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Describes a community-based HIV prevention program designed to improve confidence in condom use skills in Thailand. Details of a condom race activity implemented in the country; Information on condom promotion and distribution campaign; Participation of local leaders in the training-of-trainers program.

This study investigated the relationship between immune responses to infection with the liver fluke, Opisthorchis viverrini, and the synthesis of the carcinogen, N-nitrosodimethylamine (NDMA) in humans. it also examined associations between synthesis of nitric oxide (NO) and nitrosation of amines, in vivo. Antibody and T cell responses to fluke antigens and post-alcohol urinary NDMA excretion were assessed among three groups of 40-50 men with no, moderate and heavy liver fluke infection. Markers of NO synthesis (nitrate, nitrite) and nitrosation (nitrosamino acids) were also measured in biological fluids. Assessments were carried out under controlled conditions which minimised intake of exogenous nitrate and nitrite and were carried out at two time points, namely before and 4 months after elimination of the infection with praziquantel treatment. No statistically significant variation was observed in the amount of NDMA excreted between the 3 groups. However, during active infection, a strong negative association was observed between in vitro lymphoproliferative responses to some liver fluke antigens and NDMA excretion. After treatment this association was reduced. Multivariate statistical models revealed a highly significant relationship between NDMA levels and urinary nitrate, stimulation indices for two T cell responses to two parasite antigens (MW 37 kDa and 110 kDa) and gall bladder dimension. NDMA levels after treatment were best described by the ratio between parasite-specific IgG2 and IgE, background levels of T cell proliferation, a urinary marker of nitrosation (N-nitrosothioproline) and usual level of alcohol consumption. These results suggest that individual background immunologic activity, parasite-specific responses and/or parasite products and NO synthesis are important determinants of endogenous generation of nitrosamines in O.viverrini-infected humans. [ABSTRACT FROM PUBLISHER]

Objective: Recent Australian research with adolescents aged 13 to 17 years has found that Indigenous youth are more likely than non-Indigenous adolescents to smoke tobacco and cannabis, although they may be less likely to use alcohol. The objective of this study was to examine whether this pattern exists among younger children., Method: A school-based, self-report survey was conducted in primary schools that had high proportions of Aboriginal and Torres Strait Islander children. Four schools were located in metropolitan Brisbane and three in Far North Queensland (sample n = 507 students: 270 girls, 237 boys, aged 9-13 years)., Results: Significant numbers of these children had started to experiment with recreational drugs. Twenty-two per cent had attempted to smoke at least one cigarette, 14% smoked in the preceding year, while 3% had smoked more than 10 cigarettes in their lives. Thirty-eight per cent had had at least one drink of alcohol, while 6% had smoked marijuana at least once. There was no significant association between Indigenous/non-Indigenous background and risk of smoking tobacco or marijuana, while Indigenous children were less likely than non-Indigenous children to report experience with alcohol., Conclusions: Contrary to data from secondary school students, Indigenous youth in primary schools were not more likely than non-Indigenous children to have experimented with tobacco or marijuana, or to be frequent tobacco smokers. It appears therefore that the excessive uptake of drug use among Indigenous youth occurs in the early stages of secondary school. This finding underlines the importance of preventive education in primary schools, especially for Indigenous children who have a high risk of making the transition to drug use in adolescence.

In rural Northeast Thailand, risk of sexual transmission of HIV is popularly perceived to be site-specific. Risk of HIV transmission in local scenarios like cattle markets and village festivals has not been adequately addressed. This paper assesses the use of community consultation and formative research to overcome prevailing assumptions about HIV risk by involving community members in the process of identifying risks and developing HIV prevention strategies. This participatory approach can be used to develop prevention programs that are responsive to the specific context of risk behavior in rural environments.

