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Bottle feeding as a risk factor for cholera in infants
Insights
Infants aged 6-11 months, particularly those primarily bottle-fed, faced the highest risk during a cholera outbreak. Breastfeeding may offer protection against cholera in infants, though the exact mechanism requires further investigation.
Area of Science:
- Epidemiology
- Infectious Diseases
- Pediatrics
Background:
- Cholera remains a significant public health concern, especially in vulnerable populations like infants.
- Understanding risk factors is crucial for effective outbreak control and prevention strategies.
Purpose of the Study:
- To identify risk factors associated with cholera infection in infants during an El Tor cholera outbreak.
- To investigate the role of feeding practices and maternal factors in infant cholera cases.
Main Methods:
- A retrospective matched-pair study design was employed.
- 42 infant cholera cases were compared with matched controls during a 1978 outbreak in Bahrain.
- Infant feeding patterns (breast vs. bottle) and maternal factors were assessed.
Main Results:
- The highest cholera attack rate (125/10,000) was observed in infants aged 6-11 months, coinciding with the weaning period.
- Infants who were principally bottle-fed showed a significantly higher risk compared to principally breast-fed infants (p=0.004).
- Maternal cholera infection and antibody levels did not appear to influence infant risk.
Conclusions:
- Bottle feeding is a significant risk factor for cholera in infants, particularly during weaning.
- Breastfeeding likely provides a protective effect against symptomatic cholera in infants.
- Further research is needed to elucidate the specific protective mechanisms of breastfeeding against cholera.
Abstract:
To determine risk factors for cholera in infants, a retrospective matched-pair study of 42 cases and their controls was undertaken during an outbreak of El Tor cholera in Bahrain in the autumn of 1978. The highest attack-rate of cholera (125/10 000) occurred in infants in the 6--11 month age-group, which corresponds to the weaning age in this community. Significantly more cases than controls were principally bottle fed (greater than 50% milk intake by bottle) than principally breast fed during the week before onset of illness (p=0.004). Analysis of various patterns of breast and bottle feeding did not determine whether the protection afforded by breast feeding was a negative effect (due to the lack of exposure to contaminated bottle feedings for breast fed infants) or a positive effect (due to protective functions of constituents of human breast milk). Cholera infection (with or without symptoms) among mothers of either case or control infants was uncommon (case mothers 3, control mothers 5), and mean serum vibriocidal and antitoxic antibody levels were similar for the two groups of mothers. These observations suggest that maternal infection did not affect the relative risk of infants having symptomatic cholera.