The All-Age Prevalence of Helicobacter pylori Infection and Potential Transmission Routes. A Population-Based Study

Background and aimsPrevious 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. MethodsSubjects 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. ResultsA 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. ConclusionsIn 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.