Screening For Schistosomiasis Research Articles

Rapid and Comprehensive Screening for Urogenital and Gastrointestinal Schistosomiasis with Handheld Digital Microscopy Combined with Circulating Cathodic Antigen Testing.

Novel methods are required to aid the monitoring of schistosomiasis control and elimination initiatives through mass drug administration. Portable digital and mobile phone microscopy is a promising tool for this purpose. This cross-sectional study evaluated the diagnostic operating characteristics of a converted mobile phone microscope (the SchistoScope) for the detection of Schistosoma haematobium eggs, as determined by community-based field workers and expert microscopists, compared with a field gold standard of light microscopy. Three hundred sixty-five urine samples were evaluated by conventional light microscopy, with 49 (13.4%) positive for S. haematobium. Compared with light microscopy, the sensitivity and specificity of S. haematobium detection by field microscopists trained to use the SchistoScope were 26.5% (95% CI: 14.9-41.1%) and 98.4% (95% CI: 96.3-99.5%), respectively. The sensitivity and specificity of S. haematobium detection by expert microscopists using the SchistoScope was 74% (95% CI: 59.7-85.4%) and 98.1% (95% CI: 95.9-99.3%), respectively, compared with light microscopy. The sensitivity rose to 96.1% and 100% when evaluating for egg counts greater than five and 10 eggs per 10 mL, respectively. A point-of-care circulating cathodic anion (POC CCA) test was used to evaluate Schistosoma mansoni; however, there were too few positive samples to reliably comment on diagnostic characteristics. This study demonstrated that a "urine-only" approach to rapidly screen for schistosomiasis at the point of sample collection can be conducted with mobile phone microscopy (S. haematobium) coupled with POC CCA (S. mansoni). Such an approach may aid in streamlined schistosomiasis control and elimination initiatives.

A health decision analytical model to evaluate the cost-effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework.

Female genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30-56 million girls and women globally, mostly in sub-Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population-based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost-effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost-effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability-adjusted life-years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data-sparse environment.

Case report: Imported asymptomatic schistosomiasis among Belgian school travelers to Rwanda

Schistosomiasis is common in many tropical regions and poses a risk for the local population and travelers. In travelers, most of schistosomiasis are described as acute. We report the epidemiological, clinical, and laboratory characteristics associated with an outbreak of asymptomatic schistosomiasis among nonimmune Belgian school travelers in Rwanda. Schistosomiasis was diagnosed by serology in 12 out of the 15 (80%) travelers who swam in the lake nearly 2 years after a single exposure to freshwater at Kivu Lake, Rwanda. None showed signs of acute or chronic schistosomiasis. Eosinophilia was present in only 1 of them. Schistosoma mansoni eggs were not found in any infected patient. This report of an outbreak of asymptomatic schistosomiasis imported from Lake Kivu highlights the risk for travelers of acquiring the infection with only a short and single exposure, and provides strong arguments for routine serological screening for schistosomiasis in all individuals who have had any freshwater contact in endemic areas, irrespective of symptoms or laboratory findings.

The Detection of Circulating Cell-Free DNA for the Diagnosis of Schistosoma in Immigrants from African Countries in Italy

The rising migration and travel from and towards endemic areas has brought renewed concerns about many parasitic infections, including neglected tropical diseases, such as schistosomiasis. Although serology is the most widely used method for the screening of schistosomiasis in non-endemic countries, this technique lacks sensitivity, especially to distinguish between past and ongoing infections. More recently, a molecular test based on the detection of Schistosoma cell-free DNA in the serum has been proposed as a diagnostic procedure for parasitosis. To test the performance of a blood PCR assay, this work investigated 102 serum samples collected from migrants coming from endemic areas by using primers specific to genomic regions of S. mansoni and S. haematobium patients. The results were then compared with the detection of specific IgG Abs with serological tests. Molecular analysis detected Schistosoma DNA in 32 patients. Among them, we characterized nine S. haematobium, 20 S. mansoni, and three coinfections. Compared with molecular assay, serological analysis detected specific antibodies against Schistosoma antigens in 52 out of 102 patients. Concordance between the two tests was found in 76 out of 102 patients (74.51%): in particular, both diagnostic tests were positive in 29 patients (28.43%) and negative in 47 (46.08%). The specificity of the molecular test was 94%. Overall, our data suggest that serological diagnosis could be combined with the molecular approach, providing the clinician with the serotyping of the parasite and useful information about the infection as well as the required further diagnostic procedures.

