Breastfeeding protects against acute gastroenteritis due to rotavirus in infants

Abstract

To assess whether breastfeeding protects against acute gastroenteritis (AGE) due to rotavirus (RV) infection compared to RV-negative AGE (RV−) in children age 0–12 months. Data from a community-based study of children with AGE from 30 pediatric practices in Germany, Switzerland, and Austria were evaluated. A case–control design was conducted with RV-positive AGE (RV+) cases and RV− AGE as controls. Odds ratios and 95% confidence intervals were estimated using log-linear regression models adjusting for child’s age, family size, number of siblings, child care attendance, and nationality. A total of 1,256 stool samples were collected from infants with AGE; 315 (25%) were RV+ and 941 RV−. Being breastfed in the period of disease inception reduced the risk of AGE due to RV+ (OR, 0.53; 95% CI, 0.37–0.76). In infants 0–6 months of age, the protective effect was stronger (OR, 0.33; 95% CI, 0.19–0.55) than in 7–12-month-old children. Our study adds to the evidence of a protective concurrent effect of breastfeeding against rotavirus infection in infants, particularly in children 6 months and younger. Breastfeeding is important to diminish rotavirus-related gastroenteritis in infants before vaccination can be introduced.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abbreviations

AGE:

Acute gastrointestinal enteritis

ELISA:

Enzyme-linked immunosorbent assay

IgA:

Immunoglobulin A

OR:

Odds ratio

95% CI:

95% confidence interval

RV−:

Rotavirus negative

RV+:

Rotavirus positive

References

  1. 1.

    Banerjee I, Ramani S, Primrose B et al (2006) Comparative study of the epidemiology of rotavirus in children from a community-based birth cohort and a hospital in South India. J Clin Microbiol 44:2468–2474

    Article  PubMed  Google Scholar 

  2. 2.

    Blake PA, Ramos S, MacDonald KL et al (1993) Pathogen-specific risk factors and protective factors for acute diarrheal disease in urban Brazilian infants. J Infect Dis 167:627–632

    CAS  PubMed  Google Scholar 

  3. 3.

    Brooks RG, Brown L, Franklin RB (1989) Comparison of a new rapid test (TestPack Rotavirus) with standard enzyme immunoassay and electron microscopy for the detection of rotavirus in symptomatic hospitalized children. J Clin Microbiol 27:775–777

    CAS  PubMed  Google Scholar 

  4. 4.

    Chrystie IL, Totterdell BM, Banatvala JE (1978) Asymptomatic endemic rotavirus infections in the newborn. Lancet 1:1176–1178

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Clemens J, Rao M, Ahmed F et al (1993) Breast-feeding and the risk of life-threatening rotavirus diarrhea: prevention or postponement? Pediatrics 92:680–685

    CAS  PubMed  Google Scholar 

  6. 6.

    Cunningham AS (1987) Breast-feeding and health. J Pediatr 110:658–659

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Curns AT, Steiner CA, Barrett M et al (2010) Reduction in acute gastroenteritis hospitalizations among US children after introduction of rotavirus vaccine: analysis of hospital discharge data from 18 US states. J Infect Dis 201:1617–1624

    Article  PubMed  Google Scholar 

  8. 8.

    Dennehy PH, Cortese MM, Begue RE et al (2006) A case–control study to determine risk factors for hospitalization for rotavirus gastroenteritis in U.S. children. Pediatr Infect Dis J 25:1123–1131

    Article  PubMed  Google Scholar 

  9. 9.

    Ehlken B, Laubereau B, Karmaus W et al (2002) Prospective population-based study on rotavirus disease in Germany. Acta Paediatr 91:769–775

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Elliott EJ (2007) Acute gastroenteritis in children. BMJ 334:35–40

    Article  PubMed  Google Scholar 

  11. 11.

    Feinstein AR, Walter SD, Horwitz RI (1986) An analysis of Berkson’s bias in case–control studies. J Chronic Dis 39:495–504

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Fruhwirth M, Karmaus W, Moll-Schuler I et al (2001) A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection. Arch Dis Child 84:393–397

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Gendrel D, Akaga R, Ivanoff B et al (1984) Acute gastroenteritis and breast feeding in Gabon. Preliminary results. Med Trop (Mars) 44:323–325

    CAS  Google Scholar 

  14. 14.

    Glass RI, Stoll BJ, Wyatt RG et al (1986) Observations questioning a protective role for breast-feeding in severe rotavirus diarrhea. Acta Paediatr Scand 75:713–718

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Golding J, Emmett PM, Rogers IS (1997) Gastroenteritis, diarrhoea and breast feeding. Early Hum Dev 49(Suppl):S83–S103

    Article  PubMed  Google Scholar 

  16. 16.

    Gurwith M, Wenman W, Hinde D et al (1981) A prospective study of rotavirus infection in infants and young children. J Infect Dis 144:218–224

    CAS  PubMed  Google Scholar 

  17. 17.

