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The goal of Schistosomiasis is to provide the reader with insights
into the active research and programs currently related to
schistosomiasis, and to use these insights as a way to project
forward into the next 10-15 years of work on this disease, spanning
the spectrum from research to public health interventions. A
secondary goal of this volume is to initiate conversations among
those working across the research-to-control spectrum on
schistosomiasis about the future of their field, and by doing so
lead to constructive efforts to identify and address the most
critical questions and challenges related to schistosomiasis. The
book covers four main areas: schistosome phylogenetics, gene
expression, and the overall genome, including information on
exciting new tools for addressing questions that have long been
inaccessible to schistosomologists; the host-schistosome
interaction at the larval to adult worm interface and addresses
aspects important for vaccine development as well as how
differential gene expression as detected by DNA microarrays may be
utilized to develop tools for detection and control of infection or
pathology; the development of the host immune response to eggs,
granuloma formation and factors affecting the development and
regulation of immunopathology; and the public health concerns
associated with schistosomiasis, including morbidity control, host
genetics, treatment and proposals for improved partnerships. The
volume concludes with a chapter addressing the schisms that
sometimes exist along the spectrum from basic research programs to
the implementation of control schemes, and a proposal to make these
differences benefit patients and researchers rather than succumbto
base temptations to compete for resources to no onea (TM)s benefit.
Like many of the diseases featured in the World Class Parasites
series, the prospects for dramatic advances in schistosomiasis
coincide with a seemingly shrinking pool of both human and material
resources. The most meaningful progress will occur as the
laboratory better understands the needs in the field and the field
better understands the capabilities of the laboratory.
Human schistosomiasis is a disease with a rich and well-documented
past, and every expectation of an unfortunately long future. These
infections were known to the ancient Egyptians and their
transmission shows little evidence of slowing down, globally. The
good news is that field applicable, and increasingly affordable,
chemotherapy has been available for almost 25 years. Using
chemotherapy and other means of control, some countries have
decreased transmission and made excellent headway against
morbidity. The bad news is that the public health problems caused
by schistosomiasis are still with us, with the estimated number of
cases of schistosomiasis, while shifting geographically, remaining
approximately 200 million for the last 30 years. In fact, with the
development of field usable ultrasound technology and meta-analyses
performed on existing data, there is a new appreciation for the
extent of non-lethal morbidity associated with these infections.
While the percentage of individuals with severe hepatosplenic
disease remains below 10%, recent reassessments of morbidity
associated with schistosomiasis indicate that the prevelance of
symptoms and the cost in diability-adjusted life years is much
greater than was previously, commonly appreciated (Van der Werf, M.
J. , et al. 2003, Acta Tropica 86:125-139; Charles H. King,
personnel communication). Strong impetus for addressing these
issues is provided by the World Health Assembly's recently passed
Resolution 54. 19, which calls for efforts to reduce morbidity
caused by schistosomiasis and soil-transmitted helminths in
school-aged children, largely through chemotherapy campaigns.
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