Reported is the seasonal pattern of Opisthorchis viverrini metacercariae in cyprinoid fish in north-east Thailand. Samples of fish were collected in 1991-92 at monthly intervals from two areas-Khon Kaen Province, where the opisthorchiasis transmission rate was high, and Mahasarakham Province, where the rate was low. Metacercarial loads in both study areas had similar seasonal patterns. High burdens occurred in the late rainy season and winter (July to January) with low burdens during the summer (March to June). The average burden for Puntius leiacanthus in Khon Kaen was 1.68 metacercariae per fish (127.43 per kg), higher than for all species of cyprinoid fish from the low transmission area. The intensities of infection among P. leiacanthus and Cyclocheilichthys armatus collected in Mahasarakham were comparable, but lower than the intensity of Hampala dispar (0.75 metacercariae per fish) concurrently sampled from the same area (P < 0.05). There was no significant difference in metacercarial load per kg between fish species from Mahasarakham. The results indicate that seasonal variation in metacercariae was a common phenomenon in areas with both high and low endemicity of infection. Also, the metacerarial load in fish was positively associated with infection levels among humans.

The liver fluke, Opisthorchis viverrini, is both highly prevalent and closely associated with cholangio-carcinoma in northeast Thailand. This study measured associations between intensity of liver fluke infection and nonmalignant hepatobiliary disease diagnosed by ultrasonography among 1, 807 largely asymptomatic adult residents drawn from endemic communities. Abnormalities significantly associated with intensity of infection included gallbladder enlargerment in all dimensions, presence of sludge, irregular gallbladder wall, liver enlargement, and enhanced portal vein radicle echoes. While gallbladder enlargement was not sex-specific, the prevalence odds of the other abnormalities were 2-3 times higher among males compared with females. Those recently treated with the anthelmintic praziquantel had higher odds of these abnormalities compared with others with the same infection status who were untreated. The low prevalence of gallstones suggests that this impairment of gallbladder structure and function does not frequently stimulate gallstone formation. However, gallbladder disturbances, together with chronic inflammation and fibrosis of the bile ducts, which are visualized as enhanced portal vein radicle echoes, may contribute to the strikingly enhanced susceptibility to cholangiocarcinoma among people, especially males, with heavy liver fluke infection.

Infection with the liver fluke, Opisthorchis viverrini, is a causative agent of cholangiocarcinoma. One possible contributing factor in this carcinogenesis is the chronic, local generation of nitric oxide by inflammatory cells expressing inducible nitric oxide synthase and the production of N-nitroso compounds via the reaction between amines and nitrosating agents derived from nitric oxide. Our previous studies provided evidence that nitric oxide synthesis is elevated during human liver fluke infection. Here we present data on the same sample of men which definitively demonstrates increased nitrosation of proline and thioproline (thiazolidine-4-carboxylic acid) among infected men compared to uninfected control subjects on a low nitrate diet. This difference was specifically abolished by co-administration of ascorbic acid with proline and by elimination of parasites by praziquantel treatment. Multivariate statistical models demonstrate the importance of salivary thiocyanate levels to variation in the nitrosation of proline among uninfected individuals, but not among those with current fluke infection. This suggests that considerable generation of nitrosating agents (N203/N204) in infected people may be occurring via oxidation of arginine by nitric oxide synthase in inflamed tissue which is thiocyanate insensitive. Analyses revealed positive associations between N-nitrosoproline excretion and nitrate/nitrite levels in urine, plasma and saliva and with usual alcohol intake; with variation in these trends between groups. In conclusion, we have confirmed the relationship between O.viverrini infection and enhanced endogenous nitrosation, showing evidence of its extragastric site. New information is also provided on the determinants of N-nitrosamino acid excretion in men on a controlled low nitrate diet without smoking, conditions which reduce exogenous sources of nitrosating agents.

