Schistosomiasis (Bilharzia)

Schistosomiasis is a disease of poverty that leads to chronic ill-health. Infection is acquired when people come into contact with fresh water infested with the larval forms (cercariae) of parasitic blood flukes, known as schistosomes. The microscopic adult worms live in the veins draining the urinary tract and intestines. Most of the eggs they lay are trapped in the tissues and the body’s reaction to them can cause massive damage.

Schistosomiasis affects almost 240 million people worldwide, and more than 700 million people live in endemic areas. The infection is prevalent in tropical and sub-tropical areas, in poor communities without potable water and adequate sanitation. Urogenital schistosomiasis is caused by Schistosoma haematobium and intestinal schistosomiasis by any of the organisms S. guineensis, S. intercalatum, S. mansoni, S. japonicum, and S. mekongi.

Several million people all over the world suffer from severe morbidity as a consequence of schistosomiasis.

The WHO strategy on use of anthelminthic drugs now makes it possible to control schistosomiasis in poor and marginalized communities, in conjunction with interventions against lymphatic filariasis, onchocerciasis and soil transmitted helminthiasis. In highly endemic areas, severe morbidity due to schistosomiasis can be prevented by regular treatment of at risk groups targeted based on community diagnosis based on sentinel groups. Praziquantel has been safely co-administered with albendazole and ivermectin, in areas where these drugs have been used separately for preventive chemotherapy.

Symptoms of schistosomiasis are caused by the body’s reaction to the worms' eggs.

Intestinal schistosomiasis can result in abdominal pain, diarrhoea, and blood in the stool. Liver enlargement is common in advanced cases, and is frequently associated with an accumulation of fluid in the peritoneal cavity and hypertension of the abdominal blood vessels. In such cases there may also be enlargement of the spleen.

The classic sign of urogenital schistosomiasis is haematuria (blood in urine). Fibrosis of the bladder and ureter, and kidney damage are sometimes diagnosed in advanced cases. Bladder cancer is another possible complication in the later stages. In women, urogenital schistosomiasis may present with genital lesions, vaginal bleeding, pain during sexual intercourse, and nodules in the vulva. In men, urogenital schistosomiasis can induce pathology of the seminal vesicles, prostate, and other organs. This disease may also have other long-term irreversible consequences, including infertility.

The economic and health effects of schistosomiasis are considerable and the disease disables more than it kills. In children, schistosomiasis can cause anaemia, stunting and a reduced ability to learn, although the effects are usually reversible with treatment.

Praziquantel is the recommended treatment against all forms of schistosomiasis. It is effective, safe, and low-cost. Even though re-infection may occur after treatment, the risk of developing severe disease is diminished and even reversed when treatment is initiated and repeated in childhood.

Schistosomiasis control has been successfully implemented over the past 40 years in several countries, including Brazil, Cambodia, China, Egypt, Mauritius, Islamic Republic of Iran, Oman, Jordan, Saudi Arabia, Morocco, Tunisia, etc. In Burundi, Burkina Faso, Ghana, Niger, Rwanda, Sierra Leone, the United Republic of Tanzania, and Yemen, it has been possible to scale-up schistosomiasis treatment to the national level and have an impact on the disease in a few years. An assessment of the status of transmission is required in several countries.

Over the past 10 years, there has been scale-up of treatment campaigns in a number of sub-Saharan countries, where most of those at risk live.