Contrary to conventional wisdom, a new Dutch study has found
that the most likely way children get infected with the virus that causes warts
is from close contact with family members or classmates, rather than from
public places such as pools or communal showers.
The researchers concluded that a widespread public health
focus on encouraging kids to cover their warts with bandages when swimming or
to wear flip-flops when using public showers does not address the primary
source of wart infection.
To come to this conclusion, the study authors spent 18
months tracking wart occurrences among roughly 1 100 Dutch children enrolled in
grades one through seven (aged four to 12), all of whom were attending one of three
different primary schools in Leiden, Netherlands.
"Current recommendations on wart prevention focus
primarily on public places such as swimming pools," said lead author Dr
Sjoerd Bruggink, from the department of public health and primary care at
Leiden University Medical Center. "[But] children often get warts from
family members or classmates rather than from public spaces, [suggesting that]
covering warts at home or at school could maybe be more helpful in preventing
The Dutch team reported its findings online April 22 and in
the May print issue of the journal Pediatrics.
Warts are caused by certain strains of the human papilloma
virus (HPV); they are not the same as genital warts, which are transmitted
sexually and raise the risk for cervical cancer.
To get a handle on what drives the spread of warts among
grade school kids, the authors examined the hands and feet of all the
participating children during an 11- to 18-month period. In addition, parents
were asked to complete questionnaires indicating both their child's use of
public facilities, time spent playing sports and the presence of warts among
family members and close friends.
The team determined that the real risk for spreading warts
came from exposure to people in their home or classroom who had warts, not
through the use of public spaces.
Public health efforts
should place a greater focus
Bruggink's team suggested that public health efforts should
place a greater focus on the risk that comes from such relatively intimate
contact, rather than on the hazards of communal environments.
Practically speaking, such a shift in approach would not
necessarily involve a radical change, they said. Rather, it would mean, for
example, that children should be encouraged to cover their warts with bandages
while at home, rather than when going for a swim.
Dr Joceyln Glassberg, an obstetrician and gynecologist at
Scott and White Healthcare in Round Rock, Texas, said she believes the Dutch
team's observations accurately reflect the nature of how HPV is actually
"The study findings make sense since HPV is a
contact-borne virus, and children have the most contact with their household
members and school friends," she said. "It is a great reminder that
if anyone has a wart [they should] cover it to prevent spreading the
For more on the human papilloma virus, visit the US National
Institutes of Health.