, Saiz JC25/2016 For the nursing mothers, it is re commended that ZIKAV be detected in breast milk, even if there are no proven cases of transmission by this route.
Fleming-Dutra KE, Nelson JM, Fischer M, Staples JE, Karwowski MP, Mead P, et al26/2016 Detected RNA of ZIKAV in breast milk, but wasn’t proven replication or infection during breastfeeding
Organização Mundial da Saúde16/2016 Breastfeeding on demand, and support to this process so many in cases of mothers infected with ZIKAV, as in cases of babies with congenital abnormalities
Drabkin A.27/2016 There are no documents that correlate the transmission of ZIKAV to breastfeeding. Supports breastfeeding.
Maestre AM, Caplivski D, Fernandez-Sesma A28/2016 Although ZIKAV has been found in breast milk, there is no evidence to support this relationship of transmission through breastfeeding. Breastfeeding is recommended.
Duff E29/2016 There is no study that relates the transmission of Zika Virus to breastfeeding and because of its importance for the development of the baby, it is recommended to encourage this practice
Lockwood CJ30 /2016 The study says that breastfeeding is recommended because of the gains offered, although RNA of the virus has already been found in milk.
Falcao MB, Cimerman S, Luz KG, Chebabo A, Brigido HA, Lobo IM, et al31/2016 There is presence of ZIKAV RNA, however there is no case that confirms this form of transmission and the guidelines recommend breastfeeding
Lazear HM, Diamond MS32/2016 ZIKAV RNA was found in breast milk, and this route of transmission was documented in other flaviviruses. Nursing mothers can transmit the virus through this practice. But it is not yet known if it is infectious. Infected mothers are encouraged to breastfeed their children.
Pfaender S, Vielle NJ, Ebert N, Steinmann E, Alves MP, Thiel V33 /2017 WHO has published a guideline summarizing the current evidence regarding the risk of ZIKV transmission via breastfeeding in which mothers with suspected, probable or confirmed ZIKV infection are encouraged to breastfeed their children, as the beneficial effects of breastfeeding preponderate any potential risk of ZIKV transmission via breast milk. And The Zika virus becomes inactive in breast milk at a given time. And pasteurization helps prevent
Sharma A, Lal SK34/2017 ZIKAV RNA was detected in human milk in the French Polynesia epidemic, and more recently the presence of infectious ZIKAV particles in the milk was found. However, there is no evidence of transmission of the virus through breastfeeding. For this reason WHO recommends breastfeeding, as the benefits outweigh the risks
Hajra A, Bandyopadhyay D, Hajra SK35/2016 There is no restriction on breastfeeding to prevent transmission of the virus. Even though ZIKAV RNA was found isolated in human milk.
Organização Mundial da Saúde36/2016 Recommendation for newborns of infected or suspected ZIKAV mothers to perform breastfeeding
Wahid B, Ali A, Rafique S, Idrees M6 / 2016 It considers breastfeeding a possible route of transmission
Jamali MSR, Bayrami S, Jamali MS, Golrokhi R, Golsoorat PF, Seyed AS37/2016 It states that breastfeeding is also a way of acquiring the disease.
Patterson J, Sammon M, Garg M.38/2016 Transmission through breastfeeding was published during the French Polynesia epidemic.
Mishra B, Behera B39/2016 Breast milk has been reported as non vector transmission route during the outbreak in French Polynesia
Saiz JC, VázquezCalvo Á, Blázquez AB, Merino-Ramos T, Escribano-Romero E, Martín-Acebes MA40/40 Ibrahim NK41/2016 High ZIKV RNA load was detected in breast milk samples from both mothers, the virus could not be multiplied in susceptible cell cultures. Transmission by breastfeeding must be considered. The transmission of ZIKAV can occur through breastfeeding
Passi D, Sharma S, Dutta SR, Ahmed M42 /2017 Transmission through breastfeeding can not be excluded, although it is rare, ZIKV RNA has been reported in samples of breast Milk
Wooton AK43/2016 Questions about the possibility of breast milk being a vector of transmission
Cavalcanti MG, Cabral-Castro MJ, Gonçalves JL, Santana LS, Pimenta ES, Peralta JM 44 /2017 Transmission through breastfeeding is questionable since the presence of ZIKAV RNA in the isolation culture has been found and the results suggest that transmission through breastfeeding may be less efficient than other body fluids.
Plourde AR, Bloch EM45 /2016 The identification of the presence of ZIKAV RNA in various types of body fluids, like breast milk raises questions about transmission, but there are still no depth studies in these cases
Wang JN, Ling F46 /2016 Viral particles of ZIKAV were found in the breast milk, but virus replication was not detected, making this route uncertain but plausible. Other Flaviviruses like DENV and WNV have the transmission vector of breastfeeding. Further research is needed in this field.
German Advisory Committee Blood (Arbeitskreis Blut)47/2016 The possibility of transmission via breastfeeding should be done further res
Waddell LA, Greig JD 48 /2016 The identification of ZIKAVRNA in various types of body fluids raises questions about human vertical transmission via saliva, semen and human milk
Marrs C, Olson G, Saade G, Hankins G, Wen T, Patel J, et al 49/2016 While there is no evidence of vertical transmission. CDC discusses the benefits of BTF outweigh the risk of transmission. Studies on the infectiousness of breast milk and sequela of neonatal infection are urgently needed.

 

FINAL CONSIDERATIONS

ZIKAV is detected in breast milk, but breast milk has not been considered a transmission vector due to the lack of virus replication studies that prove this relationship. The guidelines for mothers with suspected or confirmed ZIKAV infection and for newborns with congenital ZIKAV syndrome have been as follows: breastfeeding, early stimulation of neuropsychomotor development, and follow-up with a speech therapist and a multidisciplinary team [56].

Due to the lack of research addressing speech pathology in the follow-up of these cases, we suggest that research be conducted on this approach, building theoretical knowledge produced by clinical practice and considering the generation of microcephaly cases that may occur due to the ZIKAV epidemic in recent years.

Further studies are needed to clarify whether breastfeeding is a possible transmission vector. The virus’ RNA has already been identified in breast milk, but there is no proven case of this route of infection. Moreover, we suggest long-term research to clarify the dynamic process of breastfeeding and to better understand questions regarding the duration of RNA presence in human milk, viral load, and long-term follow-up for breastfed babies.

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Marinatti T, Bartha M, Gomes Junior SC, Lopes Moreira ME (2017) Breastfeeding and Vertical Exposure to Zika Virus: A Literature Review. JSM Women’s Health 2(2): 1007.

Received : 17 Aug 2017
Accepted : 18 Oct 2017
Published : 21 Oct 2017
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JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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