is associated with a reduced frequency of acute otitis media and high
serum antibody levels against NTHi and outer membrane protein vaccine
antigen candidate P6.
of Microbiology/Immunology, University of Rochester, Rochester, New
York 14627, USA.
Haemophilus influenzae (NTHi) causes acute otitis media (AOM) in
infants. Breast-feeding protects against AOM and/or nasopharyngeal
(NP) colonization; however, the mechanism of protection is
incompletely understood. Children with AOM and healthy children were
studied according to feeding status: breastfed,breast/formula fed, or
formula fed. Cumulative episodes of AOM, ELISA titers of serum IgG
antibodies to whole-cell NTHi and vaccine candidate outer membrane
protein P6, bactericidal titers of serum and NP colonization by NTHi
were assessed. A lower incidence of AOM was found in breast- versus
formula-fed children. Levels of specific serum IgG antibody to NTHi
and P6 were highest in breast-fed, intermediate in breast/formula
fed, and lowest in formula-fed infants. Serum IgG antibody to P6
correlated with bactericidal activity against NTHi. Among children
with AOM, the prevalence of NTHi in the NP was lower in breast-
versus nonbreast-fed infants. We conclude that breast-feeding shows
an association with higher levels of antibodies to NTHi and P6,
breast-feeding modulates the serum immune response to NTHi and P6.
Higher serum IgG might facilitate protection against AOM and NP
colonization in breast-fed children.
19581824 [PubMed - indexed for MEDLINE]PMCID: PMC2783794 Free PMC
World Health Organ.
and etiology of childhood pneumonia.
Centre for Global Health, University of Split Medical School, Split,
pneumonia is the leading single cause of mortality in children aged
less than 5 years.
The incidence in this age group is estimated to be 0.29 episodes per
child-year in developing and 0.05 episodes per child-year in
developed countries. This translates into about 156 million new
episodes each year worldwide, of which 151 million episodes are in
the developing world. Most cases occur in India (43 million), China
(21 million) and Pakistan (10 million), with additional high numbers
in Bangladesh, Indonesia and Nigeria (6 million each). Of all
community cases, 7-13% are severe enough to be life-threatening and
require hospitalization. Substantial
evidence revealed that the leading risk factors contributing to
pneumonia incidence are lack of exclusive breastfeeding,
undernutrition, indoor air pollution, low birth weight, crowding and
lack of measles immunization. Pneumonia is responsible for about 19%
of all deaths in children aged less than 5 years, of which more than
70% take place in sub-Saharan Africa and south-east Asia. Although
based on limited available evidence, recent studies have identified
Streptococcus pneumoniae, Haemophilus influenzae and respiratory
syncytial virus as the main pathogens associated with childhood
18545744 [PubMed - indexed for MEDLINE]PMCID: PMC2647437Free PMC
2007 Feb 9;25(8):1497-502. Epub 2006 Oct 30.
enhances the antibody response to Hib and Pneumococcal serotype 6B
and 14 after vaccination with conjugate vaccines.
of Paediatrics, Orebro University Hospital, Orebro, Sweden.
study was performed in order to investigate the relationship between
breastfeeding and the antibody response after vaccination with
conjugate vaccines against Hib and pneumococcal diseases.
was an open non-randomised multi-centre study enrolling 101 healthy
Swedish infants. PncCRM was administered concomitantly with
DTaP/IPV/Hib at 3, 5, and 12 months at separate site. Duration of
breastfeeding was calculated for days of almost exclusive as well as
of total (any form of) breastfeeding.
13 months of age 6 out of 83 children did not reach 0.2mug/ml against
serotype 6B, and five of these were breastfed less than 90 days
(Fisher's Exact test, P=0.011). Four children did not reach 1mug/ml
against Hib and all those were breastfed less than 90 days (Fisher's
Exact test, P=0.008). One month after the second dose, at 6 months of
age, children breastfed 90 days or more showed significantly higher
GMC against serotype 14 (P=0.003).
study indicates that children exclusively breastfed 90 days or more
might get a better serological protection against Hib, and the
pneumococcal serotypes 6B and 14 after vaccination, compared to
children less breastfed.
