Presence of Helicobacter pylori in a sibling is associated with a long-term increased risk of H. pylori infection in Israeli Arab children.
OBJECTIVE
We examined the dynamics of Helicobacter pylori infection between pre-school and school ages and compared the determinants of late acquisition of H. pylori infection with determinants of early and persistent H. pylori infection.


METHODS
ELISA was used to detect H. pylori antigens in stool specimens collected from children at preschool age (3-5 years) and from their mothers and siblings in 2004. The children were tested again for H. pylori at school age (6-9 years) in 2007-2009. Household and socioeconomic characteristics were obtained by interviews.


RESULTS
The prevalence of H. pylori infection increased from 49.7% (95% CI 42.8, 56.7) in 2004 to 58.9% (95% CI 51.8, 65.6) in 2007-2009. Among children tested in both examinations, 69 (49.3%) had persistent infection, 14 (10.0%) were new cases, 56 (40.0%) remained uninfected, and one (0.7%) had lost H. pylori infection. The approximate annual incidence of infection during 2004-2009 was 5%. Sibling's H. pylori positivity at baseline increased the risk for late acquisition of H. pylori infection; adjusted prevalence ratio (PR) 4.62 (95% CI 0.76, 28.23) (p = .09), while maternal education lowered the risk; adjusted PR 0.84 (95% CI 0.69, 1.01) (p = .06). Sibling's H. pylori positivity was the only significant variable associated with early and persistent H. pylori infection in multivariate analysis.


CONCLUSIONS
Most H. pylori infections are acquired at preschool age and transient infection beyond this age is uncommon in this population. Helicobacter pylori-infected siblings are the major reservoir of H. pylori in early and late childhood demonstrating sustained intra-familial transmission of H. pylori.
Muhsen
Khitam
K
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
Athamna
Abed
A
Bialik
Anya
A
Alpert
Gershon
G
Cohen
Dani
D
D000942:Antigens, Bacterial / Q000032:analysis; D018912:Arabs; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005192:Family Health; D005243:Feces / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000208:ethnology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009035:Mothers; D015995:Prevalence; D012307:Risk Factors; D035781:Siblings; D012959:Socioeconomic Factors
D000942:Antigens, Bacterial