A large cross-sectional study to investigate the prevalence and possible modes of transmission of Helicobacter pylori was done in southern China. Serum samples (1727) were collected from Guangzhou city and three rural areas of Guangdong Province, and the prevalence of H. pylori infection was determined using an ELISA. Each subject completed a questionnaire. The overall prevalence of H. pylori infection was 44.2%; a significantly higher prevalence was found in Guangzhou (52.4%) than in the rural areas (38.6%). This difference was generally reflected in the group 0-5 years old, but the rate of increase in seroprevalence for H. pylori over 5 years of age was similar (1%/year). This study provides important new data on the acquisition of H. pylori, particularly in the early years of life, and shows that density of living conditions is a prime determinant in the acquisition of H. pylori.