title: Protective effect of breastfeeding on invasive Haemophilus influenzae infection: a case-control study in Swedish preschool children.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Orebro Medical Centre Hospital, Sweden.
authors.forename: S A
authors.initials: SA
authors.lastname: Silfverdal
authors.forename: L
authors.initials: L
authors.lastname: Bodin
authors.forename: S
authors.initials: S
authors.lastname: Hugosson
authors.forename: O
authors.initials: O
authors.lastname: Garpenholt
authors.forename: B
authors.initials: B
authors.lastname: Werner
authors.forename: E
authors.initials: E
authors.lastname: Esbjörner
authors.forename: B
authors.initials: B
authors.lastname: Lindquist
authors.forename: P
authors.initials: P
authors.lastname: Olcén
mesh_terms: D017668:Age of Onset; D000704:Analysis of Variance; D016470:Bacteremia / Q000453:epidemiology / Q000276:immunology*; D001942:Breast Feeding; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000276:immunology*; D006193:Haemophilus influenzae / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008297:Male; D008895:Milk, Human / Q000276:immunology*; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology