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The role of health education and sanitation in the control of helminth infections.

Health education and sanitation are two important components of primary health care system introduced by the World Health Organization (WHO) as a basis for the prevention and control of communicable diseases. However, the roles of health education and sanitation in disease control have been controversial, especially in the wake of recent advances in safe and effective oral drugs. This article has reviewed the various health education and sanitation interventions around the world to determine what roles they have played in the past relative to other intervention strategies and the role they have to play in future control efforts. It appears clear-cut from the review, that while chemotherapy has been and will remain the best option for morbidity control, sanitation has an important role to play not only to sustain the benefits of chemotherapy but also to protect the uninfected. Health education that is effective, simple and low-cost remains the only tool for creating the enabling environment for both chemotherapy and sanitation to thrive.

Animals↗

Trypanosome-induced modulation of responses to concurrent helminth infection.

Infections with African trypanosomes are known to suppress immune responses to vaccines and to gastrointestinal nematode infections in livestock. Experimental infections with Trypanosoma brucei (Tb) and the gastrointestinal nematode Nippostrongylus brasiliensis (Nb) in mice were used to identify possible mechanisms involved in interference with anti-worm responses and to examine the effects of host genotype on the extent of suppression seen. Concurrent infections with T. brucei resulted in a prolongation of worm survival and a dramatic increase in faecal egg output. Infection also resulted in a marked suppression of the proliferative response of mesenteric lymphocytes (MLNC) to in vitro mitogenic stimulation. When MLNC from concurrently infected mice were stimulated in vitro with the mitogen ConA they released more IFN-gamma and less IL-5 than cells from mice infected only with N. brasiliensis. These data are interpreted in terms of a trypanosome-mediated influence on the development of host-protective type-2 T helper cell responses against N. brasiliensis. The degree to which T. brucei altered the kinetics of the nematode infection was influenced by the particular mouse strain concerned.

Animals↗

Soil-transmitted helminth infections at very high altitude in Bolivia.

A cross-sectional study of soil-transmitted helminthiases in the Northern Bolivian Altiplano was carried out over the 6-year period 1992-97. Prevalences, intensities and associations were analysed from coprological results obtained in 31 surveys (28 in schools and 3 in individuals of all age-groups) performed in 24 Aymara communities located between the city of La Paz and Lake Titicaca, at an altitude of 3800-4200 m. Ascaris lumbricoides and Trichuris trichiura were detected, with local prevalences in the range 1.2-28.0% and 0.0-24.0%, respectively. Significant differences in prevalence rates of trichuriasis were detected, with highest prevalences in male schoolchildren and in subjects aged > 40 years. The global intensity ranged from 24 to 86,544 eggs per gram of faeces (epg) and from 24 to 4560 epg for ascariasis and trichuriasis, respectively. Higher intensities were noted in girls. A. lumbricoides egg counts were statistically significantly higher in the 5-8-years age-group. A positive association between A. lumbricoides and T. trichiura infections was detected. The proportion of heavy infections for A. lumbricoides was 0.1% and 1.0% in the school and community surveys, respectively. No heavy infection for T. trichiura was detected. The very high altitude and its severe environmental conditions may determine the relatively low prevalences and intensities in this area.

Adolescent↗

Common features of T cell reactivity in persistent helminth infections: lymphatic filariasis and schistosomiasis.

This review highlights striking similarities in the down-regulated inflammatory responses that are observed in chronic infectious diseases. It is clear that peripheral mononuclear cells show poor antigen-specific T cell proliferation in lymphatic filariasis as well as schistosomiasis. With respect to cytokines both Th1- and Th2-type products are down-regulated during chronic infection. Drug treatment restores responsiveness in both diseases indicating a link between infection and immune suppression. Interestingly, immunological responses in subjects carrying recent infections are characterized by strong proliferation to parasite antigen and IFN-gamma production. These heightened responses are gradually down-regulated with increased length of exposure to infection.

Animals↗