[Heterogeneity of Schistosoma haematobium transmission in irrigated fields]

Heterogeneity of Schistosoma haematobium transmission in irrigated fields. Although irrigated areas exist since a long time in the Niger Valley the distribution of the urinary schistosomiasis does not appear homogeneous, testifying to the existence of limiting or favourable factors. The identification of these factors could lead to a better definition of the distribution of the schistosomiasis risks and to optimise control programmes. The population of five villages about 1,900 inhabitants living in the same irrigated area (Sébéri) was examined at the end of 1999 before treatment and surveyed two and ten months after treatment by praziquantel in order to investigate re-infections. In parallel, the transmission sites were subject to a semi-monthly malacological follow-up from 1998 to 2001 and the water contacts were quantified in the sites of the main village during 2000. Before treatment, schistosomiasis risks appeared related to the proximity between habitat and lateral canals: the infections concerning youngers were all the more intense that the dwellings were close to the canal. The parasitological indices were the highest in the village lacking of other water sources. The morbidity indices followed a similar distribution with maximum values in the children of the 3 villages located to less than 1 km from the canal; however, morbidity was mainly observed in the adult population, in particular male, of the 2 villages which were the most distant from the canal. After treatment, the incidence of the re-infection between 2 and 10 months was comparable in the 3 villages close to the canal (28%) but was significantly weaker in the 2 villages far from the transmission sites (5%). In the villages bordering the canal, the incidence in the children was all the more high since the habitat was close to the canal. Between 1999 and 2000, the collected number of Bulinus truncatus decreased from 1.4 to 0.6 individuals per survey; moreover, no mollusc harbouring parasites was found, representing the decrease of the parasite burden. The abnormal weakness of re-infection, regarding this type of focus, could be explained by the repeated stop of water supply inducing a complete drying out of the canal for 2 months during the year preceding the study. These repeated drying out also resulted in a reduction of the exposure. Whereas the average frequentation of the sites of the canal remained rather comparable between January (cold dry season) and May (dry hot season), it decreased dramatically in September (rainy season but canals were not irrigated this year) from 99 to 11 daily contacts. The use of the lateral canal when filled represented 80% of the contacts. In the event of drying out, 80% of the contacts were transferred in the ponds but not in the river (5% of the contacts whatever the season). These results confirmed (1) that the presence of canals reduced the use of natural sites and (2) that the drying out of the canals induced a total reduction of the contacts.

[Transmission of Schistosoma haematobium in the town of Niamey, Niger]

Located in an area where Schistosoma haematobium is hyperendemic, the town of Niamey is a focus of hypoendemicity. The aim of the malacological follow-up studies undertaken over a one year period was the determination of the mollusc species present in the water bodies, the appreciation of their space-time distribution of the snail and to find out the potential seasons of transmission. The investigation applied to 22 sites of transmission in the urban community. Four molluscs species (Bulinus truncatus, B. forskalii, B. globosus and B. senegalensis) are collected. The first three species are present all the year long, with a peak of density in the dry season. The last species (B. senegalensis) is found only during the rainy season. B truncatus and B. senegalensis are the two naturally infested species. The main site of transmission is the river Niger. The ponds play a secondary role in the peripheral districts. The main intermediate host of S. haematobium is B. truncatus.

[Course of urinary schistosomiasis in Niamey, Niger]

A school survey has been carried out in 1998 on a representative sample of 30 schools to assess the effect of the recent urban growth of Niamey on the urban focus of urinary schistosomiasis. A total of 2,024 10-12 years old children were examined and questioned about their water contacts in Niamey and travels in rural areas during the previous year. Generally the prevalence of S. haematobium was low (16%). This can be explained by the lower exposure in urban areas; by the moderate transmission level in the river and by the low incidence of temporary stays in rural areas. A second survey has been carried out in 2000 in 4 schools of a periurban suburb to study the distribution of parasitological risk at the periphery level. A total of 247 10-12 years old children were examined and questioned about their water contacts. Prevalence of S. haematobium was higher in this suburb (74%) but there was a significant decrease of parasitological indices from periphery to the centre. This change seemed related to differences of exposure with an increasing use of water supply and a decreasing use of irrigation canals for swimming and domestic activities.

