PLoS Medicine: Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis

Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis

Chien-Chang Lee1,2, Nicole A. Middaugh1, Stephen R. C. Howie3, Majid Ezzati4,5,6,7*

1 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America, 2 Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan, 3 Bacterial Diseases Programme, Medical Research Council (UK) Laboratories, Fajara, The Gambia, 4 Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America, 5 Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America, 6 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom, 7 MRC-HPA Center for Environment and Health, Imperial College, London, United Kingdom

Abstract
Background

A number of epidemiologic studies have observed an association between secondhand smoke (SHS) exposure and pediatric invasive bacterial disease (IBD) but the evidence has not been systematically reviewed. We carried out a systematic review and meta-analysis of SHS exposure and two outcomes, IBD and pharyngeal carriage of bacteria, for Neisseria meningitidis (N. meningitidis), Haemophilus influenzae type B (Hib), and Streptococcus pneumoniae (S. pneumoniae).
Methods and Findings

Two independent reviewers searched Medline, EMBASE, and selected other databases, and screened articles for inclusion and exclusion criteria. We identified 30 case-control studies on SHS and IBD, and 12 cross-sectional studies on SHS and bacterial carriage. Weighted summary odd ratios (ORs) were calculated for each outcome and for studies with specific design and quality characteristics. Tests for heterogeneity and publication bias were performed. Compared with those unexposed to SHS, summary OR for SHS exposure was 2.02 (95% confidence interval [CI] 1.52–2.69) for invasive meningococcal disease, 1.21 (95% CI 0.69–2.14) for invasive pneumococcal disease, and 1.22 (95% CI 0.93–1.62) for invasive Hib disease. For pharyngeal carriage, summary OR was 1.68 (95% CI, 1.19–2.36) for N. meningitidis, 1.66 (95% CI 1.33–2.07) for S. pneumoniae, and 0.96 (95% CI 0.48–1.95) for Hib. The association between SHS exposure and invasive meningococcal and Hib diseases was consistent regardless of outcome definitions, age groups, study designs, and publication year. The effect estimates were larger in studies among children younger than 6 years of age for all three IBDs, and in studies with the more rigorous laboratory-confirmed diagnosis for invasive meningococcal disease (summary OR 3.24; 95% CI 1.72–6.13).
Conclusions

When considered together with evidence from direct smoking and biological mechanisms, our systematic review and meta-analysis indicates that SHS exposure may be associated with invasive meningococcal disease. The epidemiologic evidence is currently insufficient to show an association between SHS and invasive Hib disease or pneumococcal disease. Because the burden of IBD is highest in developing countries where SHS is increasing, there is a need for high-quality studies to confirm these results, and for interventions to reduce exposure of children to SHS.

full-text:
PLoS Medicine: Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis




PEDIATRÍA
Actualidad Ultimas noticias - JANOes y agencias -
El tabaquismo pasivo aumenta el riesgo de enfermedades bacterianas invasivas en niños

JANO.es y agencias · 09 Diciembre 2010 13:23

Una revisión de múltiples estudios concluye que su exposición al humo del tabaco incrementa las probabilidades de contraer infecciones por meningococos y neumococos, así como gripe hemofílica tipo b.


Los niños expuestos al humo de tabaco son más propensos a contraer enfermedad meningocócica en comparación con niños no expuestos, según un estudio de la Facultad de Salud Pública de Harvard (Estados Unidos) que se publica en PLoS Medicine. Los autores también descubrieron una posible asociación del tabaquismo pasivo con la enfermedad invasiva por neumococo y por Haemophilus influenzae tipo b.

Los autores revisaron la bibliografía publicada y analizaron datos sobre la comparación de presencia de enfermedad bacteriana invasiva en niños expuestos al humo de tabaco frente a niños no expuestos.

Descubrieron que el tabaquismo pasivo dobla la probabilidad de enfermedad meningocócica invasiva y además aumenta en el riesgo de desarrollar enfermedad neumocócica invasiva y Haemophilus influenzae tipo b, aunque este último hallazgo no fue estadísticamente significativo. Los efectos observados fueron mayores en los niños menores de 6 años, los más vulnerables.

Estos resultados sugieren que al disminuir la exposición de los niños al humo del tabaco, por ejemplo si los padres dejaran de fumar o no fumaran en el hogar, se reducirían las muertes y enfermedades causadas por enfermedades bacterianas invasivas. Una reducción de este tipo sería particularmente beneficiosa en los países más pobres, donde la vacunación contra las enfermedades bacterianas invasivas es baja.

Los autores concluyen que, dado que la carga de enfermedad bacteriana invasiva es superior en los países en desarrollo, donde el tabaquismo pasivo está en aumento, existe la necesidad de estudios de mayor calidad para confirmar estos resultados y para adoptar intervenciones que reduzcan la exposición de los niños al tabaquismo pasivo.


PLoS Med 7(12): e1000374. doi:10.1371/journal.pmed.1000374
PLoS Medicine: Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carriage: A Systematic Review and Meta-analysis

Harvard Medical School
Harvard Medical School

PLoS Medicine
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Actualidad Ultimas noticias - JANOes y agencias - El tabaquismo pasivo aumenta el riesgo de enfermedades bacterianas invasivas en ninos - JANO.es - ELSEVIER