Helicobacter pylori status in family members as risk factors for infection in children.

This study aimed to disentangle the independent contributions of Helicobacter pylori infections in mothers, fathers and siblings to the risk for the infection in the 11-13 years age group. Index children from a cross-sectional Stockholm school survey and their family members completed questionnaires and contributed blood samples. H. pylori serostatus was determined with an enzyme-linked immunosorbent assay and immunoblot. Fifty-four seropositive and 108 seronegative index children were included and 480 out of 548 family members contributed blood. In multivariate logistic regression modelling, having an infected mother (OR 11.6, 95% CI 2.0-67.9) or at least one infected sibling (OR 8.1, 95% CI 1.8-37.3) were risk factors for index child infection, whilst the influence of infected fathers was non-significant. Birth in high-prevalence countries was an independent risk factor (OR 10.4, 95% CI 3.4-31.3). H. pylori infections in mothers and siblings and birth in high-prevalence countries stand out as strong markers of infection risk amongst children in Sweden.

Assessment of the cag pathogenicity island status of Helicobacter pylori infections with serology and PCR.

The serological characterisation of Helicobacter pylori strains has been questioned, e.g., when the presence or absence of the cag pathogenicity island (PAI) is determined. This study compared CagA-reactive serum antibodies, assessed with immunoblot, with cag PAI status, as determined by PCR. CagA serology results were available for 101 individuals contributing 202 bacterial samples for cag PAI PCR. There was a high degree of correlation between the two methods (kappa coefficient, 0.82; 95% confidence interval, 0.68-0.97). Combined with suggested biological explanations for the discrepancies, this finding supports the application of well-evaluated serological assays in the assessment of the cag PAI status of H. pylori infections in clinical and epidemiological studies.

Helicobacter pylori eradication in children and adolescents by a once daily 6-day treatment with or without a proton pump inhibitor in a double-blind randomized trial.

AIM: To evaluate two simplified Helicobacter pylori eradication treatment alternatives for children and adolescents. METHODS: Study subjects were identified by enzyme-linked immunosorbent assay and immunoblot in a family screening project. Helicobacter pylori infected 10-21 year olds were offered treatment, individuals with abdominal pain underwent upper endoscopy and those with peptic ulcers were excluded. Participants were randomized to either azithromycin 500 mg daily and tinidazole 500 mg two tablets daily in combination with lansoprasole 30 mg daily for 6 days (ATL-group) or with placebo (ATP-group). Urea Breath Test was performed at inclusion and after a minimum of 6 weeks after end of therapy. RESULTS: In total, 131 individuals were randomized, of whom 31 (24%) had undergone upper endoscopy. Full compliance was achieved in 93% (122 of 131). The intention-to-treat eradication rate was 67% (44 of 66) and 58% (38 of 65) for the ATL- and the ATP-group, respectively. CONCLUSION: The double-blind randomized clinical trial did not identify a simplified, successful once daily H. pylori treatment for children and adolescents. Thus, twice daily proton pump inhibitor (PPI)-based triple therapies for 7 days remain as the choice of treatment in children. Further, powerful and controlled studies are needed to elucidate the best treatment strategies for H. pylori eradication in this age group.

Helicobacter pylori infection in Swedish school children: lack of evidence of child-to-child transmission outside the family.

BACKGROUND & AIMS: Helicobacter pylori infection is mainly acquired in early childhood, but the exact routes of transmission remain elusive. To distinguish between risks of intrafamilial and extraneous child-to-child transmission, we studied H. pylori seroprevalence among Swedish school children with varying family backgrounds. METHODS: In a cross-sectional study, 695 of 858 (81%) 10-12-year-olds in 36 school classes in Stockholm donated blood and answered a questionnaire. Infection was detected by enzyme-linked immunosorbent assay and confirmed by immunoblot and urea breath test. RESULTS: Overall, 112 (16%) children were infected. The seroprevalence was 2% among 435 children with Scandinavian parents and 55% among 144 children with origin in high prevalence areas (Middle East and Africa). Among children born in Scandinavia, the odds ratios (adjusted for gender, socioeconomic status, and family size) for being seropositive were 39.1 (95% confidence interval, 16.7-91.3) and 5.6 (1.8-17.3) when having parents born in high and medium prevalence areas, respectively, relative to children with Scandinavian parents. Importantly, the prevalence of infection among the classmates was not a risk factor for H. pylori infection. CONCLUSION: Our data indicate that intrafamilial transmission is far more important than child-to-child transmission outside the family. The H. pylori prevalence in the parental generation may be a crucial determinant for the child's risk of contracting the infection.

The accuracy of serologic diagnosis of Helicobacter pylori infection in school-aged children of mixed ethnicity.

UNLABELLED: The present study evaluated two non-invasive diagnostic methods for H. pylori infection in children, i.e. an in-house ELISA using sonicated Campylobacter jejuni antigen for absorption of cross-reacting antibodies and an immunoblot kit (Helico Blot 2.0, Genelabs, Singapore). 13C -Urea breath test (13C-UBT) was used as reference METHOD: Sera and questionnaires were collected from 695/858 (81%) Swedish school children with mixed ethnic backgrounds within a cross-sectional, community-based study. Of 133 children with an ELISA OD value of > or = 0.1, all were screened with immunoblot and 107 made a 13C-UBT. The negative controls were 34/37 children from three school classes with an ELISA OD value of < 0.1 and volunteering for a 13C-UBT. An adjusted cut-off level for the ELISA of OD value 0.22 resulted in a sensitivity of 97.8%, a specificity of 95.8% and a concordance index of 97.2%. The Helico Blot 2.0 had a sensitivity of 97.8%, a specificity of 93.8% and a concordance index of 96.5%. The best concordance was seen for the 26.5 kDa (98.6%), 30 kDa (95.7%) and 19.5 kDa (91.5%) antigens. The corresponding concordance index for CagA was 78%, for VacA 73.8% and for the 35kDa antigen 68.8%. A significant difference in the distribution of the 19.5 and 26.5 kDa bands but not of CagA/VacA was noted by ethnic background. With an adjusted cut-off level for the enzyme-linked immunosorbent assay (ELISA), both non-invasive methods were found to have an adequate performance in a pediatric population. The differences in antibody response patterns by ethnic background represent a caveat in the interpretation of serological studies.

Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection.

In a cohort study of 305 Swedish children, repeated blood samples and structured questionnaires were obtained from 6 mo to 11 y of age. Of the 40 children seropositive for Helicobacter pylori in one or more samples, 32 (80%) had cleared the infection by 11 y of age. No association was found between H. pylori seropositivity at any time and reported antibiotic consumption, size of home and family, type of day-care, history of atopic disease, length of breastfeeding or peptic ulcer disease in the family. Girls reported more (p = 0.002) unspecified abdominal pain during childhood than boys, but the difference in H. pylori infection rate (15/150, 10% for boys and 25/144, 17% for girls) was not significantly different (p = 0.09). Unspecified abdominal pain during childhood was reported more often (OR adjusted for gender = 2.2, 95% CI = 1.0-4.4, p = 0.04) for the children seropositive at some point (17/39, 44%) than for the seronegative children (54/217, 25%). RAP at 11 y of age was more often reported by the 9/36 (25%) children seropositive at some time in life than by the 23/172 (13%) seronegatives, but the difference was not statistically significant (OR adjusted for gender = 2.0, 95% CI = 0.8-4.6, p = 0.1). The study shows that H. pylori seropositivity was associated with a parental report of unspecified abdominal pain during childhood. Also, a history of unspecified abdominal pain was more common (OR = 51.6, 95% CI = 15.6-220, p < 0.001) in children reporting RAP at 11 y of age.

A ten year follow-up after immunization with a two component acellular pertussis vaccine.

OBJECTIVES: To investigate the duration of antitoxin response and immunity to pertussis 10 years after priming with either two or three doses of a two component acellular pertussis vaccine or with three doses of a whole cell vaccine and then boostered with the acellular vaccine. SUBJECTS: At 11 years of age 207 of 304 (68%) children of the original cohort returned for a blood sample and 262 (86%) participated by answering a questionnaire. METHODS: Neutralizing antibodies to pertussis toxin (antitoxin) were analyzed by the Chinese hamster ovary cell assay. Clinical pertussis and pertussis exposure were investigated by a structured questionnaire. RESULTS: Measurable antitoxin was found in 77% of the samples, with no differences by type of vaccine or by the number of doses given for priming. A significant decrease of antibody concentration (P<0.001) was noted from the previous recall at 4 years of age, and significant titer rises were found for 14% of the children, irrespective of known exposure. Confirmed pertussis during follow-up, as defined in the study, was reported for 14 of 262 (5%) children. CONCLUSIONS: The study showed that antitoxin concentrations are maintained in a situation of endemic pertussis and indicated that the long term protection after an acellular booster was good, irrespective of type of vaccine or the number of doses of acellular vaccine given for priming.

[Specimen culture from all children in a day care center because of an outbreak of streptococcal infection]. / Odling på samtliga barn vid streptokockutbrott i förskola.

In an outbreak of recurrent group A streptococcal (GAS) pharyngotonsillitis between January and February 1997 at a Swedish preschool, involving 58% (11/19) of the children and several family members, clinical examination showed few of the children to manifest signs and symptoms of tonsillitis. However, throat specimens yielded GAS growth of the same T-type in 42% (8/19) of the children and in 30% (6/20) of family members, but in none of the staff. Strict hygiene, appropriate antibiotic treatment of all culture-positive individuals irrespective of symptoms, and non-attendance at the preschool during the first two days of treatment promptly terminated the outbreak and there were no cases of recurrence.

Seroepidemiology of Helicobacter pylori infection in a cohort of children monitored from 6 months to 11 years of age.

A cohort of Swedish children was monitored from 6 months to 11 years of age. Immunoglobulin G (IgG) and IgA antibodies to Helicobacter pylori were measured in 1,857 serum samples, drawn at the ages of 6, 8, 10, 18 months and 2, 4, and 11 years. Of the 294 children, 40 (13.6%) were found to have been infected at some time. However, at 11 years of age, only 6 of 201 (3%) children were seropositive. The highest seroprevalence of positive results, 10%, was found at 2 years of age, and the highest incidence of 13.3% could be calculated for the period between 18 months and 2 years of age. There were no confirmed additional cases for children between 4 and 11 years of age. Infection with H. pylori thus occurs at an early age in a developed country (as well as in developing countries), and spontaneous clearance seems to be common.

[Female circumcision opposed in Haninge]. / Kvinnlig könsstympning motarbetas i Haninge.

PIP: Less radical forms of female circumcision are called infibulation and Pharaonic circumcision. It is estimated that 113 million women in the world are exposed to female circumcision of one form or another. In Sweden about 16,000 women originate from countries where female circumcision is practiced. 60% of them are from Somalia or Ethiopia, and 11,000 of these women are of reproductive age. About 5000 girls are under 18 years of age and are at risk of female circumcision if it has not already taken place. Sweden has ratified a UN convention on the right of children, and since 1982 there has been a law in force that prohibits female circumcision. A great number of African refugees have been settling in Jordbro, in the county of Haninge, south of Stockholm, since 1992. 35 central African families live there, one-third of them from Somalia. The mother and child health care agency has confronted several problems related to female circumcision: infibulated women do not get traditional gynecological examinations, families demand that women get infibulated after delivery, and some families have asked for circumcision of their newborn daughters. The agency organized African family group sessions, held for a month during evenings, in which all families were invited to discuss topics related to the improvement of women's and children's health and the fight against female circumcision. At each family group meeting 10-15 adults participated. Several sessions dealt with children's diseases, reproductive physiology, and the role of female circumcision in religion and tradition. Most women were illiterate and this was their first encounter with the Swedish health system whereby they were informed about the functioning of the human body. African traditions are deeply rooted. In Gambia female circumcision is practiced by 50-60% of people, although in milder forms. Since 1993, when the group discussions started, not a single case of circumcision was reported in pre-school-age girls.^ieng