Re-examination of Opisthorchis viverrini Infection in Northeast Thailand

  • Yeoh, Kheng-Wei (Department of Public Health, University of Oxford) ;
  • Promthet, Supannee (Department of Epidemiology, Faculty of Public Health, Khon Kaen University) ;
  • Sithithaworn, Paiboon (Department of Parasitology, Faculty of Medicine, Khon Kaen University) ;
  • Kamsaard, Supot (Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University) ;
  • Parkin, Donald Maxwell (Department of Public Health, University of Oxford)
  • Published : 2015.04.29


Background: Liver fluke infection caused by the parasite Opisthorchis viverrini (O. viverrini), a human carcinogen, is endemic in north-eastern Thailand and remains a major health problem. Objectives: The objectives of the study were to (1) resurvey the prevalence of O. viverrini infection in a field site from the Khon Kaen Cohort Study (in newly recruited subjects as well as previous cohort subjects surveyed in 1992); (2) investigate how subjects' lifestyle habits and their exposure to health promotion initiatives influence changes in prevalence of O. viverrini infection. Materials and Methods: The prevalence of O. viverrini infection in the cohort subjects (as well as new subjects) was investigated using faecal egg counts. Information on demographic factors, lifestyle and awareness of health promotion initiatives were obtained through questionnaires. Results: O. viverrini infection rates in the same individuals of the cohort were lower in 2006 than in 1992. Also, by studying the period effect, the current 35-44 year olds had a 12.4% (95% CI 3.9% to 20.9%) lower prevalence of O. viverrini infection than the 35-44 year olds in 1992 (24.2% versus 11.8%). Lifestyle choices showed that smoking and alcohol consumption were associated with an increased chance of acquiring O. viverrini infection with adjusted odds ratios of 10.1 (95%CI 2.4-41.6) and 5.3 (95%CI 1.2-23.0), respectively. Conclusions: Our study has demonstrated that although the prevalence of O. viverrini infection over a 14-year period has decreased, unhealthy lifestyle was common with smoking and alcohol consumption being associated with increased chances of infection, emphasising the double burden of disease which developing countries are facing.


Opisthorchis viverrini infection;Cholangiocarcinoma;O. viverrini antibody;lifestyle


