Transmission and Prevention of Helicobacter pylori Infection

Acquisition in Childhood

Helicobacter pylori is primarily acquired during childhood through person‑to‑person transmission within families, most commonly from infected mothers to their children, via fecal‑oral, gastric‑oral, or oral‑oral routes. 1, 2

Intrafamilial clustering is characteristic of H. pylori infection; the bacterium spreads within households, and direct person‑to‑person contact is the principal mechanism. 3, 4

Prevalence is markedly higher in certain ethnic groups: infection rates are approximately 2.6‑fold greater among Hispanics and 3.2‑fold greater among East Asians compared with the overall U.S. population. 3
Immigrants from high‑prevalence regions (Central and South America, the Caribbean, Eastern Europe, Asia, and India) retain infection rates similar to those in their countries of origin. 5, 6

Family screening is recommended once an index case is identified; all household members should be tested because transmission occurs within families. 3, 4
Eradication therapy for infected family members helps prevent further transmission, reinfection, and H. pylori‑related diseases in other relatives. 3, 4

In affluent countries, improvements in sanitation, indoor plumbing, and access to clean water have led to a progressive decline in H. pylori transmission, reflected by lower prevalence in successive birth cohorts. 5, 6

Lack of clean water and indoor plumbing markedly increases the risk of H. pylori acquisition, highlighting the role of poor sanitation in transmission. 7
Low socioeconomic status is associated with higher prevalence of H. pylori infection, indicating that economic disadvantage contributes to sustained transmission within communities. 7

Immigrants originating from regions with high endemicity (e.g., Central and South America, the Caribbean, Eastern Europe, Asia, and India) retain infection rates comparable to those of their countries of origin, underscoring the importance of birthplace in risk assessment. 7
Historically disadvantaged subpopulations continue to exhibit elevated H. pylori prevalence even when residing in affluent nations, reflecting persistent socioeconomic and environmental disparities. 7

In affluent countries, the overall prevalence of H. pylori infection is declining, a trend attributed to improvements in sanitation infrastructure, access to clean water, and better housing conditions. 7
Successive birth cohorts in developed nations demonstrate progressively lower infection rates, indicating a cohort effect linked to ongoing public‑health advances. 7