title: The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study.
abstract: OBJECTIVE
  Previous research on H. pylori epidemiology has mostly focused on adult populations. We have aimed to study H. pylori prevalence in all age groups including children and adolescents and to identify potential routes of transmission.
  
  
  METHODS
  Subjects from all age groups (children 0-11 years, adolescents 12-17 years and adults ≥18 years of age), recruited from both an urban and a rural community in Northern Norway, were invited to provide stool samples for the diagnosis of H. pylori antigen and to fill in a questionnaire (adult and adolescents only) on gastrointestinal symptoms, lifestyle factors and biometric data.
  
  
  RESULTS
  A total of 1 624 (35.3%) of the invited subjects, including 173 (39.3%) of the children, 46 (19.2%) of the adolescents, and 1 416 (36.1%) of the adults, responded to the invitation. H. pylori infection was nearly undetectable (0.6%) among the children, whereas the prevalence increased from 20% in adolescents toward a peak of 45% in the highest age group. Univariate analyses of possible risk factors of H. pylori infection showed significant associations to private well water, the use of outhouse toilet, and having farm animals in childhood, but the associations waned in multivariate analyses.
  
  
  CONCLUSIONS
  In our populations, with apparent high hygienic standards, the transmission of H. pylori infection may start not only in childhood, but also in adolescence, where potential transmission routes may be outdoor toilet use, private well water, and farm animals.
authors.affiliation: Department of Gastroenterology, Division of Medicine, Nordland Hospital, Bodø, Norway.|Research group of Gastroenterology and Nutrition, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Ragnar K
authors.initials: RK
authors.lastname: Breckan
authors.affiliation: Research group of Gastroenterology and Nutrition, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.|Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Eyvind J
authors.initials: EJ
authors.lastname: Paulssen
authors.affiliation: Department of Microbiology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Anne Mette
authors.initials: AM
authors.lastname: Asfeldt
authors.affiliation: Research group of Gastroenterology and Nutrition, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.|Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Jan-Magnus
authors.initials: JM
authors.lastname: Kvamme
authors.affiliation: Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Straume
authors.affiliation: Research group of Gastroenterology and Nutrition, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.|Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Jon
authors.initials: J
authors.lastname: Florholmen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005243:Feces / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult
keywords: 
  Helicobacter pylori
  ; Adolescents; adults; children; population-based; transmission