17097198 [PubMed - indexed for MEDLINE]
burden of pneumonia in children: an Asian perspective.
Hardinge Medical College, Associated K S Children's Hospital, Bangla
Sahib Lane, New Delhi, India. firstname.lastname@example.org
results in two million deaths each year among children worldwide (20%
of all child deaths), 70% of them in Africa and South-east Asia. Most
countries in Africa and Asia record 2-10 times more children with
pneumonia (7-40/100 annually) than in the USA. Apart from resource
constraints and an overburdened health system, there is lack of
uniformity in defining pneumonia. Most nations employ a WHO standard
case management protocol using age-specific cut-offs for increased
respiratory rates and chest in-drawing for a clinical definition of
pneumonia. The limited data available on the causative organisms have
identified Streptococcus pneumoniae, Haemophilus
and viruses such as respiratory syncytial virus (RSV), influenza,
para influenza and adenoviruses as the major pathogens. Measles
infection increases pneumonia morbidity and mortality. Low birth
weight, under-nutrition, hypovitaminosis A, zinc deficiency, lack
air pollution (including environmental tobacco smoke) and
risk for pneumonias in children.
Standard case management protocols used for acute respiratory
infections (ARIs) in these countries have brought down the disease
burden but an improvement in the diagnostic algorithm is needed to
appropriately recognise those with associated wheeze. Research is
needed to find effective and affordable preventive strategies.
15911453 [PubMed - indexed for MEDLINE]
of Haemophilus influenzae type b meningitis in Polish children varies
directly with number of siblings: possible implications for
Research Center of Public Health, National Institute of Hygiene,
the absence of an effective vaccine, Haemophilus influenzae type b
(Hib) meningitis has frequently been found to be the most common
bacterial meningitis among children less than or equal to 5 years of
age. This study was conducted prior to the introduction of Hib
vaccine in Poland, and is the first case-control study of Hib
meningitis in this country.
1:3 matched case-control study was nested within a population-based
surveillance study of Hib meningitis in children less than or equal
to 5 years old in Poland. Controls were matched on the case's age at
onset of disease and immunization center.
one or more siblings is a highly significant risk factor for Hib
meningitis and, under the rare disease assumption, risk increases
linearly with the increase in the number of siblings. The size of the
living area of the home was not itself a significant risk factor for
not protective in contrast to previous studies.
Childcare outside of the home was a significant risk factor for Hib
meningitis especially among children greater than 16 months of age,
whereas the effect of sibling number on Hib meningitis was much
greater among the younger children.
of Hib meningitis approximately doubles for every unit increase in
the number of siblings. Routine vaccination of Polish infants who
have two or more siblings could potentially prevent half of the Hib
14561054 [PubMed - indexed for MEDLINE]
Infect Dis J.
term enhancement of the IgG2 antibody response to Haemophilus
influenzae type b by breast-feeding.
of Pediatric, Orebro University Hospital, Orebro, Sweden.
of sera were obtained from 30 children <6 years of age with
invasive type b (Hib) infection and their mothers. Duration and mode
of breast-feeding were monitored. Titers of IgG1, IgG2, IgA and IgM
antibodies against Hib capsular polysaccharide were determined in
sera taken during the acute illness and during early and late
18 months or older with longer durations of exclusive breast-feeding
(13 weeks or more; mean, 19.3 weeks) had higher Hib antibody
concentrations of the IgG1, IgG2, IgA and IgM isotypes than those
with a shorter duration of exclusive breast-feeding (<13 weeks;
mean, 5.4 weeks). The difference was greatest for the IgG2 isotype.
In regression analyses the association between the duration of
exclusive breast-feeding and the anti-Hib IgG2 concentration was
significant when breast-feeding, type of Hib infection, maternal Hib
antibody titer and age were used as explanatory factors. In the group
of 14 children <18 months of age no significant differences were
study indicates the presence of a long lasting enhancing effect of
breast-feeding on the antibody response to Hib in children, in
particular on IgG2 Hib antibody production.
This may result from the content in the milk of IFN-gamma and
IFN-gamma-producing cells and possibly other factors, which can
support IgG2 antibody production.
