CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK
Exam-style questions and sample answers have been written by the authors. In examinations, the way marks are awarded
may be different.
Coursebook answers
Chapter 10
Before you start
• How human parasites survive and how they
transfer from one person to another:
• Parasites are organisms that live in or live
on a host. They derive their source of
energy by feeding on the tissues of the host.
• The discussion might start by dealing
with external parasites of humans, such
as fleas, ticks and lice. These parasites
survive by having adaptations for
attaching to the hosts’ skin and hair so are
therefore difficult for the host to remove.
• The parasites covered in this chapter are
internal parasites that live in body spaces
(cholera bacteria) and inside cells (HIV,
TB bacteria and the malarial parasite).
To survive, these parasites must have
adaptations to gain supplies of energy
from the host and must also be able to
evade attack by conditions in the body,
such as the low pH in the stomach, and
evade the host’s immune system.
• Parasites that cause harm to the host are
pathogens. If they cause so much harm
that the human host has a high chance
of dying, it is important that they can
transfer to new hosts.
• External parasites can transfer to new
hosts when they are in close proximity
or via bedding. Internal parasites can
transfer in body fluids, such as blood and
semen. Some are transferred by external
parasites that suck blood. Others may be
transferred in drinking water or in food.
•• Some ways people can protect themselves
from infection by harmful parasites:
• Make sure food is prepared and handled
carefully, e.g. keep uncooked meat in a
refrigerator.
• Make sure that food is prepared hygienically.
• Wash hands before and after preparing
food and before eating.
1 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
• Use personal hygiene, e.g. wash hands
after using the toilet.
• Use antiseptics to reduce chances of
infection through the skin.
• Do not share items of personal hygiene,
such as toothbrushes and razors.
• Use disinfectants to clean surfaces in
bathrooms and kitchens.
• Make sure that children are vaccinated
according to the programme of
vaccination available in your country.
• Find out which vaccinations are required
when travelling abroad.
• Take precautions when near wild animals
and stray dogs and cats, e.g. keep a
distance if they are likely to have rabies
and do not touch them with bare hands.
Other precautions are included in the chapter.
Science in Context
The details of the discussion will depend on how
much you know about modern technology as
applied to medicine and disease control. Some
ideas which can be researched are:
• use of GPS to track outbreaks of disease
(see Figure 10.1). Recording where and when
outbreaks occur can give scientists ideas about
how the pathogen is transmitted
• use of electronic communication, e.g. mobile
phones and email, to link health professionals
who may be working in remote areas to
scientists in research facilities (e.g. universities,
national and international organisations)
• use of databases to store large amounts of
information about outbreaks
• use of web-based resources for communicating
information about outbreaks to national and
international organisations
• artificial intelligence to analyse all the data
collected about outbreaks of disease
• use of computer modelling to predict when
and where outbreaks will happen
• use of DNA sequencing to help identify the
type of pathogen.
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK
Self-assessment questions
1 a Each cell has a nucleus. They also
have membrane-bound organelles,
such as mitochondria, Golgi body and
endoplasmic reticulum.
b Viruses do not have a cellular structure.
Each virus consists of a nucleic acid core
(RNA or DNA) surrounded by a protein
coat. Prokaryotes have cells with cell
walls, cell membranes and cytoplasm.
2 Viruses have nucleic acid (DNA or RNA)
inside a protective protein capsid. Some are
surrounded by envelopes derived from the
cell surface membrane of the cells that they
parasitise. Viruses cannot reproduce without
entering cells (prokaryote or eukaryote
depending on the type of virus) and using
their ‘machinery’ of nucleic acid production
and protein synthesis to make new viral
particles. Bacteria have cells with all the
enzymes needed to sustain life, including those
for hydrolysis of food substances, respiration,
DNA replication and protein synthesis.
3 Faeces from an infected person contain Vibrio
cholerae. These bacteria are transmitted
to uninfected people in drinking water,
contaminated food (e.g. vegetables irrigated
with raw sewage or food prepared by a
symptomless carrier), or when washing
or bathing in contaminated water. This is
sometimes called the faecal−oral route of
transmission.
1013
4 reducing transmission of the disease.
106 = 10 million
5 Public services, such as provision of clean
water and safe removal and treatment of
