RISK-FACTORS FOR INVASIVE DISEASE CAUSED BY STREPTOCOCCUS-PNEUMONIAE AMONG ALASKA NATIVE CHILDREN YOUNGER THAN 2 YEARS OF AGE

Streptococcus pneumoniae causes a significant amount of illness and de ath from pneumonia, bacteremia and meningitis among children <2 years of age. No currently available effective vaccine exists to prevent pne umococcal disease in this age group. To identify modifiable risk facto rs we conducted a retrospective case-control study of 29 Alaska Native residents of Bethel, AK, <2 years of age who had invasive pneumococca l illness from 1983 to 1992 and 85 controls matched for race, city of residence and date of birth. Data were collected through reviews of me dical records and telephone interviews. In matched univariate analysis the following variables were associated with illness at P less than o r equal to 0.25 and were included in the multivariate model: at least one prior episode of pneumonia; at least one prior hospitalization; gr oup child care center attendance; at least one tobacco smoker in the h ousehold; at least one tobacco chewer in the household; and lack of br east-feeding. Using a conditional multiple logistic regression analysi s, 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 house hold 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% conf idence interval, 0.0 to 1.0). These data suggest that breast feeding m ay prevent invasive pneumococcal disease and that strategies for decre asing risks should target children in group child care settings. Furth er studies are needed to evaluate the interaction of tobacco and pneum ococcal illness.