Helicobacter pylori, Republic of Georgia

al. Acute meningitis due to Toscana virus infection among patients from both the Spanish Mediterranean region and the region of Madrid. Cusi MG. Fast duplex one-step RT-PCR for rapid differential diagnosis of entero-or Toscana virus meningitis. of arbovirus overwintering: survival of Toscana virus (Bunyaviridae: Phlebovirus) in its natural sandfly vector Phlebotomus perniciosus. To the Editor: Helicobacter pylori infection is a principal cause of chronic active gastritis and peptic ulcer disease as well as gastric adenocarcino-ma and mucosa-associated lymphoid tissue lymphoma (1). Poverty and crowding have been associated with infection epidemiologically (2,3). The Republic of Georgia has a per capita annual income of US $591, making it one of the poorest countries in the world (4,5). Georgia also reports a high annual incidence of gastric cancer , 17/100,000 population in 2002 (National Center for Disease Control, Tbilisi, unpub. data), which suggests an elevated prevalence of H. pylori infection. Testing and treatment for H. pylori are not practiced in this country , and diagnostic capacity for H. pylori is nonexistent. In October 2003, we conducted an exploratory pilot study of H. pylori infection to begin characterizing prevalence and risk factors for infection. We studied a convenience sample of adults residing in or near the capital city of Tbilisi. Urban participants were recruited in 11 of Tbilisi's 12 residential districts and in 1 district of Rustavi, a city 20 miles south of Tbilisi. Rural participants were recruited from 3 villages within 10 miles of Tbilisi. In each district or village , we nonsystematically selected 10 households and recruited 1 adult per household. Exclusion criteria included age <18 years; reported allergy to omeprazole, clar-ithromycin, or amoxicillin; or treatment with any antimicrobial agent within the preceding 2 weeks. This protocol was reviewed and approved by the Human Subjects Review Board at the National Center for Disease Control, Tbilisi. Active infection with H. pylori was measured by a validated , point-of-care 13 C-urea breath test (6). Participants responded to a questionnaire that requested information about gastrointestinal symptoms during the preceding 12 months; diagnosis of gastritis, peptic ulcer disease, and gastric cancer made by a physician ; family history of peptic ulcer disease or gastric cancer; and knowledge about H. pylori. Low, medium, or high socioeconomic status categories were designated on an ecologic basis, according to average real estate prices and common perception of the living standard of the participant's district or village of residence. Analyses were …