Immunity and morbidity in human schistosomiasis mansoni

This paper reviews the results of a longitudinal, multidisciplinary study on schistosomiasis mansoni that has been in progress in Machakos District, Kenya, since 1980. Different methods of delivering chemotherapy have been compared in a medium scale operational control programme. It is concluded that treatment only of infected children is an effective and feasible means of control, the frequency of treatment depending on the severity of disease. Within the framework of this programme, detailed studies have been undertaken of immunity to reinfection after treatment and of the reasons for differences in observed morbidity between different areas. An apparent resistance to reinfection, especially in older individuals, may be attributable to the protective effect of IgE antibodies against adult worm antigens. Various factors other than intensity of infection may contribute to severe morbidity, including parasite strain differences, interactions with other infections, nutritional status, and abnormalities in the regulation of pathogenic immune responses to egg antigens.