12352801 [PubMed - indexed for MEDLINE]
milk and host defence: immediate and long-term effects.
of Clinical Immunology, Göteborg University, Sweden.
studies demonstrate significant protection during breastfeeding
against diarrhoea, respiratory tract infections, otitis media,
bacteraemia, bacterial meningitis, botulism, urinary tract infections
and necrotizing enterocolitis. There
is also good evidence for enhanced protection for years after the
termination of breastfeeding against Haemophilus influenzae type b
otitis media, diarrhoea, respiratory tract infections and wheezing
bronchitis. In some reports breastfeeding has also improved vaccine
responses. Several studies show that milk may actively stimulate the
immune system of the offspring via transfer of anti-idiotypic
antibodies and lymphocytes. This may explain why breastfeeding
diminishes the risk of developing coeliac disease. Some
investigations suggest that there may also be a similar effect on
allergic diseases and autoimmune diseases, as well as inflammatory
bowel diseases and certain tumours. This needs to be confirmed.
10569222 [PubMed - indexed for MEDLINE]
effect of breastfeeding: an ecologic study of Haemophilus influenzae
meningitis and breastfeeding in a Swedish population.
of Paediatrics, Orebro Medical Center Hospital, Sweden.
Orebro County, Sweden, a 2.5-fold increase in the incidence of
Haemophilus influenzae (HI) meningitis was found between 1970 and
1980. In a case-control study of possible risk factors for invasive
HI infection conducted in the same area, 1987-1992, breastfeeding was
found to be a strong protective factor.
AND METHODS: In
order to study the relation between incidence rates of HI meningitis
between 1956-1992 and breastfeeding rates in the population an
ecologic study was performed.
strong (negative) correlation between breastfeeding and incidence of
HI infection 5 to 10 years later (rho(xy) (s) approximately -0.6) was
seen, whereas no relation seems to exist for the time lag 15 years
and beyond. The correlation for contemporary data was intermediate.
There were similar results for the breastfeeding proportions at 2, 4
as well as 6 months of age.
ecologic data are consistent with results from our case-control
study. The time-lag for the delayed effect on the population level
could be estimated although sparse data make the estimates vulnerable
to sampling fluctuations. Limitations with ecologic studies are
seems to be an association between high breastfeeding rate in the
population and a reduced incidence of HI meningitis 5 to 10 years
These results do have implications on strategies for breastfeeding
promotion, especially in countries where Hib vaccination is too
costly and not yet implemented.
10195681 [PubMed - indexed for MEDLINE]Free Article
of respiratory bacterial pathogens from the throats of healthy
infants fed by different methods.
and Child Health Department, Faculty of Medicine, University of the
Ryukyus, Okinawa, Japan.
bacterial infections are caused by organisms that have already
colonized the host. Bacterial attachment to pharyngeal cells and
proliferation may be necessary to infect the lower respiratory tract
or middle ear. We investigated the incidence of pathogenic bacteria
isolated from the throat of healthy infants with different feeding
methods. The protecting role of breastmilk is also discussed. The
incidence of respiratory bacterial pathogens isolated from the
oropharynx of 113 normal infants with different feeding methods was
investigated. Group A beta haemolytic Streptococcus, Streptococcus
pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were
selected as respiratory bacterial pathogens. No respiratory bacterial
pathogens were detected in breastfed and mixed-fed infants.
Haemophilus influenzae and Moraxella catarrhalis were isolated from
the oropharynx of formula-fed infants. The incidence of respiratory
bacterial pathogens did differ among infants with different feeding
results suggest that breastmilk may inhibit the colonization by
respiratory bacterial pathogens of the throat of infants, by
enhancing mucosal immunity against respiratory tract infection.
10401200 [PubMed - indexed for MEDLINE]
Allergy Asthma Immunol.
