International Journal of Epidemiology, Vol 26, 443-450, Copyright © 1997 by International Epidemiological Association
SA Silfverdal, L Bodin, S Hugosson, O Garpenholt, B Werner, E Esbjorner, B Lindquist and P Olcen
BACKGROUND: In Orebro County a 2.5-fold increase in the incidence of
Haemophilus influenzae (HI) meningitis was found between 1970 and 1980, an
observation that initiated the present study. MATERIALS AND METHODS: In
order to search for associations between morbidity in invasive HI infection
and possible risk factors, a case-control study was conducted over a 6-year
period from 1987 to 1992, before general Hib vaccination was introduced in
Sweden. Fifty-four cases with invasive HI infection 139 matched controls
were studied for possible risk factors such as day- care outside the home,
short duration of breastfeeding, passive smoking, low socioeconomic level
of the household, many siblings in the family, allergy, frequent,
infections, repeated antibiotic treatments and immunoglobulin deficiency.
RESULTS: Multivariate analysis showed a significant association between
invasive HI infection and two independent factors, i.e. short duration
(< 13 weeks) of exclusive breastfeeding, odds ratio (OR) 3.79 (95%
confidence interval [CI] 1.6- 8.8) and history of frequent infections, OR
4.49 (95% CI : 1.0-21.0). For the age at onset 12 months or older, the
associations were stronger, OR 7.79 (95% CI : 2.4-26.6) and 5.86 (95% CI :
1.1-30.6), respectively. When breastfeeding duration in weeks was analysed
as a continuous variable the OR was 0.95 (95% CI : 0.92-0.99), indicating a
decreased risk with each additional week. Increased OR were observed for
other risk factors as well but not of the magnitude found for short
duration of breastfeeding. DISCUSSION: The association of decreased risk
for invasive HI infection and long duration of breastfeeding was persisting
beyond the period of breastfeeding itself. This finding supports the
hypothesis of a long-lasting protective effect of breastfeeding on the risk
for invasive HI infection. CONCLUSION: A decreased risk for invasive HI
infection with long duration of breastfeeding was found. Our results do
have implications for strategies in breastfeeding promotion, especially in
countries where Hib vaccination is too costly and not yet implemented.
ARTICLES
Protective effect of breastfeeding on invasive Haemophilus influenzae infection: a case-control study in Swedish preschool children
Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
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