FRI-142 - Consider schistosomiasis screening in hepatitis B patients from endemic regions: a hepatic comorbidity that should not be neglected

FRI-142 - Consider schistosomiasis screening in hepatitis B patients from endemic regions: a hepatic comorbidity that should not be neglected

Schistosomiasis screening in non-endemic countries from a cost perspective: Knowledge gaps and research priorities. The case of African long-term residents in a Metropolitan Area, Spain

Imported schistosomiasis is an emerging issue in European countries as a result of growing global migration from schistosomiasis-endemic countries, mainly in sub-Saharan Africa. Undetected infection may lead to serious long-term complications with an associated high cost for public healthcare systems especially among long-term migrants. To evaluate from a health economics perspective the introduction of schistosomiasis screening programs in non-endemic countries with high prevalence of long-term migrants. We calculated the costs associated with three approaches-presumptive treatment, test-and-treat and watchful waiting-under different scenarios of prevalence, treatment efficacy and the cost of care resulting from long-term morbidity. Costs were estimated for our study area, in which there are reported to reside 74,000 individuals who have been exposed to the infection. Additionally, we methodically reviewed the potential factors that could affect the cost/benefit ratio of a schistosomiasis screening program and need therefore to be ascertained. Assuming a 24% prevalence of schistosomiasis in the exposed population and 100% treatment efficacy, the estimated associated cost per infected person of a watchful waiting strategy would be €2,424, that of a presumptive treatment strategy would be €970 and that of a test-and-treat strategy would be €360. The difference in averted costs between test-and-treat and watchful waiting strategies ranges from nearly €60 million in scenarios of high prevalence and treatment efficacy, to a neutral costs ratio when these parameters are halved. However, there are important gaps in our understanding of issues such as the efficacy of treatment in infected long-term residents, the natural history of schistosomiasis in long-term migrants and the feasibility of screening programs. Our results support the roll-out of a schistosomiasis screening program based on a test-and-treat strategy from a health economics perspective under the most likely projected scenarios, but important knowledge gaps should be addressed for a more accurate estimations among long-term migrants.

Screening of Schistosomiasis, Strongyloidiasis and Sexually Transmitted Infections in Nigerian Female Sex Workers Living in Rome

Female Sex Workers (FSWs) are at high risk for acquisition and transmission of sexually transmission infections (STIs). Although several studies investigated the diffusion of STIs in this population, none of them investigated the occurrence of helminth infections in FSW coming from endemic regions. This study aims to assess the prevalence of STIs and helminth infections in a cohort of FSWs. authors conducted a prevalent, observational, and descriptive study on 97 Nigerian FSWs aged 17 to 52 years from January to December 2020. a total of 97 FSWs were recruited. Of these, only 82 had completed screening for hepatitis B, C, syphilis, and HIV, while all 97 were screened for schistosomiasis and strongyloidiasis. The prevalence of STIs among FSWs in Rome was lower than in other European countries. The overall prevalence of HIV and HBsAg were 1.2%, (1/82) and 2.4% (2/82), respectively, while no case of hepatitis C and syphilis was found. Regarding parasitological screening, the overall prevalence of schistosoma species was 4.1% (4/97) while 5.15% (5/97) were positive for strongyloidiasis. our study shows a low prevalence of STIs in Nigerian FSWs except for Hepatitis B and a higher prevalence of schistosomiasis and strongyloidiasis. The permanent monitoring of STI and parasitic infections in sex workers coming from Africa is strongly warranted, especially for hepatitis B, schistosomiasis and strongyloidiasis, to allow a timely diagnosis and treatment, and to plan preventive strategies.

High Sensitivity of Mobile Phone Microscopy Screening for Schistosoma haematobium in Azaguié, Côte d'Ivoire.

Schistosomiasis infections continue to impact African settings disproportionately, and there is an urgent need for novel tools to evaluate infection control and elimination strategies at the community level. Mobile phone microscopes are portable and semiautomated devices with multiple applications for screening neglected tropical diseases. In a community-based schistosomiasis screening program in Azaguié, Côte d'Ivoire, mobile phone microscopy demonstrated a sensitivity of 85.7% (95% CI: 69.7-95.2%) and specificity of 93.3% (95% CI: 87.7-96.9%) for Schistosoma haematobium identification compared with conventional light microscopy, and 95% sensitivity (95% CI: 74.1-99.8%) with egg concentrations of five or more per 10 mL of urine. Mobile phone microscopy is a promising tool for schistosomiasis control and elimination efforts.