A monoclonal antibody-based enzyme-linked immunosorbent assay (MAb-ELISA) was evaluated for its potential in the diagnosis of opisthorchiasis in an area endemic for Opisthorchis viverrini infection. The method, based on the detection of the 89-kD O. viverrini metabolic antigen in the feces (coproantigen), was previously estimated to be sensitive enough to detect antigen excreted by a single mature fluke. In the present study, fecal specimens from 207 apparently healthy villagers in northeastern Thailand were analyzed in a double-blind test for the presence of O. viverrini eggs by microscopic examination and for antigen by MAb-ELISA. The microscopic examination was carefully done to minimize false-positive results due to eggs of Lecithodendriid trematodes. The specimens were divided into six groups based on the number of eggs per gram of feces, namely, egg negative, 1-500, 501-1,500, 1,501-3,000, 3,001-6,000, and more than 6,000. The results showed that the ELISA is sufficiently sensitive and specific for the diagnosis of O. viverrini infection. The slightly higher rate of coproantigen positive by the ELISA compared with microscopic examination may reflect lower specificity of the ELISA or its higher sensitivity over microscopic examination in detecting light infections. Different lines of evidence presented here support the latter explanation.

We describe an innovative strategy to quantify risk of cancer associated with varying levels of exposure to chronic parasitic infection through the identification of asymptomatic cases of cholangiocarcinoma within a population-based survey of Opisthorchis viverrini infection. Stool samples from 12,311 adults over age 24 years from 85 villages in northeast Thailand were examined for intensity of liver fluke infection. People from varying egg count categories were selected for ultrasound examination to identify hepatobiliary disease. Fifteen preclinical cases of cholangiocarcinoma were diagnosed from a total of 1,807 people based on ultrasonographic evidence with confirmation by endoscopy where possible. The prevalence odds of the diagnosis of cholangiocarcinoma increased gradually within the light and moderate intensity groups. In contrast, sharply elevated prevalence odds [age-, sex- and locality-adjusted prevalence odds ratio (POR) 14.1, p < 0.05] were observed within the most heavily liver fluke-infected group compared with the uninfected group. Males were more frequently affected than females (crude POR 4.5), but after controlling for intensity of infection, age and locality, the magnitude and significance of this measurement was reduced. Our data clearly demonstrate a significant relationship between intensity of liver fluke infection and cholangiocarcinoma and a strikingly high prevalence of the disease among heavily infected males.

Infection with the liver fluke, Opisthorchis viverrini, remains a major public health problem in Northeast Thailand, where approximately one-third of the population is infected. The northeast region is largely populated by Laos-descendent Thais who enjoy eating raw fish, which harbour the infective stage of the fluke. The parasite has maintained its presence in the population despite the widespread use of praziquantel and dissemination of health education material throughout the region by vigorous government-sponsored programs in recent years. The most severe consequence of liver fluke infection is cholangiocarcinoma, i.e. cancer of the bile duct epithelium. Although mortality due to the parasites alone appears to be uncommon, cholangiocarcinoma arising as a result of infection is one of the leading causes of death in the region. This paper reviews the pathogenesis of infection and the geographic, hospital-based and community studies which demonstrate the close relationship between infection and cancer. In addition, data from the Cancer Registry of Khon Kaen, Northeast Thailand and population-based studies using ultrasonography to visualize early tumours which illuminate the very high frequency of the cancer among heavily infected individuals and communities are discussed. Finally, the paper will close with a brief commentary on the prospects for control of the parasite and its likely impact on the frequency of cancer given the current epidemiological situation of liver fluke infection.

Cancers arising during bacterial, viral and parasitic infection provide useful models to investigate the link between inflammation and carcinogenesis. Because the inflammatory agent is known, relationships between immune responses, the production of DNA-damaging agents, such as nitric oxide, oxygen radicles and N-nitroso compounds, and cancer risk can be explored. This paper first describes the close relationship between infection with the liver fluke, Opisthorchis viverrini, and cholangiocarcinoma in humans. Data are then presented which demonstrate an elevation in levels of salivary nitrite and urinary and plasma nitrate among men with moderate and heavy liver fluke infections compared to uninfected controls which was absent 4 months after the parasites were cleared with praziquantel. Because of the strict control over subject selection and dietary intake plus the absence of the increase following treatment, we conclude that the higher levels of nitrate and nitrite reflect endogenous generation of nitric oxide resulting from liver fluke infection. Excess nitric oxide generation in the inflamed tissue is likely to lead directly to the formation of N-nitroso compounds mediated by activated macrophages. Further work will attempt to demonstrate a link between this increase and both parasite-specific immune responses and the risk of cancer.