[Preliminary evaluation of morbidity due to S. haematobium and S. mansoni in the area of the future Adjarala Dam in Benin]

The aim of this study was to provide a preliminary assessment of morbidity due to schistosomiasis in the area of the future Adjarala Dam in Benin. We included 412 schoolchildren from five villages in the study. The mean age of the children was 9.4 +/- 2.3 years and the sex ratio (F/M) was 0.94. These children underwent parasitological examination. The children provided urine samples, which were examined by eye, filtered and tested for blood and protein. Stool samples were examined using Kato's technique and an ultrasound scan of the urinary tract was performed. We carried out a survey of snails at the possible transmission sites of all the villages, with a view to identifying the intermediate hosts. We detected S. mansoni and S. haematobium in the area. Urinary schistosomiasis was mesoendemic (prevalence of 19.7%) whereas schistosomiasis due to S. mansoni was hypoendemic (prevalence of 3. 9%). Ultrasound scans showed that 28% of the children had bladder lesions and that 2.5% were carriers of hydronephrosis. We compared the diagnostic performances of the various indirect indicators of morbidity. We found that a history of hematuria was the most sensitive indicator (88%) but that the sensitivity of this indicator differed significantly according to the sex of the child. Hematuria >= 1+ was the most effective indicator. Snail surveys showed that Biomphalaria pfeifferi and Bulinus globosus were present in the area.

Recent urban growth and urinary schistosomiasis in Niamey, Niger

A cluster sample survey was conducted in 1998 in 30 schools to assess the effect of the growth of Niamey during the last decade on a urinary schistosomiasis urban focus described in 1989. Two thousand and forty-two children (11.0 + 0.1 years old) had a urine filtration test and answered a behavioural questionnaire. Snail populations of the sites used by schoolchildren were followed up in 1999. The global prevalence was 15.7% in 1998, as opposed to 23.7% in 1989. The prevalence was very low in schools far from the river and higher in those along the Niger banks, particularly in villages on the periphery of the urban area. Geographical factors were more important than socio-economic ones in explaining the distribution of the disease. Only 46% of the children in Niamey reported water contact; mainly in the river, rarely in pools and the canal. The infection risk was low in pools (RR = 1.6), high in the river (RR = 3.5) and very high in the canal (RR = 12.5). Malacological studies confirmed the location of transmission sites obtained through parasitological studies and the questionnaire. Sixty-one per cent of the children travelled outside Niamey to the hyperendemic surrounding areas. However, these movements did not increase their infection level. The results are discussed in relation to water contact behaviour and Schistosoma haematobium transmission features.

[Reduced morbidity of schistosomiasis: report from an expert workshop on the control of schistosomiasis held at CERMES (15-18 February 2000, Niamey, Niger)]

Schistosomiasis remains a problem for public health in sub-Saharan Africa. Despite past efforts, cases have not decreased significantly. Schistosoma haematobium and S. mansoni are endemic in all the West African countries. The distribution of both parasites is focal. During a workshop held at CERMES in Niamey, in February 2000, a group of experts recommended that schistosomiasis control be considered as a public health priority in all the endemic West African countries, and National Control Programmes rapidly implemented. The objective of these control programmes would be to reduce schistosomiasis-related morbidity. Case detection should be based on clinical symptoms such as haematuria or bloody diarrhoea, and be carried out at two levels: health care centres and schools, in order to reach patients and school-age children. Health workers should be trained in case detection and community based control of schistosomiasis. The assembled experts advocated the use of praziquantel dosed at 40 mg.kg-1, which therefore must be made available and accessible in outlying areas. Associated measures consist of sanitation, water supply and health education, especially aimed at improving patients' treatment-seeking behaviour. A West African network for schistosomiasis control was created during the workshop. It runs on the Web site of CERMES as network co-ordinator. (http://www.mpl.ird.fr/cermes/).

Increase of intestinal schistosomiasis after praziquantel treatment in a Schistosoma haematobium and Schistosoma mansoni mixed focus

The recent emergence of a mixed focus of Schistosoma haematobium-Schistosoma mansoni, in the lower delta of the Senegal river, requires adapted control programmes. A mass treatment with praziquantel was organised in April 1994 by local authorities in three villages where populations had been examined. A total of 2042 subjects participated. In Savoigne S. haematobium prevailed (53% for prevalence), in Diagambaly S. haematobium (64%) and S. mansoni (76%) were both abundant, and in Boundoum S. mansoni prevailed (53%). Therapeutic coverage (80%) was assessed on a representative sample. A cohort of 968 treated subjects were followed-up 40, 100, 200 and 300 days after treatment. Six weeks after treatment, the average of egg excretion decreased by 95% for S. haematobium, ranging from 23 to one egg(s)/10 ml at Savoigne and from 14 to one egg(s)/10 ml at Diagambal. Conversely, egg excretion only decreased by 75% for S. mansoni, from 23 to six eggs/g at Boundoum and from 69 to 16 eggs/g at Diagambal, showing evidence of the low susceptibility of S. mansoni local strain to praziquantel. Ten months after treatment, reinfections with S. haematobium remained weak at Savoigne (two eggs/10 ml) while those with S. mansoni were so high at Boundoum (24 eggs/g) that they compensated the reduction of load induced by the treatment. At Diagambal, where the two parasites were present before treatment, the disappearance of the urinary schistosomiasis after treatment concurred with a dramatic increase of intestinal schistosomiasis. S. manoni egg excretion was seven times higher than before treatment (478 eggs/g). These different effects of treatment are discussed according to the ecology of transmission in the three villages.

