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American Journal of Epidemiology Advance Access originally published online on September 21, 2005
American Journal of Epidemiology 2005 162(9):817-822; 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.

Special Article

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

Clark W. Heath, Jr.

From 674 Plantation Point Road, Woodbine, GA

Reprint requests to Dr. Clark W. Heath, Jr., 674 Plantation Point Road, Woodbine, GA 31569-2124 (e-mail: cwheath{at}tds.net).

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.

child; cluster analysis; infection; leukemia; lymphoma

Editor's note: An invited commentary on this article appears on page 823, and the author's response appears on page 825.


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