We recently demonstrated a number of biliary tract abnormalities associated with moderate to heavy Opisthorchis viverrini infection among 95 selected village residents in north-east Thailand, who were treated with praziquantel immediately after initial examination and re-examined by abdominal ultrasonography 10 months later. Dramatic improvement in the gall-bladder status of previously infected individuals was observed, including reduction of gall-bladder length and width and regained contractibility of the organ following fatty meal consumption. The frequency of severe enhanced portal vein radicle echoes and gall-bladder sludge and wall irregularities also decreased following treatment, but persisted in many individuals. Two masses were observed in the right hepatic lobe of one individual who was previously considered normal. The findings suggest that gall-bladder abnormalities are reversible following elimination of liver fluke infection, but malignancies, once initiated, are not likely to be affected by treatment.

The serum antibody responses of 124 people naturally exposed to Ascaris lumbricoides infection were analysed by immunoprecipitation of radio-isotope labelled 3rd- and 4th-stage larval Ascaris suum excretory and secretory antigens (L3/4 ES). Profiles of antigens recognized were visualized by polyacrylamide gel electrophoresis (SDS-PAGE), and the band intensities of the 12 major precipitated antigens were individually scored. Most subjects were seropositive, but considerable variation was observed in the amount of total and individual ES antigens precipitated. The sex- and age-related profiles of antibody levels followed similar patterns to those of egg output. In addition, total antibody scores of individuals were closely correlated (r = 0.47-0.52) with their eggs per gram of faeces (e.p.g.) collected 4 months after blood samples were taken. These findings suggest that antibody levels against larval ES antigens reflect recent exposure and are consistent with the hypothesis that establishment of adult worms is proportional to the number of larvae that recently migrated through the lung.

Twenty-four locality-, age- and sex-matched groups of village residents with no light, moderate and heavy Opisthorchis viverrini infection were examined by ultrasonography. Highly significant differences were observed between the groups in the relative size of the left lobe of the liver and the fasting and post-meal size of the gall-bladder. In addition, indistinct gall-bladder wall, the presence of gall-bladder sludge and strongly enhanced portal vein radicle echoes were most frequently observed in the heavily infected group. Two suspected cases of cholangiocarcinoma were identified from the heavy group. The results highlight the importance of intensity of infection on the frequency and severity of fluke-associated hepatobiliary disease.

Iodine staining and scanning electron microscopy were used to determine the morphological features distinguishing Opisthorchis viverrini from lecithodendriid eggs in human feces. The embryonated eggs of lecithodendriid trematodes differ from O. viverrini by the presence of an iodophilic body, a large mass at the posterior end of miracidium that stains brown in 0.2% iodine solution and the curved miracidium of Phaneropsolus bonnei. All forms of lecithodendriid eggs can be differentiated from those of O. viverrini by a set of morphological features of the shell surface, the knob, the operculum, the shoulder, the shape and size. On the basis of these differences, it is possible to perform differential egg counts.

This paper describes patterns of infection with Opisthorchis viverrini within a human community assessed by egg count, parasite-specific antibody levels and worm burden determined by expulsion chemotherapy. All three measurements increased significantly with age, reaching a plateau in young adults. There were no significant sex-associated differences in the prevalence or intensity of infection, antibody levels, or in the frequency of heavy worm burdens. A striking 81.5% of the total Opisthorchis population and 74% of the total egg output were expelled by the most heavily infected 10% of the humans sampled. This extreme over-dispersion, together with recent findings that hepatobiliary disease frequently accompanies heavy infections, argues that the priority for community-based parasite control programmes should be to maximize treatment and health promotion efforts toward heavily infected individuals.

