The ability to induce long-term immunity to Helicobacter pylori is necessary for an effective vaccine. This study was designed to establish the most efficient route(s) (systemic, mucosal, or a combination) of immunization for induction of long-term immunity and to define correlates of protection. Mice were immunized orally alone (oral group), intramuscularly (i.m.) alone (i.m. group), orally followed by i.m. (oral/i.m. group), or i.m. followed by orally (i.m./oral group). Long-term protective immunity to oral H. pylori challenge was observed 3 months after immunization through the i.m. or oral/i.m. route. Protection correlated with an increase in H. pylori-specific interleukin-12 and both immunoglobulin G1 (IgG1) and IgG2a serum titers following challenge. Mice that were not protected (oral or i.m./oral) had increased levels of IgA in both sera and Peyer's patches. This study demonstrates the ability to induce long-term immunity against H. pylori, provides correlates of protection, and illustrates the crucial role of the immunization route(s).Helicobacter pylori is a gram-negative spiral bacterium that colonizes the gastric epithelium in nearly 50% of the world's population. Infection is typically acquired early in childhood and continues throughout the life of the host, leading to chronic gastritis and in some cases peptic ulcer disease or gastric cancer (32, 37). In spite of the development of H. pylori-specific immune responses, the bacteria are rarely eliminated from the gastric epithelium (6). Treatment for H. pylori infection includes a combination of a proton pump inhibitor and two antibiotics. However, antibiotic resistance, high cost, and recurrence of infection make world-wide eradication through drug therapy problematic. While development of a vaccine is ideal, the challenge lies in inducing long-lasting immunity. Various routes of immunization have been used to demonstrate protection against H. pylori in mice: oral, intranasal, intrarectal, intradermal, and subcutaneous (11,13,15,20,24,34,35,43). Most H. pylori vaccine studies challenge animals 2 to 4 weeks after immunization, when the immune response is still in the acute effector phase (13, 15, 18, 20-22, 35, 36), and this does not test generation and maintenance of immunologic memory. Thus, results from previous studies cannot be used to predict long-term protection.Mucosal immunization is a route commonly used to induce mucosal immunity. While immunizing through a mucosal route seems optimal for eliciting mucosal immunity, no studies have reported its success in the generation of H. pylori immunologic memory. Unlike for Helicobacter felis, against which long-term protection can be achieved through immunization, a longterm-protection model for H. pylori has yet to be reported (27,33). Recent studies have demonstrated that immunization through a combination of mucosal and systemic routes may increase mucosal immunity (22,25,39,40).The mechanisms by which protection against H. pylori occurs are still unknown. In general, immune responses, such as l...