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Chemotherapy of all persons infected with Schistosoma mansoni was begun in Marquis Valley, St. Lucia, in March 1974. From January 1972 to the start of chemotherapy, the infection rate in field Biomphalaria glabrata collected in the valley was 1.09% (117/10,736) and the rate in sentinel B. glabrata was 1.48% (56/3,790). From March 1974 through December 1975, no infections were detected in either field snails (11,742 collected) or sentinel snails (3,230 exposed). The accumulated date suggest that, because of differences in topography and average annual rainfall, S. mansoni transmission occurs in this valley during the rainy season, whereas in other St. Lucian valleys under study it occurs during the dry season.

Individual households in five settlements were provided with piped water in a pilot scheme to investigate the effect on transmission of S. mansoni in St Lucia. Nearby comparison settlements, in the same valley, were provided with water through a public standpipe system. The incidence of S. mansoni infection among children decreased in the experimental area, leading to lower prevalence rates and lower intensity of infection in all age groups. Over the study period, indices of infection increased in the comparison settlements, but by the end of the period development was making those settlements less suitable for comparison purposes and some reduction in transmission was occurring.The changes in human infection rates were reflected in the results of studies with sentinel snails. In the experimental area, infection rates gradually fell owing to reduced water contact and consequently less contamination of the river and its banks, and possibly to the gradual reduction in contamination potential of the community with reduced prevalence and intensity of infection. It is suggested that a piped water supply be considered as a method of schistosomiasis control, but that the cost should not be debited only to the control of this disease since a clean water supply has other medical and social benefits.

The size and number of colonies of Biomphalaria glabrata were reduced after four years of a surveillance/treatment snail control programme using an emulsifiable concentrate of niclosamide (25% active ingredient). Surveys among the human population showed that the incidence of new Schistosoma mansoni infections in 0-10 year-old children fell from 22% to 4.3%, while in a comparison area the incidence remained at 20%. With reduced transmission over four years, the prevalence of infection in a cohort of children examined in 1971 and 1975 fell from 34% to 23%. The fall in prevalence and intensity of infection led to a reduction of 66% in the index of potential contamination, which was reflected in a reduced rate of infection among sentinel snails and representative samples of B. glabrata collected during surveillance searches.The overall annual cost of the programme was US $3.24 per capita.

In artificial drains similar to those used in banana culture on St. Lucia, Helisoma duryi, the rams-horn snail, controlled Biomphalaria glabrata, intermediate host of schistosomiasis on that island. Time required for elimination of B. glabrata depended on environmental temperature and numbers of H. duryi initially introduced in the drains. Best fit to the data was given by the equation for the logistic curve rather than by an equation for unlimited growth. Multiple regression analyses of natality and mortality rates of both species of snails indicated that populations of B. glabrata were regulated by temperature rather than by density-dependent means while numbers of H. duryi were strongly influenced by numbers of rams-horn snails already present in the drains. Fitting of snail shell growth to von Bertalanffy equations showed that H. duryi shell diameter was uninfluenced by environmental temperatures or presence of B. glabrata while growth of the intermediate host was strongly affected both by temperature and numbers of H. duryi.

Tests of a slow-release molluscicide containing 50% copper sulfate were under-taken in laboratory and field situations in St. Lucia. In laboratory trials, a granule form of the molluscicide produced 100% mortality of Biomphalaria glabrata down to 4 mg/liter active ingredient (a.i), while the pellet form produced 100% mortality down to 8 mg/liter a.i. In field trials, a dose of 100 mg/liter a.i. in granule form caused mortality of B. glabrata in banana drains but had no effect on B. glabrata populations in a marsh habitat. In both habitats, the dose of 100 mg/liter produced mortality of other molluscan fauna which caused changes in the molluscan diversity indices. This failure in field trials may have been due to dilution of copper levels caused by flooding and also by uptake of copper by mud and algae.

An area-wide mollusciciding campaign in Cul de Sac valley, St. Lucia reduced incidence of Schistosoma mansoni from 22% to 4.3% between 1970 and 1975. Following this, a two-year focal surveillance-mollusciciding programme was introduced. Sites of potential transmission of S. mansoni were identified and routinely searched for Biomphalaria glabrata. If found, the site was treated with clonitralide 25% emulsifiable concentrate. Two chemotherapy campaigns supplemented the snail control programme. As a result of the combined measures, incidence of the infection dropped from 4.3% to 1.0% and from 2.2% to 0.6% in areas originally of high and low transmission respectively. The cost of protecting the 7,000 population was US $20,362: of these costs, labour absorbed 68%, transport 24%, equipment 4% and molluscicide 4%. The cost per person per year protected was US $1.45 which compares favourably with the $3.24 of the previous scheme. Although effective and relatively cheap, this programme was still dependent on a high standard of supervision for maximum benefit.