sewage, are disrupted. People are at risk of
drinking water that is contaminated by cholera
bacteria. Survivors of these natural disasters
often do not have access to proper sanitation,
clean water or uncontaminated food.
6 The visitor can drink bottled or boiled water
and avoid eating salads and raw vegetables.
If the person is visiting a place where there
is an outbreak of cholera or is going to work
in places where taking the precautions listed
above is likely to be difficult, then they should
receive the cholera vaccine. If their stay is
going to be longer than two years, they should
receive a booster as the vaccine only gives
short-term protection.
7 When a female Anopheles mosquito bites an
infected person, she takes up some gametes of
2 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
the malarial parasite. These develop into the
infective stage which enters the salivary glands
of the mosquito. The parasite is transmitted
when the mosquito takes another blood meal
from an uninfected person.
8 Plasmodium is eukaryotic so has a nucleus
and membranous organelles (as can be seen
in Figure 10.5). Human red blood cells do
not have nuclei as they are lost during their
development from stem cells. Mature red
blood cells do not have any membranous
organelles either. See Chapter 8 for
structural adaptations of mammalian red
blood cells.
9 a i Both numbers of cases and numbers
of deaths from malaria began to
decrease from 2002. Between 1999 and
2002, the number of cases was 10 000
a year and the number of deaths
about 375 a year. By 2008, the number
of cases had decreased to less than
1000 a year and number of deaths to
75 a year.
ii The decrease in numbers of cases
could be due to better diagnosis of
malaria so people received treatment
without having to be admitted
to hospital. Prophylactic drugs
may have been provided to those
at risk of malaria in the season
when mosquitoes are most active.
Insecticide-treated nets may have
been provided to the population so
Mosquito control programmes
may have been started or existing
programmes became more effective.
iii Data could have been collected for
the number of people who were
diagnosed with malaria and the
number of people who were treated
for malaria without attending
hospital.
b The results of the initial tests may be false.
Results that suggest someone is infected
by Plasmodium when in fact they are free
of the disease are known as false-positive
results. Providing them with drugs is an
unnecessary expense.
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK
10 Factors that make malaria difficult to control
include:
• the resistance of mosquitoes to
insecticides
• the difficulty of controlling the breeding
of mosquitoes because they lay eggs in
small bodies of water
• the resistance of some strains of
Plasmodium to anti-malarial drugs such
as chloroquine and mefloquine.
11 People can avoid being bitten by mosquitoes,
sleep under nets impregnated with insecticide,
use repellents and use anti-malarial drugs
as prophylactics (but not those to which
Plasmodium is resistant).
12 a i 27.7% / 28%
ii ‘Living with HIV’ means people
who have been infected with HIV,
including those who have symptoms
of AIDS and those who show no
symptoms at all.
b i The estimated number of people living
with HIV has increased by 28% / from
28.9 million to 36.9 million / by
8 million between 2000 and 2017.
The estimated number of people
receiving treatment has increased
by 2613% / from 0.8 million to
21.7 million / by 20.9 million between
2000 and 2017.
The estimated proportion of people
living with HIV and receiving
treatment has increased from 0.03 to
0.59 between 2000 and 2017.
Apart from 2016 there has been
an increase year on year for the
numbers estimated to be living with
HIV. The estimated numbers and
the proportion of people receiving
treatment increased year on year.
ii Many people who are infected with
HIV have not been diagnosed.
Many who have been diagnosed
may not have been recorded by
health authorities. Countries may
underreport the numbers as they have
not collected sufficient data. Countries
may also overreport the numbers
perhaps in order to receive more
funding from international donors.
The numbers may be estimated from
3 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
small samples of the population, for
example the people who are tested
for HIV.
13 Practise safer sex (e.g. use condoms); do not
use unsterile needles; have one sexual partner;
do not donate blood if at risk of HIV infection;
do not use prostitutes (male or female); have a
blood test to find out if you are HIV+.
14 HIV is a blood-borne virus; blood donations
may not be screened or heat-treated for HIV.
15 It is important for people to know whether
they are living with HIV so that they can
make sure that they reduce the chances of
transmitting the virus to others.
16 a some suggestions:
• incidence of TB / number of new cases
of TB per 100 000 people per year = 154
per 100 000 people per year for 2018
