Abstract

PIP: Field studies conducted in Bangladesh in collaboration with laboratory studies in Goteborg, Bethesda and Atlanta were directed toward identifying specific enteric infections in infants influenced by breastfeeding. The international Centre for Diarrheal Disease Research set up at the Dhaka Hospital examined 4000 children under 5 with diarrhea between March 1980 and February 1982. Breast feeding is the preferred feeding method in this population, and is extended into the 2nd and 3rd years in the majority. Infants 6-11 months old were more likely to be breast fed than younger infants (88 vs. 77%), suggesting that breast feeding confers some protection against diarrhea in the 1st 6 months. The most frequently found enteric pathogens were rotavirus (35%), enterotoxigenic E. coli (ETEC) (14%), C. jejuni (14%), shigella (11%), G. lamblia (6%), V. cholerae (6%), and E. histolytica (2%). Children with shigellosis were significantly less likely to be breast-fed than those with other infections. Those already weaned were more likely to have shigellosis (15 vs. 9/%) or cholera (6 vs. 3%). In contrast, breast feeding was more common in children with rotavirus. Rates of breastfeeding did not differ among children positive for ETEC or C. jejuni. Among children with shigellosis, breast feeding was associated with a milder disease. In mother-child pairs who were contacts of index cases, breast milk with higher IgA titers was protective against clinical cholera, but not against colonization with V. cholerae 01. Acute and convalescent phase sera from women showed consistently high anti-cholera titers, but breast milk did not in the 3- week period of the study. Shedding of G. lamblia appeared to be enhanced in breast feeding women.