Is there an occupational risk for transmission of Helicobacter pylori in healthcare workers?

Abstract

Objectives Helicobacter pylori was discovered in 1984, but up to now the way it is transmitted is not clear. Direct person-toperson transmission is thought to be most likely and could be relevant to occupational transmission, particularly in healthcare workers (HCWs). Methods Using serology, we studied the occupational risk for H pylori in HCWs in two cross-sectional studies and one cohort study (follow-up 10 years). Results In a cross-sectional study, 587 HCWs working in institutions for children with mental disabilities with a documented high prevalence of H pylori infection were compared to non-exposed controls. Using multiple logistic regression to adjust for confounding variables, an OR of 2 (95% CI 1.4 to 2.7) was found in workers having contact with faeces of inhabitants. In another cross-sectional study in 198 nursing home workers, an OR of 0.9 (95% CI 0.5 to 1.9) was found in multiple logistic regression compared to non-exposed controls after adjusting for other risk factors. In the cohort of HCWs and non-exposed controls, workers seronegative for H pylori at baseline were followed up for at least 10 years, resulting in 2254 person-years (py) in the HCW group and 1284 in nonexposed controls. In HCWs an incidence rate for H pylori infection of 0.53/100 py (95% CI 0.28 to 0.93) was found, compared to 0.39/100 py (95% CI 0.13 to 0.91) in non-exposed controls resulting in a rate ratio of 1.36 (95% CI 0.43 to 4.21). Conclusions These results show the difficulty in interpreting cross-sectional studies. Results of a cohort study show a slightly increased incidence of H pylori infection in HCWs compared to non-exposed controls.