Evaluation of Two Different Strategies for Schistosomiasis Screening in High-Risk Groups in a Non-Endemic Setting.

A consensus on the recommended screening algorithms for schistosomiasis in asymptomatic high-risk subjects in non-endemic areas is lacking. The objective of this study was to evaluate the real-life performance of direct microscopy and ELISA serology for schistosomiasis screening in a high-risk population in a non-endemic setting. A retrospective cohort study was conducted in two out-patient Tropical Medicine units in Barcelona (Spain) from 2014 to 2017. Asymptomatic adults arriving from the Sub-Saharan region were included. Schistosomiasis screening was conducted according to clinical practice following a different strategy in each setting: (A) feces and urine direct examination plus S. mansoni serology if non-explained eosinophilia was present and (B) S. mansoni serology plus uroparasitological examination as the second step in case of a positive serology. Demographic, clinical and laboratory features were collected. Schistosomiasis cases, clinical management and a 24 month follow-up were recorded for each group. Four-hundred forty individuals were included. The patients were mainly from West African countries. Fifty schistosomiasis cases were detected (11.5% group A vs. 4 % group B, p = 0.733). When both microscopic and serological techniques were performed, discordant results were recorded in 18.4% (16/88). Schistosomiasis cases were younger (p < 0.001) and presented eosinophilia and elevated IgE (p < 0.001) more frequently. Schistosomiasis is a frequent diagnosis among high-risk populations. Serology achieves a similar performance to direct diagnosis for the screening of schistosomiasis in a high-risk population.

Presumptive treatment or serological screening for schistosomiasis in migrants from Sub-Saharan Africa could save both lives and money for the Italian National Health System: results of an economic evaluation.

Schistosomiasis can lead to severe irreversible complications and death if left untreated. Italian and European guidelines recommend serological screening for this infection in migrants from Sub-Saharan Africa (SSA). However, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. This study aims to compare benefits and costs of different strategies to manage schistosomiasis in migrants from SSA to Italy. A decision tree and a Markov model were developed to assess the health and economic impacts of three interventions: (i) passive diagnosis for symptomatic patients (current practice in Italy); (ii) serological screening of all migrants and treating those found positive and (iii) presumptive treatment for all migrants with praziquantel in a single dose. The time horizon of analysis was one year to determine the exact expenses, and 28years to consider possible sequelae, in the Italian health-care perspective. Data input was derived from available literature; costs were taken from the price list of Careggi University Hospital, Florence, and from National Hospitals Records. Assuming a population of 100 000 migrants with schistosomiasis prevalence of 21·2%, the presumptive treatment has a greater clinical impact with 86.3% of the affected being cured (75.2% in screening programme and 44.9% in a passive diagnosis strategy). In the first year, the presumptive treatment and the screening strategy compared with passive diagnosis prove cost-effective (299 and 595 cost/QALY, respectively). In the 28-year horizon, the two strategies (screening and presumptive treatment) compared with passive diagnosis become dominant (less expensive with more QALYs) and cost-saving. The results of the model suggest that presumptive treatment and screening strategies are more favourable than the current passive diagnosis in the public health management of schistosomiasis in SSA migrants, especially in a longer period analysis.

