[Spread of schistosomiasis mansoni in Minas Gerais]

Schistosomiasis Prevalence and Intensity of Infection in Latin America and the Caribbean Countries, 1942-2014: A Systematic Review in the Context of a Regional Elimination Goal

Background

In 2012 the World Health Assembly adopted resolution WHA65.21 on elimination of schistosomiasis, calling for increased investment in schistosomiasis control and support for countries to initiate elimination programs. This study aims to analyze prevalence and intensity of Schistosoma mansoni infection in children in Latin America and the Caribbean countries and territories (LAC), at the second administrative level or lower.

Methodology

A systematic review of schistosomiasis prevalence and intensity of infection was conducted by searching at PubMed, LILACS and EMBASE. Experts on the topic were informally consulted and institutional web pages were reviewed (PAHO/WHO, Ministries of Health). Only SCH infection among children was registered because it can be a ‘proxi-indicator’ of recent transmission by the time the study is conducted.

Principal Findings

One hundred thirty two full-text articles met the inclusion criteria and provided 1,242 prevalence and 199 intensity of infection data points. Most of them were from Brazil (69.7%). Only Brazil published studies after 2001, showing several 'hot spots' with high prevalence. Brazil, Venezuela, Suriname and Saint Lucia need to update the epidemiological status of schistosomiasis to re-design their national programs and target the elimination of Schistosoma mansoni transmission by 2020. In Antigua and Barbuda, Dominican Republic, Guadeloupe, Martinique, Montserrat and Puerto Rico schistosomiasis transmission may be interrupted. However the compilation of an elimination dossier and follow-up surveys, per WHO recommendations, are needed to verify that status. Hence, the burden of subtle SCH chronic infection may be still present and even high in countries that may have eliminated transmission. Heterogeneity in the methodologies used for monitoring and evaluating the progress of the schistosomiasis programs was found, making cross-national and chronological comparisons difficult.

Conclusions

There is a need for updating the schistosomiasis status in the historically endemic countries and territories in LAC to address the required public health interventions for control and elimination programs or to verify the elimination of transmission of Schistosoma mansoni. Improved reporting and standardization of the monitoring and evaluation methodologies used are recommended, while using available WHO guidelines. Meeting a regional elimination goal will require additional and improved epidemiological data by age group and sex.

Schistosomiasis (Schistosoma spp) is an intestinal parasitic infection that causes anaemia, stunted growth, impaired cognition, and decreased physical fitness among other pathological effects. Currently, the control of schistosomiasis relies principally on mass drug administration of praziquantel. In addition, the implementation of further interventions such as snail (intermediate host) control, improving access to safe water and sanitation are required to achieve elimination of transmission in humans. An updated epidemiological situation will help countries to design tailor-made interventions enabling a step-up in prevention and control measures with the goal of elimination of transmission of this disease by 2020. In the region of the Americas, Schistosoma mansoni is the only species present that infect humans. This systematic review shows that in this region there is a need for re-mapping the schistosomiasis epidemiological situation in certain areas and countries in order to implement and optimize the best public health interventions needed to interrupt transmission or verify elimination of transmission. The methodology for monitoring and evaluating schistosomiasis control programs are well defined by current WHO guidelines. However, further investigations and guidelines on suitable tools for monitoring and evaluating schistosomiasis elimination programs and criteria and procedures for validating the elimination are required, and are currently being undertaken by WHO.

Schistosomiasis risk mapping in the state of Minas Gerais, Brazil, using a decision tree approach, remote sensing data and sociological indicators

Schistosomiasis mansoni is not just a physical disease, but is related to social and behavioural factors as well. Snails of the Biomphalaria genus are an intermediate host for Schistosoma mansoni and infect humans through water. The objective of this study is to classify the risk of schistosomiasis in the state of Minas Gerais (MG). We focus on socioeconomic and demographic features, basic sanitation features, the presence of accumulated water bodies, dense vegetation in the summer and winter seasons and related terrain characteristics. We draw on the decision tree approach to infection risk modelling and mapping. The model robustness was properly verified. The main variables that were selected by the procedure included the terrain's water accumulation capacity, temperature extremes and the Human Development Index. In addition, the model was used to generate two maps, one that included risk classification for the entire of MG and another that included classification errors. The resulting map was 62.9% accurate.