Phaneropsolus spinicirrus n. sp., collected in a postpraziquantel treatment stool of a 44-yr-old woman from Kalasin Province in northeastern Thailand, is described. It is the second species of the genus Phaneropsolus Looss, 1899, found to parasitize a human host. It differs from the first species, Phaneropsolus bonnei Lie, 1951, in the presence of a short spinose cirrus and the structure and distribution of tegumental spines. The new species is most similar to Phaneropsolus perodictici Goodman and Panesar, 1986, isolated from the potto, Perodicticus potto, in Uganda because digeneans of both species have numerous spines on the cirrus. However, the new species differs from P. perodictici in having more conspicuous spines, the genital pore at the posterior border of the oral sucker or lateral to the pharynx, a body and internal organs of larger size, conical spines on the tegument, an ovoid to bilobed ovary and a large V-shaped excretory bladder. Phaneropsolus spinicirrus is distinguishable from other previously reported Phaneropsolus by possessing a spinose cirrus.

Opisthorchis viverrini infection is associated with human hepatobiliary disease and cholangiocarcinoma, but the role of the immune response in the pathogenesis of infection is unclear. Here ultrasonography was used to examine the biliary tracts of residents from an endemic community. Delayed-type hypersensitivity responses to unrelated antigens, and fluke-specific IgG and IgA levels in serum of this group were also examined. Relationships between immunological parameters, intensity of infection and radiologically measured variables are reported. Immune responsiveness to unrelated antigens did not vary with intensity of parasite infection or disease status. Of all the variables, IgG levels were most markedly elevated in disease cases compared with normal subjects and were closely associated with gall bladder size and dysfunction. This is consistent with the hypothesis that an immunopathologic mechanism is involved in opisthorchiasis and suggests that antibody levels may be useful in screening populations for fluke-associated hepatobiliary disease.

Three techniques for estimating the intensity of Opisthorchis viverrini infection in individuals from a Northeast Thai community are compared. Egg counts were determined using a quantitative formalin/ethyl acetate technique, worm burdens were estimated by expulsion chemotherapy and antibody levels were measured by ELISA. Log-transformed worm and egg counts were closely correlated (r = 0.80), suggesting that both measurements provide good assessments of relative intensity of infection. However, no Opisthorchis worms were recovered from 34 people with high egg counts; probably due to problems with the expulsion technique in some individuals. Examination of egg production per fluke indicated that each fluke contributed an average of 180 eggs per gram (epg) of faeces and fecundity was negatively associated with total worm burden. Serum IgG levels correlated significantly with Opisthorchis egg count (r = 0.61) at two independent assessments. Although significant associations were observed between antibody levels and echinostome infection, analysis suggested that these reflected independent associations between these two variables and Opisthorchis infection and age. We conclude that all three measurements are useful for epidemiological studies.

The population of Northeast Thailand has one of the highest known rates of cholangiocarcinoma (cancer of the bile ducts). We sought firstly to obtain an estimate of the frequency of hospital-based diagnosis of cholangiocarcinoma in the northeastern province of Khon Kaen. All pathology, ultrasound and in-patient and out-patient records were searched for cases diagnosed in tertiary hospitals in a random calendar month in 1988. A total of 203 persons from various parts of northeastern Thailand were newly-diagnosed in the two hospitals, 75 of whom resided in Khon Kaen province. We estimated the minimal age-standardised annual incidence rate in this province to be 135.4 per 100,000 among males and 43.0 per 100,000 among females (world standard). Truncated standardised incidence rates (ages 35-64 years only) were 334.2 and 104.3 per 100,000 for males and females respectively. Secondly we aimed to assess the feasibility of secondary prevention by early clinical diagnosis. However, the symptoms and signs observed were typically non-specific and associated with advanced disease in patients with cholangiocarcinoma who presented to hospital. Primary preventive measures appear to be the key to decreasing the mortality from this disease.