• number of new cases of TB found to
be living with HIV per 100 000 per
year = 15 per 100 000 people per year
for 2018
• mortality rate / number of deaths
from TB per 100 000 people per year
= 17 deaths per 100 000 people per
year for 2018
b some suggestions:
• number of people diagnosed with
TB who started treatment within a
specific year
• number of people who completed
treatment successfully within a
specific year (e.g. 2018)
• length of time each person who
was treated successfully was on the
treatment programme (this could be
used to calculate the median length
of time)
• number of people who started the
treatment programme who did not
conclude it (because they failed to
collect drugs / take drugs under
supervision / died / other reasons)
17 HIV/AIDS decreases the number of
T-lymphocytes, weakening the ability of
the body to mount an effective immune
response against HIV and other pathogens.
About one-third of the human population
is infected with M. tuberculosis, and this
may progress to cause the symptoms of TB
if the immune system is weakened by HIV
infection.
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK
18 some suggested precautions:
• Avoid close contact with people known to
have active TB, for example avoid staying
in hostels where such people sleep.
• Only consume pasteurised, sterilised or
UHT milk and milk products made from
these types of milk.
• Those at high risk of developing TB
should have a tuberculin skin test to see
if they are infected with Mycobacterium
tuberculosis or M. bovis before they leave.
The test should be repeated when they
return to see if they have contracted the
disease while travelling.
• Consult a medical professional to see if
they should be given the BCG vaccine.
19 Viruses do not have targets for antibiotics;
for example, viruses are not cells, so they have
no cell walls. Also they do not have the cell
machinery for making proteins – they use the
ribosomes and enzymes of their host cells
to make their proteins. The antibiotics that
we use to control bacterial infections do not
interfere with human proteins, so none of
them will inhibit the reproduction of viruses.
20 some ways in which bacteria can resist the
effects of antibiotics:
• a thick cell wall that is impermeable to
antibiotics
• membrane proteins that inactivate
antibiotics
• enzymes that catalyse the breakdown
of antibiotics (e.g. β-lactamase enzymes
including penicillinases)
• membrane proteins that pump antibiotics
out of the cell
• changing the part of the protein to which
the antibiotic binds so this is not possible
21 MRSA evolved because antibiotics are used
in hospitals and act as a selection pressure.
Also there has been transfer of genes between
different types of bacteria, for example
Staphylococcus aureus and Enterococcus
faecalis, which is an intestinal bacterium.
E. faecalis was the source of vancomycin
resistance in S. aureus. MRSA is common in
prisons because many people are kept in close
proximity and a disease is easily transmitted
once it is present in such a community.
4 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
22 a  he more frequently antibiotics are used,
T
the more frequently resistant bacteria
will be selected for. If antibiotic use is
infrequent, then other selection pressures
will be more important in bacterial
populations, decreasing the likelihood of
resistant bacteria surviving.
b  hanging the antibiotic changes the
C
selection pressure. Different strains
of bacteria will be selected for when a
different antibiotic is used, decreasing the
likelihood of a resistant strain for each
antibiotic becoming widespread.
c I t is far less likely that any individual
bacterium will be resistant to two antibiotics
than to any single antibiotic. Using two
antibiotics together therefore decreases the
chance of any bacteria surviving.
23 B and E. These have inhibition zones larger
than the minimum required to be in the
sensitive range. These antibiotics could be
used together.
Reflection
Some points that are likely to be made in the
presentation:
• Many people are becoming infected with
antibiotic-resistant strains of bacteria.
• Data to support this statement should be
included, especially for TB but for other
bacterial diseases as well.
• Reasons for the increase in antibiotic
resistance should be listed – see this chapter
and supplement with research to find other
reasons.
• Examples are using antibiotics when they are
not necessary (e.g. to treat viral diseases) and
using antibiotics that are not suitable for the
treatment of the bacterial diseases concerned.
• Some strains of bacteria are very difficult to
treat and some cannot be treated with any
antibiotics.
• Examples are methicillin-resistant
Staphylococcus aureus (MRSA), Carbapenem-
resistant Enterobacteriaceae (CRE) and
Clostridium difficile.
• Antibiotics act as an agent of natural selection
(see Chapter 17).
• No new class of antibiotic has been developed
since 1987, although teixobactin, discovered
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

