Gessner B D, Ussery X T, Parkinson A J, Breiman R F
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Pediatr Infect Dis J. 1995 Feb;14(2):123-8. doi: 10.1097/00006454-199502000-00008.
Streptococcus pneumoniae causes a significant amount of illness and death from pneumonia, bacteremia and meningitis among children < 2 years of age. No currently available effective vaccine exists to prevent pneumococcal disease in this age group. To identify modifiable risk factors we conducted a retrospective case-control study of 29 Alaska Native residents of Bethel, AK, < 2 years of age who had invasive pneumococcal illness from 1983 to 1992 and 85 controls matched for race, city of residence and date of birth. Data were collected through reviews of medical records and telephone interviews. In matched univariate analysis the following variables were associated with illness at P < or = 0.25 and were included in the multivariate model: at least one prior episode of pneumonia; at least one prior hospitalization; group child care center attendance; at least one tobacco smoker in the household; at least one tobacco chewer in the household; and lack of breast-feeding. Using a conditional multiple logistic regression analysis, we found that group child care center attendance (odds ratio, 98.6; 95% confidence interval, 5.1 to 1920.6) and the presence in the household of at least one person who chewed tobacco (odds ratio, 20.6; 95% confidence interval, 1.4 to 294.5) were independently associated with illness while breast-feeding was protective (odds ratio, 0.1; 95% confidence interval, 0.0 to 1.0). These data suggest that breast-feeding may prevent invasive pneumococcal disease and that strategies for decreasing risks should target children in group child care settings. Further studies are needed to evaluate the interaction of tobacco and pneumococcal illness.
肺炎链球菌在2岁以下儿童中引发大量因肺炎、菌血症和脑膜炎导致的疾病与死亡。目前尚无有效的疫苗可预防该年龄组的肺炎球菌疾病。为了确定可改变的风险因素，我们对1983年至1992年间阿拉斯加贝瑟尔市29名2岁以下患侵袭性肺炎球菌疾病的阿拉斯加原住民居民进行了一项回顾性病例对照研究，并选取了85名在种族、居住城市和出生日期方面匹配的对照。数据通过查阅病历和电话访谈收集。在匹配的单变量分析中，以下变量在P≤0.25时与疾病相关，并被纳入多变量模型：至少有一次先前的肺炎发作；至少有一次先前的住院治疗；在集体儿童保育中心照料；家中至少有一名吸烟者；家中至少有一名嚼烟者；以及缺乏母乳喂养。使用条件多因素逻辑回归分析，我们发现，在集体儿童保育中心照料（比值比，98.6；95%置信区间，5.1至1920.6）以及家中至少有一名嚼烟者（比值比，20.6；95%置信区间，1.4至294.5）与疾病独立相关，而母乳喂养具有保护作用（比值比，0.1；95%置信区间，0.0至1.0）。这些数据表明，母乳喂养可能预防侵袭性肺炎球菌疾病，降低风险的策略应针对集体儿童保育环境中的儿童。需要进一步研究来评估烟草与肺炎球菌疾病之间的相互作用。
