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In 1966 Leibowitz et al.1 first suggested that the prevalence of MS was correlated with a childhood environment characterized by a high level of sanitation. Similar observations have led to the formulation of the hygiene hypothesis, which holds that a relative lack of “evolutionarily normal” childhood infectious exposures may predispose susceptible individuals to allergic and autoimmune diseases later in life. Recent findings that are consistent with the hygiene hypothesis have come from studies in epidemiology, immunology, and animal models, as well as successful clinical trials of probiotic treatment for allergic and autoimmune diseases.2-4 In this regard, many observers have noted that the prevalence of MS in the developed world far exceeds that of regions characterized by widespread childhood infection or poor sanitation. Nevertheless, to the best of our knowledge, to date the global relationship between MS incidence and parasitic exposure has only been addressed in qualitative terms.
To address this issue quantitatively, we first noted the global prevalence of Trichuris trichiura, a common human helminth with world-wide distribution and a surrogate marker for 1) infection with other macroparasites as well a marker for 2) low levels of community sanitation. Initial …
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