Breast milk reduces the risk of illness in children of mothers with cholera: observations from an epidemic of cholera in Guinea-Bissau.
BACKGROUND
A protective effect of breastfeeding against cholera has been demonstrated in areas endemic of cholera. To assess the protection offered by breast milk from mothers living in an area that had been free from cholera for 7 years, we investigated mothers with cholera and their children during an epidemic with Vibrio cholerae El Tor in the capital of Guinea-Bissau.


METHODS
Eighty mothers with clinical cholera and their children were identified, and interviewed. Blood samples for vibriocidal and antitoxin antibodies were collected from mother-and-child pairs. Breast milk samples were collected from lactating mothers. Cholera was defined as acute watery diarrhea during the epidemic and a vibriocidal reciprocal titer of 20 or above.


RESULTS
Three (7%) of 42 breastfed children had cholera as defined above compared with 9 (24%) of 38 nonbreastfed children (RR for breastfed children, 0.19; 95% CI, 0.04-0.91, adjusted for age). The 3 breastfed children who developed cholera received milk containing lower concentrations of anticholera toxin IgA/total IgA (median, 2.0 units/mL) than 14 children who had serologic signs of colonization but did not develop the disease (median, 17.4 units/mL).


CONCLUSIONS
The protective effect of breast milk against cholera is not confined to endemic areas. Lactating mothers with cholera should receive supportive care to continue breastfeeding.
Qureshi
Katja
K
Projecto de Saúde de Bandim, Bissau, Guinea-Bissau. kqu@ssi.dk
Mølbak
Kåre
K
Sandström
Anita
A
Kofoed
Poul-Erik
PE
Rodrigues
Amabelia
A
Dias
Francisco
F
Aaby
Peter
P
Svennerholm
Ann-Mari
AM
D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000032:analysis / Q000097:blood; D000992:Antitoxins / Q000032:analysis; D001942:Breast Feeding; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission*; D002772:Cholera Toxin / Q000276:immunology; D004196:Disease Outbreaks; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007070:Immunoglobulin A / Q000032:analysis / Q000097:blood; D007223:Infant; D008895:Milk, Human / Q000276:immunology*; D009035:Mothers; D014734:Vibrio cholerae / Q000276:immunology
D000907:Antibodies, Bacterial; D000992:Antitoxins; D007070:Immunoglobulin A; D002772:Cholera Toxin