Seroprevalence of Helicobacter pylori infection among children of low socioeconomic level in São Paulo
Keywords:
Helicobacter infections, Serology, Cross-sectional studies, Seroepidemiologic studies, Urban populationAbstract
CONTEXT AND OBJECTIVE: Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study, among patients attended at an outpatient clinic. METHODS: 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS: H. pylori infection was diagnosed in 116 children (35.6%). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p < 0.0001). The seroprevalence increased from 20.8% among children aged two to four years, to 58.3% among those older than 12 years. There were no significant relationships between seropositivity and gender, color, breastfeeding, number of people in the home, number of rooms, bed sharing, living in a shantytown, maternal educational level, family income or nutritional status. In multivariate analysis, the only variable significantly associated with H. pylori seropositivity was age. CONCLUSION: Infection had intermediate prevalence in the study population, and age was associated with higher prevalence.
Downloads
References
Malfertheiner P, Megraud F, O’Morain C, et al. Current concepts in the management of Heli- cobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56(6):772-81.
Windle HJ, Kelleher D, Crabtree JE. Childhood Helicobacter pylori infection and growth im- pairment in developing countries: a vicious cycle? Pediatrics. 2007;119(3):e754-9.
Rowland M, Daly L, Vaughan M, et al. Age-specific incidence of Helicobacter pylori. Gastro- enterology. 2006;130(1):65-72.
Rupnow MF, Shachter RD, Owens DK, Parsonnet J. A dynamic transmission model for predic- ting trends in Helicobacter pylori and associated diseases in the United States. Emerg Infect Dis. 2000;6(3):228-37.
Graham DY, Shiotani A. The time to eradicate gastric cancer is now. Gut. 2005;54(6):735-8.
Kruszon-Moran D, McQuillan GM. Seroprevalence of six infectious diseases among adults in the United States by race/ethnicity: data from the third national health and nutrition examination survey, 1988--94. Adv Data. 2005;(352):1-9.
Thjodleifsson B, Asbjörnsdottir H, Sigurjonsdottir RB, et al. Seroprevalence of Helico- bacter pylori and cagA antibodies in Iceland, Estonia and Sweden. Scand J Infect Dis. 2007;39(8):683-9.
O’Donohoe JM, Sullivan PB, Scott R, et al. Recurrent abdominal pain and Helicobacter pylori
in a community-based sample of London children. Acta Paediatr. 1996;85(8):961-4.
Yamashita Y, Fujisawa T, Kimura A, Kato H. Epidemiology of Helicobacter pylori infection in children: a serologic study of the Kyushu region in Japan. Pediatr Int. 2001;43(1):4-7.
Olmos JA, Ríos H, Higa R. Prevalence of Helicobacter pylori infection in Argentina: results of a nationwide epidemiologic study. Argentinean Hp Epidemiologic Study Group. J Clin Gastroenterol. 2000;31(1):33-7.
Newton R, Ziegler JL, Casabonne D, et al. Helicobacter pylori and cancer among adults in Uganda. Infect Agent Cancer. 2006;1:5.
Yim JY, Kim N, Choi SH, et al. Seroprevalence of Helicobacter pylori in South Korea. Helico- bacter. 2007;12(4):333-40.
Malaty HM, Kim JG, Kim SD, Graham DY. Prevalence of Helicobacter pylori infection in Kore- an children: inverse relation to socioeconomic status despite a uniformly high prevalence in adults. Am J Epidemiol. 1996;143(3):257-62.
Aguemon BD, Struelens MJ, Massougbodji A, Ouendo EM. Prevalence and risk-factors for Helicobacter pylori infection in urban and rural Beninese populations. Clin Microbiol Infect. 2005;11(8):611-7.
Ito LS, Oba-Shinjo SM, Shinjo SK, et al. Community-based familial study of Helicobacter pylori infection among healthy Japanese Brazilians. Gastric Cancer. 2006;9(3):208-16.
Fialho AM, Braga AB, Queiroz DM, et al. The association between Helicobacter pylori infec- tion and height in children from an urban community in north-east Brazil. Ann Trop Paediatr. 2007;27(1):55-61.
Weiss J, Mecca J, da Silva E, Gassner D. Comparison of PCR and other diagnostic techni- ques for detection of Helicobacter pylori infection in dyspeptic patients. J Clin Microbiol. 1994;32(7):1663-8.
