Epidemiologic, immunologic and practical considerations in developing and evaluating a human hookworm vaccine

Abstract

Hookworm is a widely prevalent human parasite and an important contributor to anemia worldwide. Efforts to control hookworm in developing countries currently focus on chemotherapy, especially for school-aged children. Due to the high rates of post-treatment hookworm reinfection and other factors that limit the success of school-based chemotherapy programs, a vaccine would represent a major new tool in the control of hookworm. Recent developments in the molecular biology of hookworm have made it possible to develop a recombinant vaccine. As hookworms have fundamentally different epidemiologic and immunologic characteristics to viral and bacterial infections, special methodologic and statistical consideration is needed in clinical trial design and evaluation. There are many remaining obstacles and issues in the research, large-scale development and delivery of a vaccine for a disease that afflicts the poorest of the poor in developing countries. There is also a need to assess the cost–effectiveness of vaccination relative to chemotherapy programs. This review summarizes current progress in vaccine development and discusses some of these issues and ongoing efforts to overcome remaining challenges.

Keywords::

• hookworm
• recombinant vaccine

Acknowledgements

Work was supported by the HHVI of the Sabin Vaccine Institute and the Bill and Melinda Gates Foundation, March of Dimes Clinical Research Grant (6FY-00–791), and a grant from the China Medical Board of New York, Inc. Simon Brooker is supported by a Wellcome Trust Advanced Training Fellowship (073656) and Jeffrey Bethony is supported by an International Research Scientist Development Award (IRSDA) (K01 TW00009) from the John E Fogarty International Center, NIH. We thank Paul Fine for his precise and insightful review of an earlier draft.