in 2016, could give rise to a new class of 1 A ; [1]

antibiotics. 2 C ; [1]
• Consider strategies to cope with antibiotic 3 D ; [1]
resistance, for example not using certain
antibiotics for a long time, rotating 4 C ; [1]
antibiotics, etc. 5 a unprotected sexual intercourse ;
• Include strategies for developing new sharing needles (between intravenous drug
antibiotics, for example use of genome users) / reuse of unsterilised needles ;
sequencing and designing new proteins to (via) blood transfusion / blood products ;
inhibit processes that occur in bacteria.
(mother to child) across the placenta / at
birth / in breast milk ; [max. 3]
Exam-style questions
b doctor’s / hospital, records ;
The mark schemes, suggested answers and
comments that appear here were written by the tests for HIV status (e.g. at antenatal
author(s). In examinations, the way marks would clinics for pregnant women) ;
be awarded to answers like these may be different. death certificates ;
data recorded by (named), national /
Notes about mark schemes international, organisations (e.g. World
A or accept indicates an alternative acceptable Health Organization) ; [max. 3]
answer.
c determine how numbers of people
R = reject. This indicates a possible answer that infected are changing ;
should be rejected.
see where medical resources should be
; The bold semicolon indicates the award of 1 mark. targeted ;
/ This indicates an alternative answer for the same e.g. drugs for treating HIV infection ;
mark. The alternatives may be separated from the
rest of the answer by commas. 
monitor success of HIV/AIDS programmes:
( ) Text in brackets is not required for the mark. in reducing spread of HIV infection ;
Underlining This is used to indicate essential in treating people who are HIV+ so they
word(s) that must be used to get the mark. do not develop AIDS ;
AW means ‘alternative wording’. It is used to to see if more education is required ;
indicate that a different wording is acceptable to provide support to national / regional
provided the essential meaning is the same, and is health organisations ;
used where students’ responses are likely to vary
AVP ; ; [max. 3]
more than usual.
730 000
AVP means ‘additional valid point’. This means d i = 0.029
25 500 000
accept any additional points given by the student   ratio = 0.029 : 1 ; [1]
that are not in the mark scheme, provided they
are relevant. But accept only as many additional ii better health care in North America ;
points as indicated by the bold semicolons, e.g.   better diagnosis, so people who
AVP ; ; means award a maximum of 2 extra marks. are tested as living with HIV start
ORA means ‘or reverse argument’ and is used treatment early ;
when the same idea could be expressed in the   more affluent countries, so
reverse way. For example: ‘activity increases antiretroviral drugs available to (nearly)
between pH2 and pH5 ORA’ means accept all people who are living with HIV ;
‘activity decreases between pH5 and pH2’.   AVP ; [max. 3]
max. This indicates the maximum number of  [Total: 13]
marks that can be given.
6 a female Anopheles (mosquito) ;
takes a blood meal from an infected person ;

