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[Intrafamilial transmission of Helicobacter pylori infection]
1Institutionen för medicinsk epidemiologi, Karolinska institutet, Stockholm. ylva.tindberg@mep.ki.se
Insights
Intrafamilial transmission is the primary route for Helicobacter pylori infection in children. Parental origin significantly influences a child's risk, outweighing peer-to-peer spread in Western societies.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Microbiology
Background:
- Helicobacter pylori infection is common globally, acquired predominantly in childhood.
- Routes of transmission, particularly between children, remain incompletely understood.
- Distinguishing intrafamilial from extraneous child-to-child transmission is crucial for public health interventions.
Purpose of the Study:
- To investigate the relative importance of intrafamilial versus extraneous child-to-child transmission of H. pylori.
- To assess the association between parental geographic origin and H. pylori seroprevalence in Swedish schoolchildren.
- To identify key risk factors for H. pylori infection in a pediatric population.
Main Methods:
- Cross-sectional study involving 695 schoolchildren aged 10-12 years in Stockholm.
- Serological detection of H. pylori infection using ELISA, confirmed by immunoblot and urea breath test.
- Structured questionnaires administered to children and families to gather data on background and potential exposures.
Main Results:
- Overall H. pylori seroprevalence was 16% (112/695 children).
- Seroprevalence was significantly higher in children with parents from high-prevalence areas (55%) compared to those with Scandinavian parents (2%).
- Infection prevalence among classmates was not a significant risk factor when controlling for family background.
Conclusions:
- Parental H. pylori infection status and origin are critical determinants of childhood infection.
- Intrafamilial transmission plays a far more significant role than transmission among peers outside the family unit in this Western population.
- Findings suggest targeted family-based prevention strategies may be effective.
Abstract:
Helicobacter pylori infection is mainly acquired in early childhood but the exact routes of transmission remain elusive. To distinguish between risks of intrafamilial and extraneous child-to-child transmission we studied the seroprevalence of Helicobacter pylori among 10-12-year-old Swedish school children with varying family background. In a cross-sectional study, 695 children (81% of all invited) in 36 school classes in southern Stockholm donated blood and answered a structured questionnaire together with their families. Infection was detected by ELISA, and confirmed by immunoblot and urea breath test. Overall, 112 (16%) of the children were H. pylori infected. Seroprevalence was 2% among 435 children with Scandinavian parents and 55% among 144 children with at least one parent born in a high prevalence area (Middle East and Africa), indicating that the prevalence of H. pylori infection in the parental generation is a crucial determinant of the child's risk of infection. Importantly, the prevalence of infection among classmates was not a risk factor for H. pylori infection when family background was taken into account. In conclusion our data indicate that intrafamilial transmission is far more important than child-to-child transmission outside the family in a western society.