Large-scale, national, family-based epidemiological study onHelicobacter pyloriinfection in China: the time to change practice for related disease prevention

Abstract

Background and aimsCurrent practice onHelicobacter pyloriinfection mostly focuses on individual-based care in the community, but family-basedH. pylorimanagement has recently been suggested as a better strategy for infection control. However, the family-basedH. pyloriinfection status, risk factors and transmission pattern remain to be elucidated.MethodsFrom September 2021 to December 2021, 10 735 families (31 098 individuals) were enrolled from 29 of 31 provinces in mainland China to examine family-basedH. pyloriinfection, related factors and transmission pattern. All family members were required to answer questionnaires and test forH. pyloriinfection.ResultsAmong all participants, the average individual-basedH. pyloriinfection rate was 40.66%, with 43.45% for adults and 20.55% for children and adolescents. Family-based infection rates ranged from 50.27% to 85.06% among the 29 provinces, with an average rate of 71.21%. In 28.87% (3099/10 735) of enrolled families, there were no infections; the remaining 71.13% (7636/10 735) of families had 1–7 infected members, and in 19.70% (1504/7636), all members were infected. Among 7961 enrolled couples, 33.21% had no infection, but in 22.99%, both were infected. Childhood infection was significantly associated with parental infection. Independent risk factors for household infection were infected family members (eg, five infected members: OR 2.72, 95% CI 1.86 to 4.00), living in highly infected areas (eg, northwest China: OR 1.83, 95% CI 1.57 to 2.13), and large families in a household (eg, family of three: OR 1.97, 95% CI 1.76 to 2.21). However, family members with higher education and income levels (OR 0.85, 95% CI 0.79 to 0.91), using serving spoons or chopsticks, more generations in a household (eg, three generations: OR 0.79, 95% CI 0.68 to 0.92), and who were younger (OR 0.57, 95% CI 0.46 to 0.70) had lower infection rates (p<0.05).ConclusionFamilialH. pyloriinfection rate is high in general household in China. Exposure to infected family members is likely the major source of its spread. These results provide supporting evidence for the strategic changes fromH. pyloriindividual-based treatment to family-based management, and the notion has important clinical and public health implications for infection control and related disease prevention.

‘Family-based’ strategy forHelicobacter pyloriinfection screening: an efficient alternative to ‘test and treat’ strategy

“…To address this gap, we built a database consisting of over one million households, based on the infection status of households and individuals from 29 provinces reported by Zhou, in order to simulate real-world scenarios. The screening protocols were simulated in national database and subdataset by province, and were defined as follows (figure 1A) 1 :…”

“…We read with utmost interest the study by Zhou et al ,1 which was the first family-based investigation of Helicobacter pylori ( Hp ) infection in China. The authors provided valuable insights into the occurrence of familial cluster effect on Hp infection and the superiority of the ‘family-based strategy’.…”

“…To address this gap, we built a database consisting of over one million households, based on the infection status of households and individuals from 29 provinces reported by Zhou, in order to simulate real-world scenarios. The screening protocols were simulated in national database and subdataset by province, and were defined as follows (figure 1A)1: The ‘test-and-treat strategy’ involved randomly selecting participants for Hp testing until all participants were tested 2. The ‘family-based strategy’ involved participants selecting, as well as Hp testing of family members only if the selected individual tested positive for Hp .…”

Epidemiology of Helicobacter in Chinese families: a foundation for cost-effective eradication strategies?

“…1 Gansu, one of the poorest provinces in China, has the highest prevalence of H. pylori and the highest incidence of gastric cancer. 2 But globally, the correlation does not always hold. India and Bangladesh are known to have a high prevalence of H. pylori but a low incidence of gastric cancer.…”

“…In China, the H. pylori prevalence is lower (~30%–50%) along the wealthier coastal cities and higher (~50%–80%) among the inner cities 1. Gansu, one of the poorest provinces in China, has the highest prevalence of H. pylori and the highest incidence of gastric cancer 2…”