5 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

transfers, parasite / pathogen / 7 a bacteria pass out in faeces of infected

Plasmodium, in saliva when takes a blood person ;
meal from an uninfected person ; [3] carried in, water / food, consumed by
b decrease in, number / concentration, of uninfected person ; [2]
red blood cells ; b poor sanitation ;
less haemoglobin to transport oxygen ; not enough clean drinking water ;
increase in risk of anaemia ; poverty ;
more likely to be, tired / fatigued ; lowered immunity / malnutrition / HIV
AVP ; [max. 3] infection ; [max. 3]
447
c i  osquito nets, reduce chances /
m c i × 100 = 1.08 ; [1]
41 421
prevent, mosquitoes, feeding on ii treatment for cholera involves supply
humans / taking blood meals ; of oral rehydration therapy ;
   osquitoes are killed by insecticides
m   and provision of safe drinking water ;
(on nets / on internal surfaces of
houses) ;    etter response to emergencies (in
b
some countries) ;
  insecticides are long-lasting so, nets do
not need to be renewed often / houses   e ffectiveness of response may depend
do not need to be sprayed often ; on number of cases ;
  children (under 5) are, most   r ef to very high number of cases in
susceptible to malaria / more likely to Haiti ;
die from malaria ;    ay depend on remoteness of regions
m
  drugs kill, Plasmodium / malarial affected by cholera ;
parasite, when it enters the body ;    r ways in which, emergency supplies /
o
  rainy season is when mosquitoes breed ; personnel, can reach affected areas ;
   osquitoes / Anopheles / vector, breeds
m   r ef to high case fatality rates in,
in small pools of water ; Nigeria / Somalia ;
  (therefore) higher risk of transmission ;    se of data to compare case fatality
u
AVP ; [max. 4] rates in individual country with
global rate ; [max. 3]
ii provision of, nets / insecticides / drugs,
is dependent on funding ; iii cholera is a serious disease ;
  availability of, health workers /    d
 eath can occur very quickly after
volunteers, to distribute, nets / drugs ; infection ;
  availability of workers to spray    s preads quickly in population
buildings ; (especially after a disaster) ;
  ability to reach, all / most, of the    deaths are avoidable ;
population ;    if oral rehydration therapy (ORT) is
    A refs to infrastructure such as available immediately ;
roads / transport
   d
 ata is useful to predict, situations
  mosquitoes become resistant to / places, where cholera may occur ;
insecticides ; WHO can coordinate responses to
  need to be several insecticides so the outbreaks ; [max. 3]
same one is not used in the same d i infected person travelled from an area
places year after year ; with an outbreak of cholera ; [1]
  nets have to be, looked after carefully /
ii water supply is not contaminated with
kept intact / kept undamaged ;
(human), sewage / faeces ;
  P  lasmodium becomes resistant to drugs ;
  piped water / water supply is treated to
  AVP ; ; [max. 3] kill bacteria ;
 [Total: 13]

