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Review • Rev. Inst. Med. trop. S. Paulo 32 (2) • Apr 1990 • https://doi.org/10.1590/S0036-46651990000200012   copy

Reinfection after treatment of schistosomiasis: environment or "predisposition"?

Reinfecção após tratamento na esquistossomose: fatores ambientais ou predisposição?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

Although very efficient for the control of morbidity due to S. mansoni in individual patients, chemotherapy has not proven successful in the management of transmission within hyperendemic areas when used alone, even if repeated at short intervals. Consequently, a great deal of effort has been expended toward immunologic investigation and development of a specific vaccine. Based upon a study of a group of children (5-14 years) from the state of Alagoas, the author demonstrates that the outcome one year after chemotherapy depends essentially on the "risk rating" of the area of domicile. A regression analysis did not reveal significant correlation to neither age, sex or initial egg counts. Although the study was not designed to reveal individual variations in the immune status, it is postulated that putative differences in genetic make-up are irrelevant in terms of large-scale intervention. Since morbidity due to S. mansoni has substantially declined during the last two or three decades, a control policy based on vaccination can only be justified if high levels of protective immunity can be attained. At any rate, such a vaccine will have to be administered in early childhood (preferably below the age of three). It can also be demonstrated that immunization in adolescence or adulthood serves no purpose whatsoever. The author is convinced that environmental intervention, usually dismissed as unrealistic in terms of the developing countries, is not only feasible, if done on a selective basis, but prioritary.

Schistosomiasis mansoni; control; Brazil

Embora a quimioterapia possa ser bastante eficiente no controle da morbidade a nível individual, quando usada como recurso único não tem sido bem sucedida no controle da transmissão da esquistossomose mansônica em regiões hiperendêmicas, mesmo que repetida a curtos intervalos. Daí os esforços dispendidos em pesquisas imunológicas e para o desenvolvimento da vacina específica. Com base no estudo de crianças entre 5 e 14 anos do Estado de Alagoas, o autor procura demonstrar que os resultados registrados um ano após a quimioterapia estão intimamente ligados ao "índice de risco" da zona de domicílio. Uma análise de regressão não demonstrou correlações em nível significativo com idade, sexo ou contagem inicial de ovos. Embora o estudo não compreendesse variações individuais no estado imunitário, o autor sustenta que eventuais diferenças de ordem genética se tornarão irrelevantes quando se pretendem campanhas de caráter mais amplo.

REVIEW

Reinfection after treatment of schistosomiasis: environment or "predisposition"?

Reinfecção após tratamento na esquistossomose: fatores ambientais ou predisposição?

Kurt Kloetzel

Faculdade de Medicina. Universidade Federal de Pelotas (Caixa Postal 464. CEP 96100 Pelotas. RS. Brazil)

SUMMARY

Although very efficient for the control of morbidity due to S. mansoni in individual patients, chemotherapy has not proven successful in the management of transmission within hyperendemic areas when used alone, even if repeated at short intervals. Consequently, a great deal of effort has been expended toward immunologic investigation and development of a specific vaccine.

Based upon a study of a group of children (5-14 years) from the state of Alagoas, the author demonstrates that the outcome one year after chemotherapy depends essentially on the "risk rating" of the area of domicile. A regression analysis did not reveal significant correlation to neither age, sex or initial egg counts. Although the study was not designed to reveal individual variations in the immune status, it is postulated that putative differences in genetic make-up are irrelevant in terms of large-scale intervention.

Since morbidity due to S. mansoni has substantially declined during the last two or three decades, a control policy based on vaccination can only be justified if high levels of protective immunity can be attained. At any rate, such a vaccine will have to be administered in early childhood (preferably below the age of three). It can also be demonstrated that immunization in adolescence or adulthood serves no purpose whatsoever.

The author is convinced that environmental intervention, usually dismissed as unrealistic in terms of the developing countries, is not only feasible, if done on a selective basis, but prioritary.

Key words: Schistosomiasis mansoni; control; Brazil.

RESUMO

Embora a quimioterapia possa ser bastante eficiente no controle da morbidade a nível individual, quando usada como recurso único não tem sido bem sucedida no controle da transmissão da esquistossomose mansônica em regiões hiperendêmicas, mesmo que repetida a curtos intervalos. Daí os esforços dispendidos em pesquisas imunológicas e para o desenvolvimento da vacina específica.

Com base no estudo de crianças entre 5 e 14 anos do Estado de Alagoas, o autor procura demonstrar que os resultados registrados um ano após a quimioterapia estão intimamente ligados ao "índice de risco" da zona de domicílio. Uma análise de regressão não demonstrou correlações em nível significativo com idade, sexo ou contagem inicial de ovos. Embora o estudo não compreendesse variações individuais no estado imunitário, o autor sustenta que eventuais diferenças de ordem genética se tornarão irrelevantes quando se pretendem campanhas de caráter mais amplo.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 7/4/1989.

These studies have been supported by grants from the Edna McConnell Clark Foundation and from the UNDP World Bank WHO Special Programme for Research and Training in Tropical Diseases.

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Publication Dates

  • Publication in this collection
    13 Sept 2006
  • Date of issue
    Apr 1990

History

  • Received
    07 Apr 1989
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