A group of 87 adults from a small village in north-east Thailand was chosen to undergo ultrasound investigation based on their intensity of infection with the liver fluke, Opisthorchis viverrini, or clinical status (history of jaundice, current hepatomegaly). From this group, 8 cases of suspected early cholangiocarcinoma were found, and the diagnostic features of 6 of the 8 were confirmed by computerized tomography scan and endoscopic retrograde cholangiopancreatography. In addition, several cases of mild gall-bladder disease, chronic cholecystitis, cholelithiasis and parenchymal liver disease were detected. A highly significant positive relationship between the intensity of liver fluke worm burden and the severity of biliary tract disease within individuals is reported. These results indicate that Opisthorchis is associated with moderate to severe hepatobiliary disease in a considerable proportion of infected individuals.

1. A field study of Phlebotomus ariasi Tonnoir, the vector of Leishmania infantum Nicolle in southern France, addressed the following questions: Is it possible to estimate reliably the life expectancy of this sandfly; can spatial or temporal variation in the life expectancy be detected, and is such variation significant for disease transmission? 2. Life expectancy was estimated by examining follicular relics in the ovaries of more than ten thousand females caught in light traps at seven sites in the Cévennes and the Garrigues, throughout their active period in 1985 and 1986. Whilst the distinction between nulliparous and parous flies was easily made, assessments of the number of times a parous fly had laid eggs were unreliable. Best estimates of life expectancy were therefore calculated from the parous rate. 3. Large samples collected from one site in the Cévennes in both years gave very similar estimates of life expectancy. 4. There was also no significant difference between estimates obtained from the Cévennes and the Garrigues, despite their distinct vegetation and climates. Therefore, large regional differences in sandfly population size and the prevalence of canine leishmaniasis cannot be explained by a difference in adult survival rate. 5. With no systematic annual or regional variation, a useful mean life expectancy can be calculated from the data collected at all sites in both years. It is 1.54 (SE 0.04) ovarian cycles. However, this estimate is sensitive to the assumption that survival rate is a discrete rather than a continuous variable. 6. Local variation in the parous rate may be associated with the proximity of traps to P.ariasi emergence sites.

Approximately 500 children from five social communities in Madras, Tamilnadu, India were surveyed for intestinal helminth infection. The results of the survey indicated that the extent and degree of helminth infections vary significantly (p less than 0.001) between communities in Madras. The frequency and intensity distributions in two of the populations, the elite and the fishing communities are discussed. It is suggested that in view of the wide variability, health education should be geared toward each type of community and its specific routes of helminth dissemination rather than mass education, much of which may be useless to large segments of the general population.

The materials released in vitro by the tissue-parasitic larval stages of the large roundworm of man, Ascaris lumbricoides, were analysed by radio-iodination, immunoprecipitation, and SDS-PAGE. The antigens were found to be heterogeneous, ranging in molecular weight from 14 to 410 kD, and were found to alter radically during the parasites' migration to the lungs. The antigens secreted by the infective and lung-stage larvae of the pig homologue, Ascaris suum, were compared with those of the human worms. This revealed a remarkable degree of homology between the products of the two, at both the molecular and immunological levels. The two species could be discriminated, however, on the basis of the SDS-PAGE profiles of the antigens secreted by both developmental stages of the parasites examined. Finally, antiserum to the canine ascarid infective to man, Toxocara canis, was found to precipitate a significant proportion of Ascaris-secreted molecules. These studies, therefore, confirm the potent antigenicity of excretory/secretory materials, and their potential for use in immunodiagnosis, but predict serious difficulties for seroepidemiology and the specific detection of ascariasis in man.

