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Olf Herbarth,¹ Peter Krumbiegel,¹ Gisela J. Fritz,² Matthias Richter,¹ Uwe Schlink,¹ Detlef M. Müller,³ and Thomas Richter³

¹Department of Human Exposure Research and Epidemiology, UFZ-Centre for Environmental Research Leipzig-Halle, Leipzig, Germany; ²Environmental Hygiene and Epidemiology; and ³Children´s Hospital, University of Leipzig, Leipzig, Germany

Abstract

In 1998, the Helicobacter pylori [¹³C]urea breath test was offered to all school beginners (birth cohort 1991/1992) in the city of Leipzig and in Leipzig County, Germany, to determine the colonization prevalence and potential transmission pathways of the bacterium. A total of 3,347 school beginners participated in the test, and 2,888 parents completed the detailed, self-administered questionnaire. The H. pylori prevalence was 6.5% [95% confidence interval (CI) , 5.3-7.6] in the city and 5.7% (CI, 4.2-7.0) in the county. Using cluster analysis (WARD's method, Euclidean distances) , we identified different sets of variables (confirmed by multivariate logistic regression analyses [odds ratios (ORs) ] that are signficantly associated with H. pylori positivity. Among city children, the risk is significantly increased with contact to a pet hamster (OR = 2.4 ; 95% CI, 1.2-4.7 ; p < 0.015) and travels to Asian countries (OR = 3.7 ; 95% CI, 1.6-8.7 ; p < 0.002) . Among county children, H. pylori positivity increased significantly with drinking of water from nonmunicipal sources (OR = 16.4 ; 95% CI, 3.1-88.5 ; p < 0.001) , more than 3 children living in a household (OR = 4.2 ; 95% CI, 1.2-14.6 ; p < 0.02) , and contact with pet hamsters (OR = 2.4 ; 95% CI, 1.0-5.7 ; p < 0.04) . These data suggest that, in a general population sample, indirect fecal-oral transmission and living conditions are important risk factors in the spread of H. pylori infection. However, clinical symptoms do not necessarily indicate H. pylori positivity. Key words: ¹³C breath test, Germany, Helicobacter pylori, prevalences, risk factors, rural county, school beginners, urban center. Environ Health Perspect 109:573-577 (2001) . [Online 21 May 2001]

http://ehpnet1.niehs.nih.gov/docs/2001/109p573-577herbarth/ abstract.html

Address correspondence to O. Herbarth, Department of Human Exposure Research and Epidemiology, UFZ Leipzig-Halle, Permoserstrasse 15, 04318 Leipzig, Germany. Telephone: +49-341-235-2365. Fax: +49-341-235-2288. E-mail: herbarth@expo.ufz.de

We thank W. Braun and W. Kiess, University Children's Hospital, B. Gronemann, Public Health Department, Leipzig ; and F.-J. Gutsmuths and R. Remane, Public Health Services, City and County of Leipzig. We are grateful to all of the participating doctors and technical staff of the Public Health Services, Division of Children and Adolescents, City and County of Leipzig, for incorporating our study into their work schedule and the medical students, S. Jedwilayties, J. Donaubauer, T. Richter, S. List, D. Boeckler, J. Nounia, B. Düring, P. Mehlhorn, J. Üri, and H. Pawlowski, for carrying out the tests. We especially thank all of the children and their parents for their interest and participation in the study.

This study was funded by the UFZ-Centre for Environmental Research Leipzig-Halle, GmbH.

Received 28 June 2000 ; accepted 4 January 2001.