title: Pathogen-specific risk factors and protective factors for acute diarrheal disease in urban Brazilian infants.
abstract: To evaluate potential risk factors and protective factors for acute diarrheal disease in urban infants, 500 infants < or = 12 months old with diarrhea and 500 age-matched control subjects coming to a São Paulo emergency room were studied. On multivariate analysis, these apparently sporadic community-acquired cases of diarrhea were significantly associated with hospitalization in the month before onset (odds ratio [OR], 3.4), day care center exposure (OR, 2.0), prior diarrhea in another household member (OR, 4.4), and low family income (OR, 1.8). Breast-feeding infants < 6 months old (OR, 0.3) and boiling household drinking water (OR, 0.4) were protective. Enteropathogenic Escherichia coli (EPEC; OR, 12.0) and Salmonella (OR, 7/0, discordant pairs) infections were associated with prior hospitalization, rotavirus infections were associated with day care (OR, 6/0), and breast-feeding was protective against EPEC infections (OR, 0.1). These results suggest that certain preventive strategies can prevent a substantial proportion of cases of diarrheal disease in Brazilian infants.
authors.affiliation: Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: P A
authors.initials: PA
authors.lastname: Blake
authors.forename: S
authors.initials: S
authors.lastname: Ramos
authors.forename: K L
authors.initials: KL
authors.lastname: MacDonald
authors.forename: V
authors.initials: V
authors.lastname: Rassi
authors.forename: T A
authors.initials: TA
authors.lastname: Gomes
authors.forename: C
authors.initials: C
authors.lastname: Ivey
authors.forename: N H
authors.initials: NH
authors.lastname: Bean
authors.forename: L R
authors.initials: LR
authors.lastname: Trabulsi
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D016022:Case-Control Studies; D002656:Child Day Care Centers; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D014505:Urban Population; D014881:Water Supply