Does Breastfeeding Protect Young Infants From Pertussis? Case-control Study and Immunologic Evaluation

Pertussis Study Group

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)e48-e53
JournalThe Pediatric infectious disease journal
Volume36
Issue number3
DOIs
Publication statusPublished - Mar 2017

Fingerprint

Whooping Cough
Breast Feeding
Case-Control Studies
Human Milk
Bordetella pertussis
Pertussis Toxin
Immunoglobulin A
Immunoglobulin G
Odds Ratio
Mothers
Confidence Intervals
Nutritional Support
Serum
Siblings
Real-Time Polymerase Chain Reaction
Bacteria
Antigens

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 journalArticle

@article{c27df92a256447bcae7d57173bf6ac79,
title = "Does Breastfeeding Protect Young Infants From Pertussis?: Case-control Study and Immunologic Evaluation",
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.",
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",
author = "{Pertussis Study Group} and Elisabetta Pandolfi and Francesco Gesualdo and Emanuela Carloni and Alberto Villani and Fabio Midulla and Rita Carsetti and Paola Stefanelli and Giorgio Fedele and Tozzi, {Alberto Eugenio}",
year = "2017",
month = "3",
doi = "10.1097/INF.0000000000001418",
language = "English",
volume = "36",
pages = "e48--e53",
journal = "Pediatric Infectious Disease Journal",
issn = "0891-3668",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

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 -