6 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

  V. cholera destroyed in sewage    poor access to health care ;

treatment ; [max. 2]
e cholera outbreaks occur after natural
disasters before medical aid can be
provided / AW ;
e.g. during wars / civil unrest, when
medical aid cannot be provided ;
oral rehydration therapy is not started
soon enough ;
death occurs within 24 hours if no
treatment provided ; [max. 2]
 [Total: 17]
8 a i  ycobacterium tuberculosis ;
M
A Mycobacterium bovis
ii infected person, coughs / sneezes /
spits ;
  aerosol / droplets, containing bacteria,
breathed in by uninfected person ; [2]
b i idea that the total populations of
the five countries are different ;
  allows valid comparisons between
the countries ; [2]
ii number of new cases / incidence,
of TB increased from 1990 in all
countries ;
  between 2000 and 2005 numbers
of new cases, reached a maximum /
remained constant ;
  except in Belarus which reached
maximum number before 2000 ;
  number of new cases remained
constant and then decreased ;
  except in Belarus where decrease did
not continue to 2013 ;
  use of figures for numbers of new
cases with year(s) to illustrate any of
the points above ;
  (minimum of two data quotes from
the graph, e.g. two countries for the
same year or one country for two
years) ; [max. 3]
iii t ransmission where there is,
overcrowding / poor housing ;
  high rates of transmission are linked
with poverty ;
   ref to drug-resistant forms of TB ;
   poor ventilation of housing ;
   poor nutrition ;
  poorly organised treatment for people
with TB ; [max. 5]
 [Total: 13]
9 a i  as antibiotic use increases so does the
percentage of resistant bacteria ;
   a ccurate data quotes for a minimum
of two countries taken from the
scatter graph ;
   e .g. country [4] 13 units and 3%,
country [19] 38 units and 42% ;  [2]
ii either
   a minimum of any two countries with
[1]
similar antibiotic use, but different
percentage resistance ;
   or
   a minimum of any two countries with
similar percentage resistance, but
different antibiotic use ;
   and
   a ccurate data quotes for a minimum
of two countries to support ;
   e .g. any two countries with antibiotic
use between 20 and 30 units show
antibiotic resistance between 15%
and 33% ;
   e .g. any two countries with antibiotic
resistance between 10% and 20% have
antibiotic use between 2 and 20 units ;
 [2]
b 
examples of steps to reduce antibiotic
resistance:
doctors should not prescribe antibiotics
for viral infections ;
antibiotics should not be used as
preventative medicines ;
antibiotics should only be used (for
treatment) when necessary ;
doctors / hospitals, should use the most
effective antibiotic(s) ;
e.g. carry out antibiotic sensitivity tests (see
Figure 10.17 and ESQ3) / find the minimum
inhibitory concentration (see ESQ10) ;
carry out genetic tests to find resistance
genes in pathogens ;
doctors / health authorities, should ensure
people take the correct dose ;

7 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020
 CAMBRIDGE INTERNATIONAL AS & A LEVEL BIOLOGY: COURSEBOOK

ensure that people complete the course of indicates susceptibility / resistance ;

their antibiotic ;
A ensure people follow the instructions
ensure people do not use, ‘left-over’ /
other people’s, antibiotics ;
antibiotics should, only be supplied on
prescription / not be supplied ‘over the
counter’ or for sale on the internet / AW ;
use more than one antibiotic (at the same
time) / use antibiotics in combination ;
A ‘a mixture of antibiotics’
different antibiotics should not be used all
the time ;
i.e. some antibiotics should be rotated
indicates degree of resistance ;
ensures a suitable dosage of antibiotic is
used ;
AVP ; [max. 4]
c shape of, growth / ellipse, the same as in
the diagram in the question ;
8 μg cm–3 shown in the same relative
position as on E-test strips in the diagram ;
no growth of bacteria shown at
concentrations higher than 8 μg cm–3 ;
ε
D
µg cm−3

so that they are used for a year and then

replaced by a different antibiotic for a while
some antibiotics should be kept to use as
a ‘last resort’ ;
the same antibiotics should not be used
for animals and for humans ; 8

use of antibiotics in, food production /

(livestock) agriculture, should be
reduced ;
use other antimicrobial drugs ;
develop new, types of antibiotics / drugs ;
improve, knowledge of antibiotic
resistance among, healthcare professionals [3]
/ the general population ; d growth only occurs next to E-test strip ;
improve disease prevention methods with from top of E-test strip down to 6 µg cm–3 ;
an example ; (e.g. vaccines / good hygiene [2]
in hospitals) [Total: 12]
break transmission cycle of resistant
bacteria / described example ; (e.g. put
people infected with antibiotic resistant
strains in quarantine)
[max. 5]
[Total: 9]
10 a A 1.5 µg cm ;
–3

B 0.094 µg cm–3 ;
C 0.25 µg cm–3 ; [3]
b ref to ease of reading the E-test strip ;
where edge of, growth / ellipse, intercepts
the test strip ;
gives quantitative results ;
avoids measuring areas of inhibition as
with card discs (Figure 10.17) ;

8 Cambridge International AS & A Level Biology – Jones, Fosbery, Taylor & Gregory © Cambridge University Press 2020