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Long-term enhancement of the lgG2 antibody response to Haemophilus influenzae type b by breastfeeding
Department of Paediatrics, Örebro Medical Centre Hospital, Örebro.
Department of Biostatistics and Epidemiology, Örebro Medical Centre Hospital, Örebro.
Department of Clinical Immunology, Göteborg University, Göteborg, Sweden.
Department of Clinical Immunology, Göteborg University, Göteborg, Sweden.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Subjects. Sets of sera were obtained from 30 children below 6 years of age with invasive Haemophilus influenzae type b (Hib) infection, and therr mothers. DuratiOn and mode of breastfeeding were registered. Levels of IgG1, IgG2, IgA and IgM antibodies agamst Hrb capsular polysaccharide (CP) were determined in sera taken during acute the illness as well as in the early and late convalescence.

Results. Children 18 months or older with longer duration of exclusive breastfeeding (13 weeks or more, mean 19.3 weeks) had higher anti-Rib antibody levels of the IgG1, IgG2, IgA and IgM isotypes than those with shorter duration of exclusive breastfeeding (less than 13 weeks, mean 5.4 weeks). The difference between the breastfeeding groups was greatest for the IgG2 isotype. In regression analyses the association between the duration of exclusive breastfeeding and the anti-Hib IgG2 level was significant when breastfeeding, type of Hib infection, maternal anti-Rib antibody level and age were used as explanatory factors. In the group of 14 children below 18 months of age no significant differences were noted.

Discussion. Human milk is rich in IFN-y as well as in IFN-y producing cells, which may result in a specific stimulatory effect of breastfeeding on the IgG2 anti-Rib antibody response. In conclusion, this study indicates the presence of a long lasting enhancing effect of breastfeeding on the antibody response to Hib in children, in particular on IgG2 anti-Hib antibody production.

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81108OAI: oai:DiVA.org:liu-81108DiVA: diva2:550502
Available from: 2012-09-07 Created: 2012-09-07 Last updated: 2012-09-07Bibliographically approved
In thesis
1. Invasive Haemophilus influenzae Infection and Breastfeeding: Aspects of epidemiology and immunology
Open this publication in new window or tab >>Invasive Haemophilus influenzae Infection and Breastfeeding: Aspects of epidemiology and immunology
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Invasive Haemophilus influenzae (Hi) infection is still an important cause of morbidity and mortality in the world. Vaccination against Haemophilus influenzae type b (Hib) has been implemented in many industrial countries during the 1990s with a dramatic decrease in mortality and morbidity due to Hib. This is in sharp contrast to the situation in developing countries where Hib is still a threat.

In a prospective study conducted in Örebro County, Sweden, between 1987 and 1992, before large scale Hib vaccination of children was introduced, the incidence of invasive Hi infection in children 0-4 years of age was 55/100 000 children/year. Hib caused 98% of the Hi cases in children.

In a case control study it was found that duration of exclusive breastfeeding less than 13 weeks as well as a history of frequent infections were independent factors associated with an increased risk of invasive Hi infection with odds ratios, OR, of 3.79 (1.6-8.8) and 4.49 (1.0-21.0) respectively. For the age at onset of 12 months or older, the associations were stronger, OR 7.79 (2.4-26.6) and 5.86 (1,1-30.6), respectively. When breastfeeding duration in weeks was analysed as a continuous variable the OR was 0.95 (0.92-0.99), indicating a decreased risk for each additional week of breastfeeding.

An ecologic study of the relation between incidence rates of Hi meningitis between 1956 and 1992 and breastfeeding rates in the population was performed. A strong negative correlation between breastfeeding and incidence of Hi meningitis was found with a maximum for a time Jag of 5-10 years. The correlation for contemporary data was intermediate. The result implies that a low breastfeeding rate was followed by an increased incidence rate of Hi meningitis up to 10 years later in time.

In two laboratory assays the anti-Hib antibody response was investigated in children with invasive Hib infection as well as in healthy children in relation to age, duration of exclusive breastfeeding, history of frequent infections and exposure to passive smoking. Children 18 months or older with a duration of exclusive breastfeeding of 13 weeks or more had higher levels of anti-Hib antibodies of the IgG1, IgG2 and IgM isotypes during the Hib infection compared to those less breastfed. The differences between the breastfeeding groups (<13 weeks versus ≥ 13 weeks) were greatest for the IgG2 isotype. In control children a duration of exclusive breastfeeding of ≥ 13 weeks emerged as a protective factor against non-invasive and non-specific infections with an OR of 0.92 (0.86-0.99). The protective effect was stronger in children < 18 months of age with an OR of 0.87 (0.76-1,0). Duration of exclusive breastfeeding was not associated with anti-Hib antibody levels in children < 18 months of age. In children ≥ 18 months of age there was a weak association between duration of exclusive breastfeeding and anti-Hib antibody levels of the IgG2 isotype, strongest in those without frequent infections. Expression of idiotype I (Id-1) antibodies increased with age in contrast to idiotype 2 (Id-2) antibodies that were found only in children ≤ 24 months of age, but the levels of neither Id-1 nor ld-2 were related to duration of breastfeeding or exposure to passive smoking.

In conclusion, exclusive breastfeeding seems to be protective against invasive Hi infections. Exclusive breastfeeding seems to be protective against Hi meningitis also at a population level. There are indications of a long lasting enhancing effect of breastfeeding on the antibody response to Hib in children, in particular on the IgG2 anti-Hib antibody production.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2001. 59 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 676
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28636 (URN)13792 (Local ID)91-7219-972-5 (ISBN)13792 (Archive number)13792 (OAI)
Public defence
2001-05-22, Willandersalen, M-huset, Regionsjukhuset, Örebro, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-07Bibliographically approved

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Olcén, Per

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