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American Journal of Epidemiology Advance Access published online on September 21, 2005
American Journal of Epidemiology, doi:10.1093/aje/kwi289
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received November 15, 2004
Accepted April 1, 2005

SPECIAL ARTICLE

Community Clusters of Childhood Leukemia and Lymphoma: Evidence of Infection?

Clark W. Heath Jr.1*

1 From 674 Plantation Point Road, Woodbine, GA

* To whom correspondence should be addressed.
Clark W. Heath Jr., E-mail: cwheath{at}tds.net


  Abstract

Information suggesting that infection may be an underlying cause of childhood leukemia and lymphoma includes the occasional appearance of cases in time-space clusters within communities and increased incidence after communities experience marked population influxes (population mixing). Among 50 clusters involving cases of childhood leukemia and lymphoma investigated in the United States in 1961-1977, eight showed suggestive evidence of underlying infectious causation. In seven of the eight communities, case occurrence was associated with the attendance of patients or their siblings at particular schools or with family participation in particular church groups. In five, rapid population growth had occurred. Other findings included the possible association of cases with unusual patterns of infectious disease (rheumatic illness in one community, chickenpox in another) and with other childhood diseases, including other forms of childhood cancer. In one community, two cases of Burkitt's lymphoma occurred at the same time, and a third case arose 3 years later in boys living in a newly developing neighborhood. Such community observations support the need for continued biologic research regarding the possible role of infectious agents in childhood leukemia and lymphoma.

Keywords: child; cluster analysis; infection; leukemia; lymphoma.
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