1. Having family members or classmates with cutaneous warts put school children at increased risk of developing warts themselves.
2. Use of public facilities, including swimming pools and public showers, did not significantly increase the risk of developing cutaneous warts in children.
Evidence Rating Level: 2 (Good)
Study Rundown: Advice on preventing transmission of cutaneous warts has often focused on public showers and swimming pools, despite limited evidence to support this. On the contrary, this study found that it was infected family members and classmates who put children at a greater risk of developing new warts, and there was no significant increased risk with exposure to pools and public showers. These findings suggest that emphasizing wart hygiene in the family and school setting could be effective in reducing transmission of warts in children.
This study was also one of the first in recent history to evaluate the incidence of warts in schoolchildren, which was found to be 29 per 100 person-years in this Dutch population of 4- to 12-year-olds. Their findings were supported by strong follow-up rates and a prospective design, but limited by dependence on self-reported data from parents for assessing exposures to some risk factors.
In-Depth prospective cohort study]: The hands and feet of 1099 school children in grades 1-7 were examined for the presence of warts at baseline and again 11 to 18 months later (9% lost to follow-up). Parental questionnaires at baseline assessed environmental risk factors, including use of public swimming pools, use of public showers, and practicing sports or walking at home barefoot. Rates of cutaneous warts in any of the following were also assessed: family members, anyone in the class, three closest friends, and the individual. Having a family member with warts increased the child’s risk for warts (hazard ratio (HR) 2.08, p<0.001). Additionally, there was an increased risk of warts (HR 1.2, p<0.001) per 10% increase in classmates with warts. Use of swimming pools, practicing sports barefoot, and use of public showers were all insignificant as risk factors.
By Laurel Wickberg and Devika Bhushan
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