The distribution and abundance of Enterobius vermicularis in a fishing community in South India, as determined by counting worms expelled following mass anthelmintic chemotherapy, was examined in samples of patients stratified by age, sex and family grouping. The results of a worm expulsion study in January 1984 are compared with those of a second expulsion programme in November 1984, following an 11-month period of reinfection. The prevalence of Enterobius infection was consistently high in all age groups of both males and females. A comparison of the overall prevalence and intensity of infection in the January and November surveys revealed significant increases in both the percent infected and the mean number of worms harboured in November relative to the initial level. No significant trends in the intensity of Enterobius according to host age or sex were detected in either survey. The frequency distribution of Enterobius was found to be highly aggregated in the population as a whole and within age groups. At both sampling dates, the most heavily infected 25% of the community harboured over 90% of the total pinworms recovered. There was a significant pattern within most age groups for individuals to re-acquire worm burdens of a similar magnitude to their initial pre-treatment burdens. Heavy infections were found to be associated with household. A selective or targetted approach to treatment of heavily infected individuals or households is likely to be an efficient means of reducing parasite abundance on a community-wide basis. It must be stressed, however, that treatment must be applied at frequent intervals in order to achieve a long-term reduction in pinworm abundance and to avoid the possibility of increasing the intensity of infection, as was observed in this community.

The study design of a project to investigate the epidemiology, population dynamics and control of intestinal nematode infections in fishing village communities in Southern India is described. The paper focuses on Ascaris lumbricoides infection and describes changes in prevalence and intensity (worm burdens) with host age, the aggregated frequency distributions of parasite numbers per person, a density-dependent relationship between parasite fecundity and worm burden and rates of reinfection following chemotherapeutic treatment. The age-intensity of infection profile is convex in form, where maximum worm burdens are attained in children in the age range five to nine years. On the basis of juvenile to adult worm ratioos, the life expectancy of Ascaris in man is estimated to be of the order of one year. Rates of reacquisition of worms after chemotherapy are shown to be dependent on host age. Wormy individuals with heavy infections are shown to be predisposed to this state such that they reacquire heavier than average worm burdens following treatment.

Analysis of egg and worm counts of Ascaris recorded at various intervals following a mass anthelmintic treatment programme in a South Indian fishing community is presented. Three indices of infection in the community are compared, namely the prevalence and intensity of egg output (at 2, 6 and 11 months following treatment) and the number of worms expelled following an 11 month period of reinfection. Detailed examination of these measurements revealed significant associations with patient sex and age. The age-prevalence profile of Ascaris infection changed little over time (except immediately following treatment) with the peak prevalence found in the 5-9 year age group. Although 85% of both males and females harboured Ascaris initially, the prevalence following 11 months reinfection was decreased, due to a significantly lower proportion of males being reinfected. By the 11th month of reinfection, the age-intensity profiles of egg output were similar to those observed at initial treatment in the older age groups (10 years and above) and in male children (less than 10 years). However, a dramatic increase in the egg output of female children, greatly exceeding the initial mean, was observed within a 6 month period of reinfection. The intensity of egg output did not accurately reflect the abundance of Ascaris recovered via drug-induced expulsion following an 11 month period of reinfection. Although the egg output attained preintervention levels, the average worm intensity reached only half the initial value. The trends in the sex- and age-intensity profiles were consistent at the two sampling dates and showed similar patterns to the egg output curves. The relevance of the results to helminth control and the monitoring of reinfection is discussed.

A semi-quantitative analysis of individual human antibody responses to larval Ascaris excretory and secretory (ES) antigens using radioimmunoprecipitation and SDS-PAGE is presented. A significant relationship was observed between the intensity of antibody-precipitated radiolabelled ES antigens and host age. The antibody response profile followed a similar age-related pattern to that of intensity of infection, with blood samples from 5-9-year-old children showing the strongest banding patterns and the heaviest infections. These findings support the hypothesis that the degree of exposure to infective stages of Ascaris is a major determinant of the convex age-intensity profile observed in the community. Considerable heterogeneity was observed in the antibody profiles of individuals, particularly in the recognition of a 14 kD molecule. Positive correlations were observed between the strength of banding at several mol. wts and the worm burdens of individuals. However, the sample size was too small to determine whether these relationships simply reflect age-related profiles or represent independent associations between antibody levels and worm burden. When the data were stratified by age, negative associations between the strength of recognition of some bands and the intensity of infection were suggested and require further study.

