Abstract

In the survey of l1,005 subjects in l3 villages of Che Ju lsland, 1,450 persons were egg-positive by repeated sputum examinations. The response rate to intradermal test ranged 50-80 per cent of the population and to sputum examination for skin positive 60-70 per cent in the first survey done in l964. 93 per cent of all egg-positive was treated with 40 mg/kg body weight of bithionol on alternate days for 10-15 doses in l965. Follow-up studies were carried out in one year, three-year, five-year, and eight year after the mass treatment. The one year follow-up study covered 86.5 per cent of all treated cases in all villages but only a part of the population of a few villages in further follow-up studies. In this paper only the result obtained from the age group of 7-18 years, the common population studied in every follow-up for the purpose of comparison, is presented. Intermediate hosts of P. westermani were examined at the same time. In one year follow-up it was found that 91 per cent of egg-positive treated became negative. Three parameters, skin reaction, sputum examination, and infection status of intermediate hosts by area and year were used for comparison. Skin positive rate showed gradual decrease with more marked drop in Kang Chung where more thorough survey and mass treatment (about 43 per cent of all infected persons estimated among whole population) were carried out than other areas (only 20-30 per cent). The proportion of intermediate skin reation (60-100 mm(3) wheal size) increased markedly indicating decreased dose of infection which corresponds to the dropped infection rate and average number of metacercaria in crabs. Egg-positive rate in sputum examination done for skin positive reactors also presented similar pattern to skin reaction although it should be taken account that the result of 1964 was from repeated sputum examinations but that of other years from a single examination. Increased proportion of intermediate skin reaction which has much lower egg-positive rate probably played major role in decreased egg-positive rate. The infection rate of snail started to drop about one year earlier than crab; crab infection rate and intensity started to drop about four year after the mass treatment. The duration needed to show the change of infection status in intermediate hosts after the mass chemotherapy may correspond to the duration of survival of the parasite in the intermediate hosts. With the data available presently, it is difficult to determine on what point of the curve the present status is situated (on decreasing phase or increasing phase?), how far the rate will go down if it is on decreasing phase, and how long would it take in returning to the original status without further management. The result of follow-up study, however, strongly indicate that continous and intense chemotherapy may be able to put the paragonimiasis under control. Further follow-up study on total population including survey on changes of environment and eating habits is planned.