A geoprocessing approach for studying and controlling schistosomiasis in the state of Minas Gerais, Brazil

Geographical information systems (GIS) are tools that have been recently tested for improving our understanding of the spatial distribution of disease. The objective of this paper was to further develop the GIS technology to model and control schistosomiasis using environmental, social, biological and remote-sensing variables. A final regression model (R(2) = 0.39) was established, after a variable selection phase, with a set of spatial variables including the presence or absence of Biomphalaria glabrata, winter enhanced vegetation index, summer minimum temperature and percentage of houses with water coming from a spring or well. A regional model was also developed by splitting the state of Minas Gerais (MG) into four regions and establishing a linear regression model for each of the four regions: 1 (R(2) = 0.97), 2 (R(2) = 0.60), 3 (R(2) = 0.63) and 4 (R(2) = 0.76). Based on these models, a schistosomiasis risk map was built for MG. In this paper, geostatistics was also used to make inferences about the presence of Biomphalaria spp. The result was a map of species and risk areas. The obtained risk map permits the association of uncertainties, which can be used to qualify the inferences and it can be thought of as an auxiliary tool for public health strategies.

Schistosomiasis risk estimation in Minas Gerais State, Brazil, using environmental data and GIS techniques

The influence of climate and environmental variables to the distribution of schistosomiasis has been assessed in several previous studies. Also Geographical Information System (GIS), is a tool that has been recently tested for better understanding the spatial disease distribution. The objective of this paper is to further develop the GIS technology for modeling and control of schistosomiasis using meteorological and social variables and introducing new potential environmental-related variables, particularly those produced by recently launched orbital sensors like the Moderate Resolution Imaging Spectroradiometer (MODIS) and the Shuttle Radar Topography Mission (SRTM). Three different scenarios have been analyzed, and despite of not quite large determination factor, the standard deviation of risk estimates was considered adequate for public health needs. The main variables selected as important for modeling purposes was topographic elevation, summer minimum temperature, the NDVI vegetation index, and the social index HDI91.

Analysis and estimative of schistosomiasis prevalence for the state of Minas Gerais, Brazil, using multiple regression with social and environmental spatial data

The aim of this work is to establish a relationship between schistosomiasis prevalence and social-environmental variables, in the state of Minas Gerais, Brazil, through multiple linear regression. The final regression model was established, after a variables selection phase, with a set of spatial variables which contains the summer minimum temperature, human development index, and vegetation type variables. Based on this model, a schistosomiasis risk map was built for Minas Gerais.

Biomphalaria spp. (Preston, 1910) snails in the municipality of Juiz de Fora, Zona da Mata Mineira mesoregion, ate of Minas Gerais, Brazil

This study focuses on the geographic distribution of the snail of the genus Biomphalaria and evaluates its infectivity by Schistosoma mansoni in 5264 specimens collected in the municipality of Juiz de Fora, Minas Gerais, Brazil. Of the 31 locations studied, 6 were reservoirs, 11 rudimentary holding ponds, 7 irrigation ditches, 5 lakes, 1 ornamental pond, and 1 waterfall. Intermediate hosts were found only in the rudimentary ponds and ditches, which were 100% positive. Using morphological and molecular analysis techniques, B. tenagophila, B. peregrina, and B. straminea were identified. This is the first report of B. stramínea in the municipality, and evaluation of its infective potential revealed susceptibility of 25.4%. Although we did not find specimens of Biomphalaria infected by S. mansoni, the data obtained indicate the presence of intermediate hosts, especially in the irrigation ditches in Juiz de Fora, and their proximity to contaminated areas.

First report on the presence of Biomphalaria straminea in the municipality of Jaboticatubas, State of Minas Gerais, Brazil

This is the first report on occurrence of Biomphalaria straminea in the district of São José de Almeida (municipality of Jaboticatubas) State of Minas Gerais, Brazil. The presence of B. glabrata and B. tenagophila had already been reported in this area. Such municipality is part of the metropolitan region of Belo Horizonte and comprises 60% of the Tourist Complex of Serra do Cipó. Since the 1950s throughout the 1990s, a schistosomiasis prevalence ranging from 15 to 40% has been observed. Although no B. straminea specimen has been found naturally infected in the region, descendants of these snails collected in the area, showed to be experimentally susceptible to Schistosoma mansoni infection reaching rates from 14.6 to 28.6%. Even not being found naturally infected, in the State of Minas Gerais, the possibility that the species B. straminea may keep endemicity foci of schistosomiasis should be regarded, as in the Northeastern region of Brazil where the high density of this planorbid and the social-economic and sanitary conditions enable to the transmission.

