Gastroenteritis and Transmission of Helicobacter pylori Infection in Households

Sharon Perry; Maria de la Luz Sanchez; Shufang Yang; Thomas D. Haggerty; Philip Hurst; Guillermo Perez-Perez; Julie Parsonnet

Disclosures

Emerging Infectious Diseases. 2006;12(11) 

In This Article

Abstract and Introduction

Abstract

The mode of transmission of Helicobacter pylori infection is poorly characterized. In northern California, 2,752 household members were tested for H. pylori infection in serum or stool at a baseline visit and 3 months later. Among 1,752 person considered uninfected at baseline, 30 new infections (7 definite, 7 probable, and 16 possible) occurred, for an annual incidence of 7% overall and 21% in children <2 years of age. Exposure to an infected household member with gastroenteritis was associated with a 4.8-fold (95% confidence interval [CI] 1.4-17.1) increased risk for definite or probable new infection, with vomiting a greater risk factor (adjusted odds ratio [AOR] 6.3, CI 1.6-24.5) than diarrhea only (AOR 3.0, p = 0.65). Of probable or definite new infections, 75% were attributable to exposure to an infected person with gastroenteritis. Exposure to an H. pylori-infected person with gastroenteritis, particularly vomiting, markedly increased risk for new infection.

Introduction

Helicobacter pylori infects at least 50% of the world's population. Infection occurs in early life.[1,2] Because acute infection invariably passes undetected, however, the precise age of acquisition is unknown. In industrialized countries, infection rates are declining rapidly,[1,3] but high rates of infection persist among disadvantaged and immigrant populations.[4,5]

The mechanisms of H. pylori transmission are incompletely characterized. Person-to-person transmission is most commonly implicated with fecal/oral, oral/oral, or gastric/oral pathways;[6] each has supportive biologic as well as epidemiologic evidence. Like many common gastrointestinal infections, infection is associated with conditions of crowding and poor hygiene [7,8] and with intrafamilial clustering.[9,10,11,12] The organism has been recovered most reliably from vomitus and from stools during rapid gastrointestinal transit.[13] These findings raise the hypothesis that gastroenteritis episodes provide the opportunity for H. pylori transmission.

Household transmission of gastroenteritis is common in the United States, particularly in homes with small children.[14] If H. pylori is transmitted person to person, one might expect rates of new infection to be elevated after exposure to persons with H. pylori-infected cases of gastroenteritis. To explore whether diarrhea or vomiting contributes to disease transmission, we monitored northern Californian households experiencing gastroenteritis for new H. pylori infections and evaluated the contributions of household H. pylori infection and gastroenteritis to new infection. We were also interested in whether symptoms of new infection could be identified.

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