title: Extremely low Helicobacter pylori prevalence in North Sulawesi, Indonesia and identification of a Maori-tribe type strain: a cross sectional study.
abstract: BACKGROUND
  Sulawesi in Indonesia has a unique geographical profile with assumed separation from Sundaland. Studies of Helicobacter pylori in this region are rare due to the region's rural location and lack of endoscopy equipment. Indirect methods are, therefore, the most appropriate for measuring H. pylori infection in these areas; with the disposable gastric brush test, we can obtain gastric juice as well as small gastric tissue samples for H. pylori culture. We investigated the prevalence of H. pylori infection and evaluated human migration patterns in the remote areas of North Sulawesi.
  
  
  METHODS
  We recruited a total of 251 consecutive adult volunteers and 131 elementary school children. H. pylori infection was determined by urine antibody test. A gastric brush test was used to culture H. pylori. We used next-generation and polymerase chain reaction based sequencing to determine virulence factors and multi-locus sequence typing (MLST).
  
  
  RESULTS
  The overall H. pylori prevalence was only 14.3% for adults and 3.8% for children, and 13.6% and 16.7% in Minahasanese and Mongondownese participants, respectively. We isolated a single H. pylori strain, termed -Manado-1. Manado-1 was East Asian type cagA (ABD type), vacA s1c-m1b, iceA1 positive/iceA2 negative, jhp0562-positive/β-(1,3) galT-negative, oipA "on", and dupA-negative. Phylogenetic analyses showed the strain to be hspMaori type, a major type observed in native Taiwanese and Maori tribes.
  
  
  CONCLUSIONS
  Our data support that very low H. pylori infection prevalence in Indonesia. Identification of hspMaori type H. pylori in North Sulawesi may support the hypothesis that North Sulawesi people migrated from north.
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan ; Gastroentero-Hepatology Division, Department of Internal Medicine, Airlangga University Faculty of Medicine, Surabaya, 60131 Indonesia ; Institute of Tropical Disease, Airlangga University, Surabaya, 60115 Indonesia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Miftahussurur
authors.affiliation: Department of Parasitology, Faculty of Medicine, Sam Ratulangi University, Manado, 95115 Indonesia.
authors.forename: Josef
authors.initials: J
authors.lastname: Tuda
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan.
authors.forename: Rumiko
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kido
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kawamoto
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Matsuda
authors.affiliation: Institute of Tropical Disease, Airlangga University, Surabaya, 60115 Indonesia.
authors.forename: Indah S
authors.initials: IS
authors.lastname: Tantular
authors.affiliation: Institute of Tropical Disease, Airlangga University, Surabaya, 60115 Indonesia.
authors.forename: Suhintam
authors.initials: S
authors.lastname: Pusarawati
authors.affiliation: Institute of Tropical Disease, Airlangga University, Surabaya, 60115 Indonesia.
authors.lastname: Nasronudin
authors.affiliation: Department of Internal Medicine, Public Hospital of Bethesda Tomohon, Minahasa, 93562 Indonesia.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Harijanto
authors.affiliation: Department of Medicine-Gastroenterology, Baylor College of Medicine and Michael E. Debakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, Texas 77030 USA.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
keywords: Helicobacter pylori; Indonesia; Maori