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

Pandolfi, Elisabetta MD; Gesualdo, Francesco MD; Carloni, Emanuela DStat; Villani, Alberto PhD; Midulla, Fabio PhD; Carsetti, Rita PhD; Stefanelli, Paola PhD; Fedele, Giorgio PhD; Tozzi, Alberto Eugenio MDfor the Pertussis Study Group

The Pediatric Infectious Disease Journal: March 2017 - Volume 36 - Issue 3 - p e48–e53
doi: 10.1097/INF.0000000000001418
Original Studies

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.

From the *Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital; Department of Pediatrics, Bambino Gesù Children Hospital IRCSS; Department of Pediatrics, Sapienza University of Rome; §Immunology Unit, Immunology and Pharmacal Therapy Area, Bambino Gesù Children Hospital IRCSS; and Department of Infectious, Parasitic & Immuno-mediated Disease, Istituto Superiore di Sanità, Rome, Italy.

Accepted for publication October 24, 2016.

This study was supported by grant number RF-2010-2317709 from the Italian Ministry of Health.

A.E.T. has received research grants for vaccine studies from Sanofi Pasteur MSD, Pfizer and Glaxo SmithKline. The other authors have no conflicts of interest to disclose.

Address for correspondence: Francesco Gesualdo, MD, Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children’s Hospital, Rome, Italy. E-mail: f.gesualdo@gmail.com.

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