The impact of the local water-development programme on the abundance of the intermediate hosts of schistosomiasis in three villages of the Senegal River delta

The populations of the potential intermediate hosts of Schistosoma mansoni and S. haematobium were studied for a year at transmission sites near three villages in the lower delta of the Senegal River. Biomphalaria pfeifferi, found to be widely distributed and increasingly abundant, appears to be well adapted to the new areas of irrigation (created by the dams at Diama and Manantali) thanks to its ability to withstand changes in temperature and to aestivate. This species is responsible for intense transmission of S. mansoni during the rainy season. In contrast, Bulinus globosus, the species responsible for the transmission of S. haematobium (which occurs during the dry season), had a more limited distribution. The changing distributions of these two snail species appear to be linked to changes in local ecology, themselves the result of the recent programme of water-development in the delta.

Severe adverse reaction risks during mass treatment with ivermectin in loiasis-endemic areas

The control of onchocerciasis remains a priority in sub-Saharan Africa. Jean-Philippe Chippaux, Michel Boussinesq, Jacques Gardon, Nathalie Gardon-Wendel and Jean-Christophe Ernould here outline studies concerning possible severe adverse reactions to ivermectin used to control onchocerciasis in areas where loiasis is also endemic, and discuss precautions that may be advisable during the implementation of such programmes.

Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London, 18 May 1995. The epidemiology of human schistosomiasis in the Senegal river basin

Extensive water development has taken place in the north of Senegal over the last decade, resulting in a large increase in the amount of fresh water for irrigation. The objectives of the present study were to determine the prevalence and intensity of Schistosoma mansoni and S. haematobium in the Senegal river basin (SRB), and to ascertain the distribution of the snail species acting as intermediate hosts for both species of schistosomes. The schistosomiasis survey started in January 1994 and was completed in March 1995. Compared to studies before the construction of the Diama dam, there was a significant increase in both the prevalence and intensity of urinary and intestinal schistosomiasis in the human population in parts of the SRB. From the 9014 people who were registered from 180 villages and 4 towns (10 districts), 7750 were examined. S. mansoni was found in the lower valley (lower delta-Senegal river, lower delta-Lampsar river, upper delta, and diéré) but not in the middle valley. The mean prevalence ranged from 4.4% in the lower delta-Senegal River to 71.8% in the zone of Lac de Guiers, where prevalence and intensity of infection were higher on the eastern side of the lake (81.3% with a mean number of 2088 eggs/g of faeces) compared with the western side (50.3% with a mean 1111 eggs/g). S. haematobium was recorded throughout the area of study, ranging from a mean prevalence of 0.37% in diére (lower valley) to 41.5% in the lower valley (Lampsar river), where the mean egg count was 313/10 mL of urine. Physical and chemical changes to the environment have favoured the spread and increase in the populations of freshwater snails. The only snail involved in the transmission of S. mansoni was Biomphalaria pfeifferi. Five species of bulinid snails were present--Bulinus globosus, Bu. umbilicatus, Bu. senegalensis, Bu. forskalii and Bu. truncatus--but only the first 3 species were involved in the transmission of S. haematobium in the lower and middle valleys.

Effect of repeated treatments with ivermectin on the incidence of onchocerciasis in northern Cameroon

Mass treatments with ivermectin have been undertaken each year since 1987 in an area hyperendemic for onchocerciasis in northern Cameroon. The impact of these successive treatments on the incidence of infection in humans was evaluated by comparing the prevalence of skin microfilariae (PMF) and the mean microfilarial skin densities (MFD) observed in 1987 and 1992 in 5-7-year-old children who had never taken the drug but who were members of the treated communities. In 1992, the PMF and the MFD in children in this age group who never received ivermectin were reduced by 55% and 77%, respectively, in comparison with the values observed in 1987, before the first treatment round. These results reflect a pronounced reduction in the intensity of the transmission of Onchocerca volvulus in the treatment zone. The influence of the ivermectin treatment coverage in the human population, as well as the vectorial capacity and the dispersal of the vector blackflies, on the transmission of onchocerciasis is discussed.