[Schistosomiasis: new occurrence of Biomphalaria straminea in Belo Horizonte, Minas Gerais]

In Belo Horizonte, Minas Gerais, Brazil, the snail Biomphalaria straminea was found in the Pampulha region. Recently the snail was found in ditches in the old Santa Lúcia Reservoir, a now-extinct focus of schistosomiasis transmission by B. glabrata. The snails were collected and examined to verify whether they were naturally infected with Schistosoma mansoni. Negative specimens were used for breeding or infection with the LE strain of S. mansoni from the laboratory and another strain obtained from eggs found in the feces of a schoolchild (VGS) from Belo Horizonte. Among the 1890 snails collected from 1994 to 1995, none were infected with S. mansoni. Among 87 snails collected and exposed to the LE strain, 9 (10.3%) shed cercariae; among 83 snails from F1, and exposed to LE, 10 (12.0%) shed cercariae. Among 88 snails exposed to VGS, 10 (11.3%) shed cercariae. In Belo Horizonte, schistosomiasis is transmitted by B. glabrata and B. tenagophila. However, currently there exists the risk of appearance of a focus in which B. straminea could be the host if prophylactic measures are not taken by the authorities responsible for the construction of a park and lake at that site.

[Susceptibility of Biomphalaria tenagophila and Biomphalaria glabrata from a same region to 2 Schistosoma mansoni strains]

B. tenagophila snails from Ouro Branco, MG, showed positivity for S. mansoni, with infection rates of 5%, 10%, (SJ strain), and 1% (LE strain) using a pool of miracidia. The mollusks were found to be susceptive from the 3rd generation reared in laboratory onwards. The B. tenagophila (OB, MG) when individually exposed to 10 miracidia, showed infection rate of 2% for LE strain. B. glabrata snails from Gagé, MG, showed a positivity rate of 58% for S. mansoni (LE strain), under experimental conditions. The B. tenagophila from Cabo Frio, RJ and B. glabrata from Belo Horizonte, MG used as a control for SJ strain showed infection rates of 47%-85% and 36% respectivily. For the LE strain, B. glabrata (BH, MG) used as control showed infection rate of 40%-75%.

[Malacological survey of the Soledade lake hydrographic basin, in Ouro Branco (Minas Gerais, Brazil)]

A malacological survey was carried out at the Soledade Lake, in Ouro Branco, State of Minas Gerais, for the period 1986-1991. A total amount of 46,579 mollusks was collected, and among them seven species corresponding to five families could be found, as follows: 39,176 specimens of Biomphalaria tenagophila; 1,296 B. glabrata; 7 Drepanotrema cimex; 2,527 Physa sp; 417 Lymnaea sp; 92 Pomacea hastrum, and 3,064 specimens of Melanoides tuberculata (Melanniidae = Thiaridae) were collected from March/1990 onwards. Four specimens of B. tenagophila were found to be positive for Schistosoma mansoni.

The introduction of Melanoides tuberculata (Mollusca: Thiaridae) to the island of Saint Lucia (West Indies) and its role in the decline of Biomphalaria glabrata, the snail intermediate host of Schistosoma mansoni

A malacological survey was carried out in May 1992 in the whole hydrographic system of Saint Lucia 11 years after the end of a biological control programme to eliminate Biomphalaria glabrata, the snail intermediate host of Schistosoma mansoni. A competitor snail, Melanoides tuberculata, was introduced to Saint Lucia in 1978 and field experiments in several habitats were conducted by Prentice between 1978 and 1986. At the present time M. tuberculata is the most common freshwater snail in Saint Lucia. The results of the survey, undertaken in sites where B. glabrata occurred in large populations in the past showed (i) the absence of the snail hosts from seven sites now extensively colonized by the competitor (ii) the presence of B. glabrata in low or very low densities in 17 sites together with the competitor and (iii) the presence of the intermediate hosts in large populations in only two sites where M. tuberculata was absent. These results confirm the positive results observed by Prentice. The presence of another planorbid snail, B. straminea, is reported for the first time in Saint Lucia.

[Schistosomiasis mansoni in the southwest of the State of Minas Gerais (Brazil)]

A new focus of schistosomiasis mansoni at Passos, a town in the Southwest of the State of Minas Gerais (Brazil), region until now considered free of the disease is reported. Malacological surveys showed Biophalaria glabrata naturally infected with Schistosoma mansoni in a country club near Passos. All B. straminea captured at the pisciculture station of the Furnas hydroelectric dam were negative. Six out of seven individuals living in the country club were found to be infected with S. mansoni, including four children who had never been out of Passos. The epidemiological importance of these findings is discussed.