Epidemiological aspects of Trichuris and trichuriasis in Caribbean communities.

The review argues for a reappraisal of the health significance of the human whipworm, Trichuris trichiura. Infections with this geohelminth are at least as prevalent as Ascaris lumbricoides in many localities, and are associated with significant morbidity. Infection may result in severe trichuriasis syndrome or, more frequently, in a chronic colitis associated with growth stunting. Under-reporting of the chronic manifestations of disease has resulted in a gross under-estimation of the health impact of trichuriasis. Furthermore, estimation of the population dynamical parameters of T. trichiura transmission suggests that whipworm infections are intrinsically more resistant to control than those of other common geohelminths. A major determinant of the transmission dynamics and morbidity characteristics of this helminthiasis is the aggregation of worm burdens in certain predisposed individuals and age groups. It is suggested that improved understanding of the factors generating this distribution of infection intensity is a pre-requisite for effective control of both infection and morbidity.