1998 Dec;81(6):523-33; quiz 533-4, 537.
provides passive and likely long-lasting active immunity.
of Clinical Immunology, Göteborg University, Sweden.
reader of this review will learn about the mechanisms through which
breastfeeding protects against infections during and most likely
after lactation, as well as possibly against certain immunologic
diseases, including allergy.
have followed the literature in the area closely for the last 30 to
40 years and have made repeated literature searches through MEDLINE,
most recently in 1998. Textbooks and peer-reviewed journals have been
sought for, as well as books representing meeting reports in English,
French, German, and Spanish.
milk protects against infections in the breastfed offspring mainly
via the secretory IgA antibodies, but also most likely via several
other factors like the bactericidal lactoferrin. It is striking that
the defense factors of human milk function without causing
inflammation, some components are even directly anti-inflammatory.
Protection against infections has been well evidenced during
lactation against, e.g., acute and prolonged diarrhea, respiratory
tract infections, otitis media, urinary tract infection, neonatal
septicemia, and necrotizing enterocolitis. There is also interesting
evidence for an enhanced protection remaining for years after
lactation against diarrhea, respiratory tract infections, otitis
influenzae type b infections,
and wheezing illness. In several instances the protection seems to
improve with the duration of breastfeeding. Some, but not all studies
have shown better vaccine responses among breastfed than
non-breastfed infants. A few factors in milk like anti-antibodies
(anti-idiotypic antibodies) and T and B lymphocytes have in some
experimental models been able to transfer priming of the breastfed
offspring. This together with transfer of numerous cytokines and
growth factors via milk may add to an active stimulation of the
infant's immune system. Consequently, the infant might respond better
to both infections and vaccines. Such an enhanced function could also
explain why breastfeeding may protect against immunologic diseases
like coeliac disease and possibly allergy. Suggestions of protection
against autoimmune diseases and tumors have also been published, but
may, in addition to the well-known passive protection against
infections during lactation, have a unique capacity to stimulate the
immune system of the offspring possibly with several long-term
9892025 [PubMed - indexed for MEDLINE]
effect of breastfeeding on invasive Haemophilus influenzae infection:
a case-control study in Swedish preschool children.
of Pediatrics, Orebro Medical Centre Hospital, Sweden.
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.
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
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.
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.
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.
9169183 [PubMed - indexed for MEDLINE]Free Article
milk secretory IgA antibody to nontypeable Haemophilus influenzae:
possible protective effects against nasopharyngeal colonization.
of Pediatrics, School of Medicine, State University of New York at
children fed human milk were followed prospectively from birth to 12
months of age to assess the effect of milk antibody on nasopharyngeal
colonization. Human milk secretory IgA antibody to P6, a highly
conserved outer membrane protein of nontypeable Haemophilus
influenzae, was measured with the use of an enzyme-linked
immunosorbent assay. Nasopharyngeal colonization with nontypeable H.
influenzae and the occurrence of otitis media were determined.
Nasopharyngeal colonization was found in 22 children (32%), and 39
children (57%) had otitis media. Frequency of isolation of
nontypeable H. influenzae was directly related to episodes of otitis
media (r = 0.35; p = 0.001). The level of human milk anti-P6
secretory IgA antibody was inversely related to frequency of
isolation of the organism (r = -0.27; p = 0.026). The average
antibody level, expressed as nanograms per 0.1 mg total secretory
IgA, in human milk fed to children with no colonization of
nontypeable H. influenzae was significantly higher than in milk fed
to children in whom colonization occurred on multiple occasions (156
+/- 120 vs 69 +/- 50; p = 0.013). Prevention
of colonization was most evident during breast-feeding. These data
suggest that the protective effects of human milk against otitis
media may be due in part to inhibition of nasopharyngeal colonization
with nontypeable H. influenzae by specific secretory IgA antibody.
