Abstract
BACKGROUND: Pertussis infection can be severe in unvaccinated infants. A case-control study was conducted to investigate the potential role of breastfeeding in protecting young, unvaccinated infants from pertussis.
METHODS: Hospitalized infants <6 months of age with positive real time polymerase chain reaction for pertussis on nasopharyngeal aspirate were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound screening. Vaccinated infants were excluded. Sociodemographic, clinical and feeding information were collected. The effect of breastfeeding on pertussis was investigated through multivariable analysis. Breast milk and blood samples were obtained from mothers of patients. IgA and bacterial binding against Bordetella pertussis and other bacteria were tested in breast milk. IgG against pertussis toxin (PT) was tested in serum.
RESULTS: We enrolled 296 patients (61 cases and 235 controls). Exclusive breastfeeding was not associated with pertussis compared with partial breastfeeding/artificial feeding [odds ratio: 1.2; 95% confidence interval (CI): 0.31-4.67]. Children with siblings were at higher risk for pertussis (odds ratio: 2.5; 95% CI: 1.21-5.35). IgA against pertussis antigens were not higher in cases (IgA anti-PT median = 0.24 optical density) compared with controls (IgA anti-PT median = 0.21 optical density). Though bacterial binding to B. pertussis, measured in breast milk, was higher in cases (median = 4.35%) compared with controls (median = 2.8%; P = 0.004), bacterial binding to B. pertussis was low compared with other pathogens. IgG titers were higher in mothers of cases, but no correlation was found between serum IgG and breast milk IgA.
CONCLUSION: Breastfeeding remains a mainstay of prevention for numerous diseases, though it does not seem to play a role against pertussis. Alternative strategies to protect unvaccinated infants from pertussis should be considered.
| Original language | English |
|---|---|
| Pages (from-to) | e48-e53 |
| Journal | The Pediatric infectious disease journal |
| Volume | 36 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2017 |
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Keywords
- Antibodies, Bacterial/analysis
- Breast Feeding/statistics & numerical data
- Case-Control Studies
- Female
- Humans
- Immunoglobulin A/analysis
- Immunoglobulin G/analysis
- Infant
- Infant, Newborn
- Italy
- Male
- Milk, Human/immunology
- Whooping Cough/epidemiology
Cite this
Does Breastfeeding Protect Young Infants From Pertussis? Case-control Study and Immunologic Evaluation. / Pertussis Study Group.
In: The Pediatric infectious disease journal, Vol. 36, No. 3, 03.2017, p. e48-e53.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Does Breastfeeding Protect Young Infants From Pertussis?
T2 - Case-control Study and Immunologic Evaluation
AU - Pertussis Study Group
AU - Pandolfi, Elisabetta
AU - Gesualdo, Francesco
AU - Carloni, Emanuela
AU - Villani, Alberto
AU - Midulla, Fabio
AU - Carsetti, Rita
AU - Stefanelli, Paola
AU - Fedele, Giorgio
AU - Tozzi, Alberto Eugenio
PY - 2017/3
Y1 - 2017/3
N2 - BACKGROUND: Pertussis infection can be severe in unvaccinated infants. A case-control study was conducted to investigate the potential role of breastfeeding in protecting young, unvaccinated infants from pertussis.METHODS: Hospitalized infants <6 months of age with positive real time polymerase chain reaction for pertussis on nasopharyngeal aspirate were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound screening. Vaccinated infants were excluded. Sociodemographic, clinical and feeding information were collected. The effect of breastfeeding on pertussis was investigated through multivariable analysis. Breast milk and blood samples were obtained from mothers of patients. IgA and bacterial binding against Bordetella pertussis and other bacteria were tested in breast milk. IgG against pertussis toxin (PT) was tested in serum.RESULTS: We enrolled 296 patients (61 cases and 235 controls). Exclusive breastfeeding was not associated with pertussis compared with partial breastfeeding/artificial feeding [odds ratio: 1.2; 95% confidence interval (CI): 0.31-4.67]. Children with siblings were at higher risk for pertussis (odds ratio: 2.5; 95% CI: 1.21-5.35). IgA against pertussis antigens were not higher in cases (IgA anti-PT median = 0.24 optical density) compared with controls (IgA anti-PT median = 0.21 optical density). Though bacterial binding to B. pertussis, measured in breast milk, was higher in cases (median = 4.35%) compared with controls (median = 2.8%; P = 0.004), bacterial binding to B. pertussis was low compared with other pathogens. IgG titers were higher in mothers of cases, but no correlation was found between serum IgG and breast milk IgA.CONCLUSION: Breastfeeding remains a mainstay of prevention for numerous diseases, though it does not seem to play a role against pertussis. Alternative strategies to protect unvaccinated infants from pertussis should be considered.
AB - BACKGROUND: Pertussis infection can be severe in unvaccinated infants. A case-control study was conducted to investigate the potential role of breastfeeding in protecting young, unvaccinated infants from pertussis.METHODS: Hospitalized infants <6 months of age with positive real time polymerase chain reaction for pertussis on nasopharyngeal aspirate were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound screening. Vaccinated infants were excluded. Sociodemographic, clinical and feeding information were collected. The effect of breastfeeding on pertussis was investigated through multivariable analysis. Breast milk and blood samples were obtained from mothers of patients. IgA and bacterial binding against Bordetella pertussis and other bacteria were tested in breast milk. IgG against pertussis toxin (PT) was tested in serum.RESULTS: We enrolled 296 patients (61 cases and 235 controls). Exclusive breastfeeding was not associated with pertussis compared with partial breastfeeding/artificial feeding [odds ratio: 1.2; 95% confidence interval (CI): 0.31-4.67]. Children with siblings were at higher risk for pertussis (odds ratio: 2.5; 95% CI: 1.21-5.35). IgA against pertussis antigens were not higher in cases (IgA anti-PT median = 0.24 optical density) compared with controls (IgA anti-PT median = 0.21 optical density). Though bacterial binding to B. pertussis, measured in breast milk, was higher in cases (median = 4.35%) compared with controls (median = 2.8%; P = 0.004), bacterial binding to B. pertussis was low compared with other pathogens. IgG titers were higher in mothers of cases, but no correlation was found between serum IgG and breast milk IgA.CONCLUSION: Breastfeeding remains a mainstay of prevention for numerous diseases, though it does not seem to play a role against pertussis. Alternative strategies to protect unvaccinated infants from pertussis should be considered.
KW - Antibodies, Bacterial/analysis
KW - Breast Feeding/statistics & numerical data
KW - Case-Control Studies
KW - Female
KW - Humans
KW - Immunoglobulin A/analysis
KW - Immunoglobulin G/analysis
KW - Infant
KW - Infant, Newborn
KW - Italy
KW - Male
KW - Milk, Human/immunology
KW - Whooping Cough/epidemiology
U2 - 10.1097/INF.0000000000001418
DO - 10.1097/INF.0000000000001418
M3 - Article
C2 - 27870812
VL - 36
SP - e48-e53
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 3
ER -