title: Serologic Evidence for Fecal-Oral Transmission of Helicobacter pylori.
abstract: Helicobacter pylori infection is among the most prevalent infections in the world and a key cause of gastric diseases; however, its route of transmission remains unclear. This study aimed to assess the potential for fecal-oral transmission of H. pylori by leveraging its association with a disease with known etiology. Utilizing serology data from the National Health and Nutrition Examination Survey (NHANES 1999; N = 6,347), the association between H. pylori and hepatitis A virus (HAV), a sensitive indicator for fecal-oral exposure, was assessed. Survey-weighted kappa and multiple logistic regression were used to quantify the association between H. pylori and HAV after controlling for age, sex, race, poverty, birthplace, crowding, smoking, and alcohol use. Concordant serological results were found among 69.8% of participants (survey-weighted κ = 0.30, 95% confidence interval [CI] = 0.26, 0.35). The adjusted odds of H. pylori seropositivity were over two times higher after adjusting for confounders (odds ratio = 2.27, 95% CI = 1.79, 2.87). Results from this study suggest H. pylori and HAV infections are strongly associated. Since HAV is primarily transmitted through the fecal-oral route, fecal-oral transmission may be an important pathway for H. pylori spread.
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona davidbui@email.arizona.edu.
authors.forename: David
authors.initials: D
authors.lastname: Bui
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Brown
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
authors.forename: Robin B
authors.initials: RB
authors.lastname: Harris
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.
authors.forename: Eyal
authors.initials: E
authors.lastname: Oren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000907:Antibodies, Bacterial / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000382:microbiology*; D016480:Helicobacter pylori / Q000145:classification*; D006506:Hepatitis A / Q000635:transmission / Q000821:virology; D030041:Hepatitis A virus; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016036:Seroepidemiologic Studies; D012698:Serologic Tests; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral