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A comparison of re‐infection rates with Schistosoma haematobium following chemotherapy in areas with high and low levels of infection

Two groups of children (6–15 years) from a Schistosoma haematobium endemic area were followed for 9 months after praziquantel treatment. Seventy‐three children came from an area of high infection while 67 children came from an area of low infection. Pre‐treatment infection prevalence in the high infection area (76.6%) was significantly higher than that in low infection area (36.3%). Levels of anti‐SEA immunoglobulin (Ig)A and IgM were significantly higher and levels of IgG3 significantly lower in children from the low infection area. Nine months after treatment, infection prevalence was significantly higher in the high infection area (29.0%) (where re‐infection rates were higher) than in the low infection area (12.9%). Children from the high infection area were six times more likely to get re‐infected than those from the low infection area, while younger children were 30 times more likely to get re‐infected than older children. These results are discussed in relation to differences in transmission and the development of acquired immunity. Pre‐treatment levels of IgM and the difference between IgE and IgG4 were positively associated with re‐infection in the high infection area. These results are discussed in relation to the interpretation of simple correlations between infection and some antibody levels and the inference of causal relationships between observed epidemiological and immunological patterns.