    Haffejee IE (1991) Neonatal rotavirus infections. Rev Infect Dis 13:957–962

    CAS  PubMed  Google Scholar 

  18. 18.

    Hanson LA, Hahn-Zoric M, Berndes M et al (1994) Breast feeding: overview and breast milk immunology. Acta Paediatr Jpn 36:557–561

    CAS  PubMed  Google Scholar 

  19. 19.

    Jayashree S, Bhan MK, Kumar R et al (1988) Protection against neonatal rotavirus infection by breast milk antibodies and trypsin inhibitors. J Med Virol 26:333–338

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Kurugol Z, Geylani S, Karaca Y et al (2003) Rotavirus gastroenteritis among children under 5 years of age in Izmir, Turkey. Turk J Pediatr 45:290–294

    PubMed  Google Scholar 

  21. 21.

    Kvistgaard AS, Pallesen LT, Arias CF et al (2004) Inhibitory effects of human and bovine milk constituents on rotavirus infections. J Dairy Sci 87:4088–4096

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Laubereau B, Gateau S, Ehlken B et al (1999) Rotavirus gastroenteritis in infants and children. Results of a prospective study in the area of Geneva and Basel 1997/1998 (RoMoS). RoMoS Study Group. Schweiz Med Wochenschr 129:1822–1830

    CAS  PubMed  Google Scholar 

  23. 23.

    Linhares AC, Gabbay YB, Freitas RB et al (1989) Longitudinal study of rotavirus infections among children from Belem, Brazil. Epidemiol Infect 102:129–145

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Mastretta E, Longo P, Laccisaglia A et al (2002) Effect of Lactobacillus GG and breast-feeding in the prevention of rotavirus nosocomial infection. J Pediatr Gastroenterol Nutr 35:527–531

    Article  PubMed  Google Scholar 

  25. 25.

    Misra S, Sabui TK, Basu S et al (2007) A prospective study of rotavirus diarrhea in children under 1 year of age. Clin Pediatr (Phila) 46:683–688

    Article  Google Scholar 

  26. 26.

    Naficy AB, Abu-Elyazeed R, Holmes JL et al (1999) Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control. Am J Epidemiol 150:770–777

    CAS  PubMed  Google Scholar 

  27. 27.

    Newburg DS, Peterson JA, Ruiz-Palacios GM et al (1998) Role of human-milk lactadherin in protection against symptomatic rotavirus infection. Lancet 351:1160–1164

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Newburg DS, Ruiz-Palacios GM, Morrow AL (2005) Human milk glycans protect infants against enteric pathogens. Annu Rev Nutr 25:37–58

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Ochoa TJ, Cleary TG (2009) Effect of lactoferrin on enteric pathogens. Biochimie 91:30–34

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Plosker GL (2010) Pentavalent rotavirus vaccine (RotaTeq): a review of its use in the prevention of rotavirus gastroenteritis in Europe. Drugs 70:1165–1188

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Ruuska T, Vesikari T (1990) Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis 22:259–267

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Soriano-Gabarro M, Mrukowicz J, Vesikari T et al (2006) Burden of rotavirus disease in European Union countries. Pediatr Infect Dis J 25:S7–S11

    Article  PubMed  Google Scholar 

  33. 33.

    Totterdell BM, Chrystie IL, Banatvala JE (1976) Rotavirus infections in a maternity unit. Arch Dis Child 51:924–928

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Webb A, Starr M (2005) Acute gastroenteritis in children. Aust Fam Physician 34:227–231

    PubMed  Google Scholar 

  35. 35.

    Weinberg RJ, Tipton G, Klish WJ et al (1984) Effect of breast-feeding on morbidity in rotavirus gastroenteritis. Pediatrics 74:250–253

    CAS  PubMed  Google Scholar 

  36. 36.

    Yolken RH, Peterson JA, Vonderfecht SL et al (1992) Human milk mucin inhibits rotavirus replication and prevents experimental gastroenteritis. J Clin Invest 90:1984–1991

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was sponsored by Wyeth-Pharma, Münster, Germany. We thank Saroochi Agarwal, Alycia Albergottie, Kesinee Hanjangsit, and Olurinde Oni for editing previous versions of this manuscript. We are obliged to patients and parents who consented to take part in this study and the helpful cooperation of practice assistant, without whom this study would not have been feasible.

Conflicts of interest

The authors declare no conflicts of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wilfried Karmaus.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Plenge-Bönig, A., Soto-Ramírez, N., Karmaus, W. et al. Breastfeeding protects against acute gastroenteritis due to rotavirus in infants. Eur J Pediatr 169, 1471–1476 (2010). https://doi.org/10.1007/s00431-010-1245-0

Download citation

Keywords

  • Acute gastroenteritis
  • Breastfeeding
  • Rotavirus
  • Infants