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Possible mechanisms of protection in animal models and humansThe mechanism of protection (elimination of adult worms) in the mouse model has been well studied using multitudes of irradiated cercarial vaccine regimens and the topic has been extensively reviewed.29,30 Briefly, this immune mediated protection appears to be a highly orchestrated series of events starting in the skin, involving draining lymph nodes and lungs where most larvae are killed, 3 weeks post-challenge.30,31 Vaccination with irradiated cercariae results in the development of various effector responses that can range from Th1-type cell-mediated response to parasite-specific antibodies–all of these responses play some role in the immune killing of worms.29,30,32In humans, evidence from multiple studies documents an age-acquired resistance to re-infection in older children and adults.5,33-35 Individuals living in endemic communities display a characteristic left-skewed convex distribution by age of prevalence and intensity of infection for schistosomes.36,37 Factors predictive of resistance in multiple immuno-epidemiologic studies include a high concentration of serum parasite-specific IgE, increased circulating CD23+ B cells, eosinophilia, and secretion of IL-5 in response to crude worm extracts.9,38-41 However, whether any of these immune responses is directly involved in worm killing has not been elucidated and there are too few reports that delve into the mechanistic aspects of protective immunity.
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