Portorreal A, Kawakami E. Avaliação do método imunoenzimático (ELISA) para diagnóstico da infecção por Helicobacter pylori em crianças e adolescentes [Evaluation of enzyme- linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children and adolescents]. Arq Gastroenterol. 2002;39(3):198-203.
Vittinghof E, Glidden DV, Shiboski SC, McCulloch CE. Regression methods in biostatistics: linear, logistic, survival, and repeated measures models (Statistics for Biology and Health). New York: Springer; 2005.
Oliveira AM, Queiroz DM, Rocha GA, Mendes EN. Seroprevalence of Helicobacter pylori in- fection in children of low socioeconomic level in Belo Horizonte, Brazil. Am J Gastroenterol. 1994;89(12):2201-4.
Braga AB, Fialho AM, Rodrigues MN, et al. Helicobacter pylori colonization among children up to 6 years: results of a community-based study from Northeastern Brazil. J Trop Pediatr. 2007;53(6):393-7.
Escobar ML, Kawakami E. Evidence of mother-child transmission of Helicobacter pylori in- fection. Arq Gastroenterol. 2004;41(4):239-44.
Granström M, Tindberg Y, Blennow M. Seroepidemiology of Helicobacter pylori infection in a cohort of children monitored from 6 months to 11 years of age. J Clin Microbiol. 1997;35(2):468-70.
Malaty HM, El-Kasabany A, Graham DY, et al. Age at acquisition of Helicobacter pylori infec- tion: a follow-up study from infancy to adulthood. Lancet. 2002;359(9310):931-5.
Glynn MK, Friedman CR, Gold BD, et al. Seroincidence of Helicobacter pylori infection in a cohort of rural Bolivian children: acquisition and analysis of possible risk factors. Clin Infect Dis. 2002;35(9):1059-65.
Ozen A, Ertem D, Pehlivanoglu E. Natural history and symptomatology of Helicobacter pylori in childhood and factors determining the epidemiology of infection. J Pediatr Gastroenterol Nutr. 2006;42(4):398-404.
Opekun AR, Gilger MA, Denyes SM, et al. Helicobacter pylori infection in children of Texas. J Pediatr Gastroenterol Nutr. 2000;31(4):405-10.
Rocha GA, Oliveira AM, Queiroz DM, et al. Serodiagnosis of Helicobacter pylori in- fection by Cobas Core ELISA in adults from Minas Gerais, Brazil. Braz J Med Biol Res. 1998;31(10):1263-8.
de Oliveira AM, Rocha GA, Queiroz DM, et al. Evaluation of enzyme-linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children from different age groups with and without duodenal ulcer. J Pediatr Gastroenterol Nutr. 1999;28(2):157-61.
Sobala GM, Crabtree JE, Dixon MF, et al. Acute Helicobacter pylori infection: clinical features, local and systemic immune response, gastric mucosal histology, and gastric juice ascorbic acid concentrations. Gut. 1991;32(11):1415-8.
Kawakami E, Machado RS, Reber M, Patrício FR. 13 C-urea breath test with infrared spec- troscopy for diagnosing Helicobacter pylori infection in children and adolescents. J Pediatr Gastroenterol Nutr. 2002;35(1):39-43.
Raguza D, Granato CF, Kawakami E. Evaluation of the stool antigen test for Helicobacter pylori in children and adolescents. Dig Dis Sci. 2005;50(3):453-7.
Elitsur Y, Yahav J. Helicobacter pylori infection in pediatrics. Helicobacter. 2005;10 Suppl 1:47-53.
Hopkins RJ, Vial PA, Ferreccio C, et al. Seroprevalence of Helicobacter pylori in Chile: vege- tables may serve as one route of transmission. J Infect Dis. 1993;168(1):222-6.
Webb PM, Knight T, Greaves S, et al. Relation between infection with Helicobacter pylori and living conditions in childhood: evidence for person to person transmission in early life. BMJ. 1994;308(6931):750-3.
Kikuchi S, Ohgihara A, Hasegawa A, et al. Seroconversion and seroreversion of Helicobacter pylori antibodies over a 9-year period and related factors in Japanese adults. Helicobacter. 2004;9(4):335-41.
Zaterka S, Eisig JN, Chinzon D, Rothstein W. Factors related to Helicobacter pylori prevalence in an adult population in Brazil. Helicobacter. 2007;12(1):82-8.
Klein PD, Graham DY, Gaillour A, Opekun AR, Smith EO. Water source as risk factor for He- licobacter pylori infection in Peruvian children. Gastrointestinal Physiology Working Group. Lancet. 1991;337(8756):1503-6.
