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American Journal of Epidemiology Vol. 131, No. 3: 400-411
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health

research-article

BREAST FEEDING AND THE RISK OF SEVERE CHOLERA IN RURAL BANGLADESHI CHILDREN

JOHN D. CLEMENS1,2,, DAVID A. SACK1,3, JEFFREY R. HARRIS1,4, M. R. KHAN1, J. CHAKRABORTY1, SHAHRIAR CHOWDHURY1, M. R. RAO1, FREDERIK P. L. VAN LOON1, BONITA F. STANTON1, MD. YUNUS1, MD. ALI1, M. ANSARUZZAMAN1, ANN-MARI SVENNERHOLM5 and JAN HOLMGREN5

1International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
2Center for Vaccine Development, University of Maryland School of Medicine Baltimore, MD
3Johns Hopkins University School of Hygiene and Public Health Baltimore, MD
4Centers for Disease Control Atlanta, GA
5University of Göteborg Göteborg, Sweden

Reprint requests to Dr. John D. Clemens, Center for Vaccine Development, University of Maryland School of Medicine, 10 S. Pine Street, Baltimore, MD 21201

The association between breast feeding and the risk of severe cholera was examined in a case-control study of rural Bangladeshi children under 36 months of age who were studied in 1985–1986 during a field trial of killed oral cholera vaccines. A total of 116 cases who were treated for severe cholera were compared with 464 age-matched community controls without severe cholera. Overall, the odds ratio relating breast feeding to severe cholera (0.30, p < 0.0001) reflected a 70% reduction in the risk of severe cholera among breast-fed children. The estimated reduction of risk declined with age, but was clearly evident in children up to 30 months of age. Although the association between breast feeding and a reduced risk of severe cholera was not significantly greater in children of mothers who had received cholera vaccine than in children whose mothers had received placebo during the trial, maternal vaccination per se was suggestively associated with a reduced risk of severe cholera in their nonvaccinated children (odds ratio = 0.53, p = 0.05). These results indicate that breast feeding was associated with a substantial reduction of the risk of severe cholera and raise the possibility that vaccination of mothers may provide protection to their young children in endemic settings.

breast feeding; cholera; vaccination


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