Hookworm infections, as assessed by counting worms expelled following anthelmintic treatment and by egg output, were found to be of low prevalence and intensity in a South Indian fishing community. The initial overall prevalence of infection in the community was 43%, and the average burden was estimated at 2.2 hookworms per person. The age profiles of prevalence and intensity differed between males and females, with the latter harbouring significantly higher levels of infection. Children of both sexes under 10 years of age rarely harboured hookworms. Treatment with pyrantel pamoate was estimated to be 91% effective in clearing hookworm infections. Egg counts made on stools collected during an 11-month period of reinfection indicated that female patients became reinfected soon after treatment, while little hookworm egg excretion was observed in males during the observation period following treatment. Females acquired a significantly higher number of worms during the reinfection period compared with males, although the average burden in females reached only 28% of the initial, pre-treatment level. The hookworm population consisted of predominantly Necator americanus, and less than 10% of Ancylostoma duodenale. The parasites were highly aggregated within the host population with 10% of the community harbouring over 65% of the total hookworms. Low values of the negative binomial aggregation parameter, k, (indicating extreme over-dispersion) were recorded in groups stratified by age and sex. Highly significant positive correlations were observed between the initial (pre-treatment) and reinfection worm burdens of female (but not of male) patients. It is suggested that occupational practices related to walking through areas contaminated with hookworm larvae play an important role in generating the observed patterns of infection within this community.

Studies of patterns of reinfection with four species of intestinal nematodes (Ascaris, hookworm, Trichuris and Enterobius) in 174 individual patients following chemotherapeutic treatment revealed statistical evidence for predisposition to heavy or light infection (relative to the average level in the overall population). Analyses of associations between the abundances of the four species of nematodes within a combined sample of 525 worm burdens showed significant correlations between 5 out of the 6 possible pair-wise comparisons between species. The relevance of these results to the design of control programmes based on chemotherapeutic application is discussed.

The cosmopolitan nematode parasites Ascaris lumbricoides, Ascaris suum, and Toxocara canis are closely related phylogenetically, and are all pathogenic to man. In the case of the latter, the antigens released by the tissue-invasive parasitic larvae in vitro ('excretory/secretory' or 'ES' antigens) are routinely used for serodiagnostic purposes. Here we have found, using radioimmunoprecipitation with defined rabbit antiserum, and SDS-PAGE, that there is a significant antigenic similarity between the secreted and somatic antigens of the three nematodes, and have characterized cross-reactive components. Among these is a 14 kD internal protein which has a homologue in all three parasites. This molecule is the subject of an IgG antibody response in Ascaris infection, but there is no measurable response to it in toxocariasis. Lastly, using quantitative immunofluorescence, the antigens exposed on the surface of intact, living, larvae were found to be cross-reactive or specific depending on the developmental stage of the parasites. This means that the surface of tissue-invasive Ascaris larvae bears stage-specific epitopes.

Weight and length profiles are presented of 3505 Ascaris worms recovered after mass anthelmintic treatment of a human community in January 1984 and, after an 11 month period of reinfection, in November 1984. Male and female worms recovered after reinfection were significantly heavier and longer than those expelled after initial treatment (P less than 0.0001). Multiple regression models were employed to examine variability in parasite size. A positive influence of host body weight on the weight of parasites recovered in January, but not in November, was observed. No negative relationship was recorded at either date between worm size and the total number of worms harboured, even after controlling for host weight. Striking host age-related variability was observed in the distribution profile of weights and lengths of individual worms recovered in January. Children harboured predominantly smaller worms before initial treatment, while adults expelled mainly heavy worms. In contrast, worms expelled by both children and adults after reinfection were heavier and more homogeneous in size, particularly within the relatively heavily infected group. These patterns argue against a primary role for density-dependent or acquired resistance mechanisms in determining the size of Ascaris in humans. However, the results are consistent with a hypothesis initially suggested by Jung (1954) that established worms may inhibit the development of newly acquired Ascaris larvae, perhaps regulating their own abundance.