Elevated risk of Helicobacter pylori infection in submarine crews.

In a prospective study designed to elucidate the route of transmission of Helicobacter pylori, the seroprevalence and incidence of Helicobacter pylori infection was determined in the following branches of the armed forces presumed to be at increased risk of acquiring transmissible diseases by the fecal-oral or oral-oral route: German submarine crews (n = 64, mean age 26.2 years) and regular officers of the French infantry (n = 51, mean age 26.5 years) who had served for a minimum of three years. The submarine crews were compared with air force staff (n = 74, mean age 23.7 years), and the French officers with French infantry recruits (n = 135, mean age 20.5 years) who started their service at the beginning of the study. The frequency of IgG and IgA antibody responses to the 120, 88, 86 and 82 kDa proteins was determined by the immunoblot method. The frequency of a positive antibody response was strongly dependent on age (p less than 0.001). When results were controlled for age by the logistic regression analysis, the submarine crews revealed significantly increased frequencies of the IgG and IgA responses compared to air force staff. The antibody responses of French officers and recruits were not significantly different. It is concluded that submarine crews serving during their missions in an overcrowded space with extremely limited sanitary facilities must be considered a high-risk group for Helicobacter pylori infection. These results strongly suggest person-to-person transmission of Helicobacter pylori, by either the oral-oral or the fecal-oral route.