Schistosomiasis as a Re-emerging Disease

I. Definition
Schistosomiasis, or Bilharzia, is a neglected tropical parasitic disease caused by blood
flukes of the genus Schistosoma.

Parasites: Schistosoma mansoni, S. Haematobium, S. japonicum, S. mekongi, S. intercalatum

Of the disease-causing schistosome species, Schistosoma japonicum, also known as
Asian or oriental blood fluke, is responsible for human and animal infections (in mammalian
hosts such as cattle and wide rodents) in China, Philippines and to a lesser extent, Indonesia.
Intermediate Host: Snails – Oncomelia spp.
Infectious form: Cercariae
Parasite Species and Geographic Distribution:

Species Geographical distribution

Intestinal Schistosoma Africa, the Middle East, the Caribbean,

schistosomiasis mansoni Brazil, Venezuela and Suriname
Schistosoma
China, Indonesia, the Philippines
japonicum
Schistosoma Several districts of Cambodia and the Lao
mekongi People’s Democratic Republic
Schistosoma
guineensisand
Rain forest areas of central Africa
related S.
intercalatum
Urogenital Schistosoma
Africa, the Middle East, Corsica (France)
schistosomiasis haematobium

II. EPIDEMIOLOGICAL BACKGROUND

 ranks third among the most devastating tropical diseases, and is a major cause of
morbidity in the tropics
 first reported in the Philippines in 1906

WORLDWIDE DISTRIBUTION
 o Tropical and subtropical areas
o Poor communities without access to safe drinking water and sanitation
o Endemic in 76 countries 46 of which are in Africa.
o About 207 M people are infected with 120 M people showing symptoms and 20 
M severely ill

 Philippines
o Endemic in 28 out of 81 provinces distributed in 12 regions
o Total population of 12 M exposed to the disease
o The infection affects almost the whole of the Mindanao region, the eastern part
of the Visayas, and a few provinces in Luzon

MORBIDITY

MORTALITY
o >200 000 deaths per year in sub-Saharan Africa
 TRANSMISSION PATTERN
o Waterborne transmission
 Infection occurs when skin comes in contact with contaminated freshwater in which
certain types of snails that carry the parasite are living.

RISK POPULATION
o People living in or travelling to areas where schistosomiasis occurs
o School-age children who live in areas with poor sanitation
o poor and rural communities
o Inadequate hygiene and contact with infected water

III. PREVENTION AND CONTROL

PREVENTION
o No vaccine is available.
o Avoid swimming or wading in freshwater
o Drink safe water.
o Water used for bathing should be brought to a rolling boil for 1 minute to kill any
cercariae, and then cooled before bathing to avoid scalding.
o Vigorous towel drying after an accidental, very brief water exposure may help to
prevent parasites from penetrating the skin.

CONTROL
• In countries where schistosomiasis causes significant disease, control efforts usually focus
on:
 Reducing the number of infections in people and/or
 Eliminating the snails that are required to maintain the parasite’s life cycle
 Improved sanitation
 Mass drug treatment of entire communities and targeted treatment of
school-age children
 Praziquantel
• Some of the problems with control of schistosomiasis include:
 Chemicals used to eliminate snails in freshwater sources may harm other species of
animals in the water and, if treatment is not sustained, the snails may return to
those sites afterwards.
  For certain species of the parasite, such as S. japonicum, animals such as cows or
water buffalo can also be infected. Runoff from pastures (if livestock are infected)
can contaminate freshwater sources.

IV. ISSUE OF RE-EMERGENCE

https://www.ncbi.nlm.nih.gov/books/NBK20370/

 Dam Construction
o Dams lead to an increase in schistosomiasis because they reduce populations of
snail predators. Dams block the migration of river prawns that eat snails which
are intermediate hosts for schistosomiasis.

 Ecological changes favoring snail host

o Increasing temperatures in freshwater bodies in sub-tropical and tropical areas
may therefore alter the geographic distribution of schistosomiasis
o Temperature changes impact snail distributions in general as well as the
maturation of the intermediate stages of the parasite inside this intermediate
host
o Temperature influences fecundity, growth, survival and parasite development in
the snail and thus dictates the time it takes the parasite to complete the life
cycle. This has implications on transmission of schistosomiasis in the context of
global warming.