Supported by : Khon Kaen University


  1. Al-Ghamdi HS and Anil S (2007). Serum antibody levels in smoker and non-smoker Saudi subjects with chronic periodontitis. J Periodontol, 78, 1043-50.
  2. Andrews RH, Sithithaworn P, Petney TN (2008). Opisthorchis viverrini: an underestimated parasite in world health. Trends Parasitol, 24, 497-501.
  3. Attasara P, Sriplung H (2012). Cancer incidence inThailand. In: Khuhaprema T, Attasara P, Sriplung H, Wianggnon S, Sumitsawan Y, Sangrajrang S, editors. Cancer inThailand. Vol.VI, 2004-2006. Bangkok: Ministry of Public Health, Ministry of Education; 2012. p3-68.
  4. Bouvard V, Baan R, Straif K, et al (2009). WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens - Part B. Biological agents. Lancet Oncol, 10, 321-2.
  5. Elkins DB, Sithithaworn P, Haswell-Elkins M, et al (1991). Opisthorchis viverrini: relationships between egg counts, worms recovered and antibody levels within an endemic community in northeast Thailand. Parasitology, 102, 283-8.
  6. Fürst T, Keiser J, Utzinger J (2012). Global burden of human food-borne trematodiasis: a systematic review and metaanalysis. Lancet Infect Dis, 12, 201-21.
  7. Grundy-Warr C, Andrews RH, Sithithaworn P, et al (2012). Raw attitudes, wetland cultures, life cycles: socio-cultural dynamics relating to Opisthorchis viverrini in the Mekong Basin. Parasitology Int, 61, 65-70.
  8. Honjo S, Srivatanakul P, Sriplung H, et al (2005). Genetic and environmental determinants of risk for cholangiocarcinoma via Opisthorchis viverrini in a densely infested area in Nakhon Phanom, northeast Thailand. Int J Cancer, 117, 854-60.
  9. International Agency For Research On Cancer, IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2012). Biological agents. A review of human carcinogens. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 100, 1-441.
  10. Johansen MV, Sithithaworn P, Bergquist R, Utzinger J (2010). Towards improved diagnosis of zoonotic trematode infections in Southeast Asia. Adv Parasitol, 73, 171-95.
  11. Jongsuksuntigul P, Imsomboon T. 2003. Opisthorchis control in Thailand. Acta Tropica, 88, 229-232.
  12. Kaewpitoon N, Kaewpitoon SJ, Pengsaa P, Chutigan P (2007). Knowledge, attitude and practice related to liver fluke infection in northeast Thailand. World J Gastroenterol, 13, 1837-40.
  13. Murray CJ, Vos T, LozanoR, et al (2012). Disability adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2197-223.
  14. Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB eds. (2002). Cancer incidence in five continents, Vol.VIII. IARC Scientific Publications No.155. Lyon: International Agency for Research on Cancer.
  15. Parkin DM, Ohshima H, Srivatanakul P, Vatanasapt V (1993). Cholangiocarcinoma: epidemiology, mechanisms of carcinogenesis and prevention. Cancer Epidemiol Biomarkers Prev, 2, 537-44.
  16. Rhongbutsri P, Kitvatanachai P (2002). Survey of the fluke infection rate in Ban Kok Yai village, Khon Kaen, Thailand. J Trop Med Parasitol, 25, 76-8.
  17. Sadun EH (1955). Studies of Opisthorchis viverrini in Thailand. Am J Hyg, 2, 81-115.
  18. Saengsawang P, Promthet S, Bradshaw P (2013). Infection with Opisthorchis viverrini and use of praziquantel among a working-age population in northeast Thailand. Asian Pac J Cancer Prev, 14, 2963-6.
  19. Shang S, Ordway D, Henao-Tamayo M, et al (2011). Cigarette smoke increases susceptibility to tuberculosis-evidence from in vivo and in vitro models. J Infect Dis, 203, 1240-48.
  20. Shin H, Oh J, Masuyer, Curado M, et al (2010). Epidemiology of cholangiocarcinoma: an update focusing on risk factors. Cancer Sci, 101, 579-85.
  21. Sithithaworn P (2003). Epidemiology of Opisthorchis viverrini. Acta Tropica, 88, 187-94.
  22. Sithithaworn P, Andrews RH, Nguyen VD, et al (2012). The current status of opisthorchiasis and clonorchiasis in the Mekong Basin. Parasitol Int, 61, 10-6.
  23. Songserm N, Promthet S, Sithithaworn P, et al (2012). Risk factors for cholangiocarcinoma in high-risk area of Thailand:role of lifestyle, diet and methylenetetrahydrofolate reductase polymorphisms. Cancer Epidemol, 36, 89-94.
  24. Sriamporn S, Parkin DM, Pisani P, et al (2005). A prospective study of diet, lifestyle, and genetic factors and the risk of cancer in Khon Kaen province, northeast Thailand: description of the cohort. Asian Pac J Cancer Prev, 6, 295-303.
  25. Sriamporn S, Pisani P, Pipitgool V, et al (2004). Prevalence of Opisthorchis viverrini infection and incidence of cholangiocarcinoma in Khon Kaen, Northeast Thailand. Trop Med Int Health, 9, 588-94.
  26. Sriraj P, Aukkanimart R, Boobmars T, et al (2013). Alcohol and alkalosis enhance excystation of Opisthorchis viverrini metacercariae. Parasitol Res, 112, 2397-402.
  27. Sripa B, Pairojkul C (2008). Cholangiocarcinoma: lessons from Thailand. Curr Opin Gastroenterol, 24, 349-56.
  28. Sripa B, Tangkawattana S, Laha T, et al (2015). Toward integrated opisthorchiasis control in northeast Thailand: The Lawa project. Acta Trop, 141, 361-67.
  29. StataCorp LP (2007). Stata Release 10: User's guide. College Station TX: Stata Press.
  30. Thammapalerd N, Tharavanji S, Nacapunchai D, et al (1988). Detection of antibodies against Opisthorchis viverrini in pateints before and after treatment with praziquantel. Southeast Asian J Trop Med Pub Health, 19, 101-8.
  31. Thaewnongiew K, Singthong S, Kutchamart S, et al (2014). Prevalence and risk factors for Opisthorchis viverrini infections in upper Northeast Thailand. Asian Pac J Cancer Prev, 15, 6609-12.
  32. Upatham ES, Viyanant V (2003). Opisthorchis viverrini and opisthorchiasis: a historical review and future perspective. Acta Trop, 88, 171-6.
  33. Upatham ES, Viyanant V, Brockelman WY, et al (1988). Rate of re-infection by Opisthorchis viverrini in an endemic northeast Thai community after chemotherapy. Int J Parasitol, 18, 643-69.
  34. Vatanasapt V, Pengsaa P, Tangvoraphonkchai V, et al (1992). Thailand: Khon Kaen Cancer Registry. In Parkin DM, Muir CS, Whelan SL, Gao TT, Ferlay J and Powell J (eds). Cancer incidence in five continents, Vol. VI. IARC Scientific Publications No. 120, pp 546-549. Lyon: International Agency for Research on Cancer.
  35. Wang H, Zhou H, Mahler S, et al (2011). Alcohol affects the late differentiation of progenitor B cells. Alcohol and Alcoholism, 46, 26-32.
  36. WHO (1995). Control of foodborne trematode infection. WHO technical report series, 849.
  37. Wykoff DE, Harinasuta C, Juttijudata P, Winn MM (1965). Opisthorchis viverrini in Thailand-the life cycle and comparison with O. felineus. J Parasitol, 51, 207-14.

Cited by

  1. Immunodiagnosis of opisthorchiasis using parasite cathepsin F vol.114, pp.12, 2015,
  2. Review and Current Status of Opisthorchis viverrini Infection at the Community Level in Thailand vol.16, pp.16, 2015,
  3. Detection of the Carcinogenic Liver Fluke Opisthorchis viverrini Using a Mini Parasep SF Faecal Parasite Concentrator vol.17, pp.1, 2016,
  4. Prevalence and Factors Associated with Opisthorchis viverrini Infection in Khammouane Province, Lao PDR vol.17, pp.3, 2016,
  5. Uncovering the Pathogenic Landscape of Helminth (Opisthorchis viverrini) Infections: A Cross-Sectional Study on Contributions of Physical and Social Environment and Healthcare Interventions vol.10, pp.12, 2016,