Association of Household Food- and Drink-Sharing Practices With Human Herpesvirus 8 Seroconversion in a Cohort of Zambian Children

Our study presents the first longitudinal data on incident childhood human herpesvirus 8 infection in a highly endemic area, Zambia in central-southern Africa. We confirm infection and transmission patterns within the household, most likely through shared feeding and eating practices. Abstract Background Human herpesvirus 8 (HHV-8) infection occurs in early childhood and is associated with human immunodeficiency virus type 1 (HIV-1) infection and risk for Kaposi sarcoma, but behaviors associated with HHV-8 transmission are not well described. Methods We enrolled and followed a prospective cohort of 270 children and their household members to investigate risk factors for HHV-8 transmission in Lusaka, Zambia. Results We report an incidence of 30.07 seroconversions per 100 child-years. Independent risk factors for HHV-8 incident infection included having a child who shared utensils with a primary caregiver (hazards ratio [HR], 2.33; 95% confidence interval [CI], 1.49–7.14), having an increasing number of HHV-8–infected household members (HR, 1.27; 95% CI, 1.09–2.79), and having ≥5 siblings/children in the household (HR, 2.24; 95% CI, 1.03–4.88). Playing with >5 children a day was protective against infection (HR, 0.54; 95% CI, .33–0.89), as was increasing child age (HR, 0.96; 95% CI, .93–.99). Conclusions This is the first study to find a temporal association between limited child feeding behaviors and risk for HHV-8 infection. Child food- and drink-sharing behaviors should be included in efforts to minimize HHV-8 transmission, and households with a large number of siblings should receive additional counseling as childhood infections occur in the home context.