8301421 [PubMed - indexed for MEDLINE]
Infect Dis J.
prospective cohort study on breast-feeding and otitis media in
of Medical Microbiology, Lund University, Sweden.
study analyzed the effect of breast-feeding on the frequency of acute
otitis media. The protocol was designed to examine each child at 2, 6
and 10 months of age. At each visit nasopharyngeal cultures were
obtained, the feeding pattern was recorded and the acute otitis media
(AOM) episodes were documented. The analysis was based on 400
children from whom complete information was obtained. They
represented 83% of the newborns in the study areas. By 1 year of age
85 (21%) children had experienced 111 AOM episodes; 63 (16%) had 1
and 22 (6%) had 2 or more episodes. The AOM frequency was
significantly lower in the breast-fed than in the non-breast-fed
children in each age group (P < 0.05). The first AOM episode
occurred significantly earlier in children who were weaned before 6
months of age than in the remaining groups. The frequency of
nasopharyngeal cultures positive for Haemophilus influenzae,
Moraxella catarrhalis and Streptococcus pneumoniae was significantly
higher in children with AOM. At 4 to 7 and 8 to 12 months of age, the
AOM frequency was significantly higher in children with day-care
contact and siblings (P < 0.05 and < 0.01, respectively). The
frequency of upper respiratory tract infections was increased in
children with AOM but significantly reduced in the breast-fed group.
8177624 [PubMed - indexed for MEDLINE]
feeding: overview and breast milk immunology.
of Clinical Immunology, University of Göteborg, Sweden.
transfer of host defence capacity to the human offspring provides a
remarkable model of passive transfer of immunity. In fact it may also
provide an example of active immunization. The transfer of mucosal
protection via breast feeding offers many additional advantages for
the mother and infant. Through its contraceptive effects it increases
the spacing between births, thus diminshing the infant mortality and
the burden on the mother. It also enhances bonding between mother and
child, it seems to increase the IQ and school result of the infant
and might decrease the risk of certain malignancies and perhaps of
juvenile diabetes. A fully breast-fed infant receives as much as
0.5-1 g of secretory immunoglobulin A (SIgA) antibodies daily, the
predominant antibody of human milk. This can be compared to the
production of some 2.5 g of SIgA per day for a 60 kg adult. These
SIgA antibodies have been shown to protect against Vibrio cholerae,
ETEC, Campylobacter, Shigella and Giardia. Furthermore, milk is rich
in receptor analogues for certain epithelial structures which
microbes need for attachment to host tissues as an initial step in
the adherence of Haemophilus influenzae and pneumococci for example
to retropharyngeal cells is efficiently inhibited by human milk.
This may be one explanation for the fact that breast-fed babies have
less otitis media than the non-breast-fed. Other milk factors like
lysozyme and lactoferin may contribute to the host defence, but this
has not yet been well defined. However, human milk also supports the
well-being of the infant by being anti-inflammatory.(ABSTRACT
TRUNCATED AT 250 WORDS)
7825463 [PubMed - indexed for MEDLINE]
of bacterial respiratory pathogens in the nasopharynx in breast-fed
versus formula-fed infants.
of Pediatrics, University of Pittsburgh School of Medicine,
several studies, breast-feeding has been associated with decreased
frequency or duration of otitis media episodes. If a causal
relationship exists, the mechanism of protection of breast-feeding
has not been established. We hypothesized that infants who are
breast-fed, compared with infants who are formula-fed, have a lower
prevalence of nasopharyngeal colonization with the bacterial
respiratory pathogens (Streptococcus pneumoniae, Haemophilus
influenzae, Moraxella catarrhalis, Streptococcus pyogenes) commonly
isolated from the middle ear effusions of children with acute otitis
media. In two private pediatric practices, we obtained specimens from
the nasopharynx for culture from 211 infants at 1 month of age and
from 173 of these infants at 2 months of age. A swab was left in
place in the nasopharynx for 45 s and was then immediately
transferred onto appropriate culture media. Exclusively breast-fed (n
= 84) and exclusively formula-fed (n = 76) infants were similar
regarding the number of persons in the household, the number of
children in the household, the number of siblings in day care, and
the proportion with a recent upper respiratory tract infection. The
two groups did not differ significantly in the proportions found to
have one or more respiratory pathogens at 1 month of age (10.7 versus
18.4%; P = 0.12) or 2 months of age (34.8 versus 35.1%; P = 0.57). We
conclude that during the first 2 months after birth, the exclusive
receipt of breast milk appears not to substantially influence the
prevalence of nasopharyngeal colonization with common bacterial
8253964 [PubMed - indexed for MEDLINE]PMCID: PMC265971Free PMC