Bastos et al. [11] confirmed in a meta-analysis a moderate positive association with frequency of childcare as a risk factor for H. pylori infection, especially in settings with a high prevalence of infection. Erlotinib mouse In other studies, the role of transmission of infection from adults to children was emphasized. Urita et al. [12] studied transmission of

H. pylori in children in a Japanese rural town. They demonstrated that not only mother-to-child transmission but also grandmother-to-child transmission is an important mechanism for the spread of H. pylori in a three-generation household. In contrast, having an infected father or grandfather was not an independent predictor for children’s Selleckchem Adriamycin infection. In other studies, it was noted that after eradication, a first-year relapse is likely to be a recurrence of the previous infection, while later on it is probably a reinfection with a new strain [13]. Mendoza et al. [14] directed their attention to a frequent occurrence of cagA-positive strains. A total of 37.9%

of school children had an active or past H. pylori infection; of them 73.8% were carrying a cagA-positive strain. School children with iron deficiency and a small height for their age had a higher risk of H. pylori infection. The odds ratio (OR) for active or past infection was 2.30 (95% CI 1.01–5.23) compared with school children with normal iron status and height or with normal iron status but small height for their age [11]. In the studies of Vanderpas

et al. [15], the reinfection rate after eradication during 5 years was 48.6%, while a new infection during 10 years in previously negative people was 38.7%. The risk of infection was fourfold greater in children of non-European origin (p < .001). Infection with H. pylori either in children or in adults is a risk factor for gastric cancer. Ghasemi-Kebria et al. [16] studied 194 children (1–15 years old) enrolled in two different areas in the Golestan province for the incidence of gastric cancer. They found that the prevalence of H. pylori infection Ceramide glucosyltransferase was significantly higher in the high-risk area for stomach cancer than in the low-risk area (p = .004) and that the H. pylori (p = .03) and CagA (p = .04) seropositivities were significantly lower in children less than 5 years old than in the others. The authors concluded that there is a positive relationship between childhood H. pylori infection and the risk of gastric cancer and they called for an implementation of preventive programs to reduce the burden of childhood H. pylori infection and gastric cancer in that area. Finally, Hirsch et al. [17] detected H. pylori DNA by PCR in plaque and root canal samples, and cultured H. pylori from two root canals, suggesting that these sites may be a reservoir for H. pylori and serve as a potential source of transmission.