Opisthorchis viverrini infection is one of the major public health problems in Thailand. Although information about transmission of this parasite to humans is well established, infections are still prevalent in the northern and northeastern Thailand. Thus, prospective epidemiologic information is needed for developing more effective public health interventions. A cohort study to identify incidence and risk factors of O. viverrini infection was conducted in a rural community in Thailand during December 2002-February 2004. The incidence rate of opisthorchiasis was 21.6/100 person-years. The independent factors associated with opisthorchiasis were an age > 60 years and consuming chopped raw fish salad (Koi pla). Thus, avoiding this raw fish salad should be emphasized in the national control program.