Developing vaccines to combat hookworm infection and intestinal schistosomiasis

• Published in: Nature reviews. Microbiology 2010-11, Vol.8 (11), p.814-826
• Main Authors: Hotez, Peter J, Bethony, Jeffrey M, Diemert, David J, Pearson, Mark, Loukas, Alex
• Format: Article
• Language: English
• Subjects: 631/326/590; 692/699/255/1715; Acquired immune deficiency syndrome; Adults; AIDS; Anemia - etiology; Anemia - prevention & control; Animals; Antigens, Helminth; Biomedical and Life Sciences; Developing countries; Distribution; Females; Health aspects; Health problems; HIV; Hookworm disease; Hookworm Infections - complications; Hookworm Infections - immunology; Hookworm Infections - prevention & control; Human immunodeficiency virus; Humans; Infections; Infectious Diseases; LDCs; Life Sciences; Lungs; Malaria; Malnutrition; Medical Microbiology; Microbiology; Necator americanus; Necator americanus - immunology; Necator americanus - pathogenicity; Necator americanus - physiology; Parasites; Parasitology; Pathology; Prevention; review-article; Risk factors; Schistosoma mansoni; Schistosoma mansoni - immunology; Schistosomiasis; Schistosomiasis mansoni - immunology; Schistosomiasis mansoni - prevention & control; Skin; Small intestine; Tropical diseases; Vaccines; Vaccines - isolation & purification; Vaccines, Combined - isolation & purification; Virology
• ISSN: 1740-1526; 1740-1534
• DOI: 10.1038/nrmicro2438

Key Points Hookworm infection and schistosomiasis are two of the most common neglected tropical diseases of humans and among the most important in terms of their global disease burden in developing countries. Global control of each infection currently relies on mass drug administration using donated or low-cost anthelmintic drugs, but high rates of both drug failure (with mebendazole) and post-treatment reinfection necessitate the development of anthelmintic vaccines. A human hookworm vaccine is being developed as a bivalent injectable product combining two recombinant proteins, derived from the gut of the adult stage of the hookworm Necator americanus , that interfere with parasite blood feeding. One of the leading schistosomiasis vaccines under development targets a tetraspanin antigen involved in biogenesis of the tegument of Schistosoma mansoni , the main etiological agent of intestinal schistosomiasis. Both vaccines are being developed for children living in endemic areas of developing countries and could be linked to anthelmintic treatments in a programme of vaccine-linked chemotherapy. Both the hookworm and schistosome antigens may ultimately be combined as a multivalent anthelmintic vaccine. In terms of disability-adjusted life years, the disease burden resulting from hookworm infection and schistosomiasis is considerable. In this Review, Hotez and colleagues outline the pathology of these parasitic infections and discuss recent progress in vaccine development. Hookworm infection and schistosomiasis rank among the most important health problems in developing countries. Both cause anaemia and malnutrition, and schistosomiasis also results in substantial intestinal, liver and genitourinary pathology. In sub-Saharan Africa and Brazil, co-infections with the hookworm, Necator americanus , and the intestinal schistosome, Schistosoma mansoni , are common. The development of vaccines for these infections could substantially reduce the global disability associated with these helminthiases. New genomic, proteomic, immunological and X-ray crystallographic data have led to the discovery of several promising candidate vaccine antigens. Here, we describe recent progress in this field and the rationale for vaccine development.