Worm burdens in schistosome infections

Schistosomiasis, caused by fluke worms of Schistosoma spp, is one of the most common tropical diseases. Despite decades of research and progress towards the control of the disease, many aspects of the dynamics of infection and immunity remain unresolved. There is, in fact, not even an approximate measure of how many worms are harboured by infected humans. Epidemiological, mathematical and biomedical arguments indicate that individual worm burdens in endemic areas number hundreds to thousands of adult schistosomes, instead of the few to dozens generally assumed on the basis of available autopsy data. As Bruno Gryseels and Sake de Vlas here discuss, this hypothesis has important consequences for research and control, as many constants in schistosomiasis research have to be reconsidered.