At the time, the global recognition of the public health importance of this and other soil-transmitted helminths (STH) was not fully appreciated. Over 25 years ago, Miller (1979) reviewed the current understanding of the biology, pathology and morbidity of human hookworm infection in this series. These early investigations conducted in the first four decades of the twentieth century provided an important framework for our current knowledge of the pathogenesis and population biology of hookworm infection. In 1916, the first Department of Helminthology in the United States was founded at the Johns Hopkins School of Hygiene and Public Health in order to begin applying modern science and quantitative methods to the study of hookworm ( Fee & Acheson, 1987 Nawalinski and Schad, 1991). Subsequently, the Rockefeller Sanitary Commission was established to combat hookworm in the United States and the Internatonal Health Commission was formed to control hookworm overseas. In 1901, the public health importance of hookworm infection was revealed when it was found to be hyperendemic on the island of Puerto Rico and linked to the death of almost 12,000 of its inhabitants annually ( Ashford, 1934). duodenale was first elucidated by Looss (1901), and Necator americanus was discovered in the Western Hemisphere ( Stiles, 1902 Dock and Bass, 1910 Chandler, 1929).

At the beginning of the 20 th century, the life cycle of A. The pathophysiology and epidemiology of human hookworm infection has been the subject of intensive study for over one hundred years, beginning with the work of Theodore Bilharz who linked intestinal helminths with tropical chlorosis in Egypt, and studies by Italian pathologists who identified Ancylostoma duodenale as the cause of anaemia among labourers constructing the Saint Gothard railway tunnel in the Swiss Alps ( Peduzzi and Piffaretti, 1983 Nawalinski and Schad, 1991). There are also efforts underway to develop novel anthelmintic drugs and anti-hookworm vaccines. Large-scale treatment programmes are currently underway, supported by health education and integrated with the provision of improved water and sanitation. Recent recognition of the subtle, but significant, impact of hookworm on health and education, together with the simplicity, safety, low cost, and efficacy of chemotherapy has spurred international efforts to control the morbidity due to infection.

Our epidemiological understanding of hookworm has improved through the development of mathematical models of transmission dynamics, which coupled with decades of field research across mutliple epidemiological settings, have shown that certain population characteristics can now be recognised as common to the epidemiology, population biology and control of hookworm and other helminth species. At present, relatively little is known about the immune responses to hookworm infection, although it has recently been speculated that hookworm and other helminths may modulate specific immune responses to other pathogens and vaccines. Advances in molecular biology has lead to the identification of a variety of new molecules from hookworms, which have importance either in the molecular pathogenesis of hookworm infection or in the host-parasite relationship some are also promising vaccine targets. This article reviews recent advances in our understanding in the biology, immunology, epidemiology, public health significance and control of hookworm, and to look forward to the study of this important parasite in the 21 st century. In recent years, there have been dramatic improvements in our understanding of many aspects of this globally widespread parasite. The scientific study of human hookworm infection began at the dawn of the twentieth century.

What causes hookworms in humans