title: Repeated Schistosoma japonicum infection following treatment in two cohorts: evidence for host susceptibility to helminthiasis?
abstract: BACKGROUND
  In light of multinational efforts to reduce helminthiasis, we evaluated whether there exist high-risk subpopulations for helminth infection. Such individuals are not only at risk of morbidity, but may be important parasite reservoirs and appropriate targets for disease control interventions.
  
  
  RESULTS
  We followed two longitudinal cohorts in Sichuan, China to determine whether there exist persistent human reservoirs for the water-borne helminth, Schistosoma japonicum, in areas where treatment is ongoing. Participants were tested for S. japonicum infection at enrollment and two follow-up points. All infections were promptly treated with praziquantel. We estimated the ratio of the observed to expected proportion of the population with two consecutive infections at follow-up. The expected proportion was estimated using a prevalence-based model and, as highly exposed individuals may be most likely to be repeatedly infected, a second model that accounted for exposure using a data adaptive, machine learning algorithm. Using the prevalence-based model, there were 1.5 and 5.8 times more individuals with two consecutive infections than expected in cohorts 1 and 2, respectively (p<0.001 in both cohorts). When we accounted for exposure, the ratio was 1.3 (p = 0.013) and 2.1 (p<0.001) in cohorts 1 and 2, respectively.
  
  
  CONCLUSIONS
  We found clustering of infections within a limited number of hosts that was not fully explained by host exposure. This suggests some hosts may be particularly susceptible to S. japonicum infection, or that uncured infections persist despite treatment. We propose an explanatory model that suggests that as cercarial exposure declines, so too does the size of the vulnerable subpopulation. In low-prevalence settings, interventions targeting individuals with a history of S. japonicum infection may efficiently advance disease control efforts.
authors.affiliation: Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, United States of America. ejcarlton@berkeley.edu
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Carlton
authors.forename: Alan
authors.initials: A
authors.lastname: Hubbard
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.forename: Robert C
authors.initials: RC
authors.lastname: Spear
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011223:Praziquantel / Q000627:therapeutic use*; D012008:Recurrence; D012549:Schistosoma japonicum / Q000302:isolation & purification*; D012554:Schistosomiasis japonica / Q000188:drug therapy* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D011223:Praziquantel