Warts in primary schoolchildren: prevalence and relation with environmental factors.
BACKGROUND
Warts are very common in primary schoolchildren. However, knowledge on wart epidemiology and causes of wart transmission is scarce.


OBJECTIVE
To determine the prevalence of warts in primary schoolchildren and to examine the relation with environmental factors in order to provide direction for well-founded recommendations on wart prevention.


METHODS
In this cross-sectional study, the hands and feet of 1465 children aged 4-12 years from four Dutch primary schools were examined for the presence of warts. In addition, the children's parents completed a questionnaire about possible environmental risk factors for warts.


RESULTS
Thirty-three per cent of primary schoolchildren had warts (participation rate 96%). Nine per cent had hand warts, 20% had plantar warts and 4% had both hand and plantar warts. Parental questionnaires (response rate 76%) showed that environmental factors connected to barefoot activities, public showers or swimming pool visits were not related to the presence of warts. An increased risk of the presence of warts was found in children with a family member with warts [odds ratio (OR) 1.9, 95% confidence interval (CI) 1.3-2.6] and in children where there was a high prevalence of warts in the school class (OR per 10% increase in wart prevalence in school class 1.6, 95% CI 1.5-1.8).


CONCLUSIONS
One-third of primary schoolchildren have warts. This study does not find support for generally accepted wart prevention recommendations, such as wearing protective footwear in communal showers and swimming pool changing areas. Rather, recommendations should focus on ways to limit the transmission of wart viruses within families and school classes.
Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden 2300 RC, The Netherlands.
F M
FM
van Haalen
S C
SC
Bruggink
J
J
Gussekloo
W J J
WJ
Assendelft
J A H
JA
Eekhof
D000203:Activities of Daily Living; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005534:Foot Diseases / Q000453:epidemiology*; D006229:Hand Dermatoses / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010290:Parents; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014860:Warts / Q000453:epidemiology* / Q000209:etiology