Recurrence of Helicobacter pylori infection in Bolivian children and adults after a population-based "screen and treat" strategy.
BACKGROUND
Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based "screen and treat" eradication program.


METHODS
We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection.


RESULTS
We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78-84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8-15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10-29) in persons <5 years, 20% (95% CI: 10-29) in 5-9 years, 8% (95% CI: 1-15) in 10-14 years, and 8% (95% CI: 4-12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2-5.8) and 5-9 years (OR 2.7, 95% CI: 1.4-5.1).


CONCLUSIONS
Children <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings.
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Sumathi
S
Sivapalasingam
Anu
A
Rajasingham
Jonathan T
JT
Macy
Cindy R
CR
Friedman
Robert M
RM
Hoekstra
Tracy
T
Ayers
Benjamin
B
Gold
Robert E
RE
Quick
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001838:Bolivia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012008:Recurrence; D012424:Rural Population; D016036:Seroepidemiologic Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents
Helicobacter pylori; prevention; reinfection; seroprevalence; treatment