PATTERN OF LIVER DISEASE ADMISSIONS AT A TERTIARY GOVERNMENT HOSPITAL IN SANA’A, YEMEN

Back ground and objectives: Liver disease causes major public health problems international, especially in poor countries, and it is associated with poor long-term clinical outcomes and results in the deaths of millions worldwide annually. The aim of this study is to ascertain the virtual frequencies of liver disease and to assess etiological factors among patients admitted to Al-Thawra tertiary Hospital in Sana'a City, Yemen.
 Methods: This was a descriptive retrospective analysis study of gastrointestinal patients admitted from January 1, 2021 to December 31, 2021 to the medical wards of Al-Thawra Hospital. This is a tertiary hospital located in the Yemeni capital, Sana'a City. Data were extracted from patient case folders for the period of under review. Data validated with Microsoft Excel version 13 and exported to SPSS version 23.0 for windows; for statistical analysis. Data were evaluated for demographic and other clinical characteristics as definite variables.
 Results: Of the 516 gastroenterology patients admitted to the gastroenterology service in medical wards during a one-year period, liver disease accounted for 30% of all gastroenterology in the same period. There were 155 patients diagnosed with liver disease. There were 86 (55.5%) males and 69 (44.5%) females, with a male to female ratio of 1.2:1. The mean overall age of patients and the age range were 46.14±16.5 and 8-85 years, respectively. The peak incidence of age occurred during the fifth and sixth decades of life at 38.1%. The most common liver disease was; autoimmune hepatitis 43 (27.7%), followed by nonalcoholic fatty liver disease 35 (22.6%), viral hepatitis 32 (20.6%) and schistosomiasis 10 (6.5%).
 Conclusion: Current findings show that autoimmune hepatitis was the most common cause among gastrointestinal diseases in Sana'a city, Yemen; the male to female ratio was roughly the same. In light of this, health education and public awareness about hepatitis virus screening tests and schistosomiasis screening and treatment is the primary preventive strategy to be considered.
 
 Peer Review History: 
 Received: 4 July 2022; Revised: 12 August; Accepted: 7 September, Available online: 15 September 2022
 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com 
 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. 
 Received file: Reviewer's Comments:
 Average Peer review marks at initial stage: 6.0/10
 Average Peer review marks at publication stage: 7.5/10
 Reviewers:
 Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com
 Dr. Tamer Elhabibi, Suez Canal University, Egypt, tamer_hassan@pharm.suez.edu.eg
 Dr. Rima Benatoui,Laboratory of Applied Neuroendocrinology, Department of Biology, Faculty of Science, Badji Mokhtar University Annaba, Algeria. benattouiryma@gmail.com
 Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com
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Scoping review: bladder cancer in Nigeria – what are the gaps in clinical care and research?

ObjectivesThere are currently no national guidelines regarding bladder cancer treatment and clinical care pathways in Nigeria. The aim of this scoping review was to identify any gaps in the knowledge...

Sensitive Diagnosis and Post-Treatment Follow-Up of Schistosoma mansoni Infections in Asymptomatic Eritrean Refugees by Circulating Anodic Antigen Detection and Polymerase Chain Reaction.

ABSTRACT.The increasing number of refugees coming from or passing through Schistosoma-endemic areas and arriving in Europe highlights the importance of screening for schistosomiasis on arrival, and focuses attention on the choice of diagnostic test. We evaluate the diagnostic performance of circulating anodic antigen (CAA) detection in 92 asymptomatic refugees from Eritrea. Results were compared with already-available stool microscopy, serology, and urine point-of-care circulating cathodic antigen (POC-CCA) data. For a full diagnostic comparison, real-time polymerase chain reaction (PCR) and the POC-CCA were included. All outcomes were compared against a composite reference standard. Urine and serum samples were subjected to the ultra-sensitive and highly specific up-converting particle lateral flow CAA test, Schistosoma spp. real-time PCR was performed on urine and stool, and the POC-CCA was used on urine using the G-score method. CAA was detected in 43% of urine and in 40% of serum samples. Urine PCR was negative in all 92 individuals, whereas 25% showed Schistosoma DNA in stool. POC-CCA was positive in 30% of individuals. The CAA test confirmed all microscopy positives, except for two cases that were also negative by all other diagnostic procedures. Post-treatment, a significant reduction in the number of positives and infection intensity was observed, in particular regarding CAA levels. Our findings confirm that microscopy, serology, and POC-CCA lack the sensitivity to detect all active Schistosoma infections. Accuracy of stool PCR was similar to microscopy, indicating that this method also lacks sensitivity. The CAA test appeared to be the most accurate method for screening active Schistosoma infections and for monitoring treatment efficacy.

Variation in Arsenic metabolism in schistosomiasis associated bladder pathology in a rural community, Eggua, Ogun State, Nigeria

Exposure to toxic inorganic Arsenic (iAs) in areas endemic for urogenital schistosomiasis may confer increased risk for bladder cancer. The severity of the adverse effects of iAs however depends on its metabolism, which is highly variable among individuals. Genetic polymorphism in Arsenic (+3) Methyl Transferase enzyme, accounts significantly for these variations. To investigate the relationship of AS3MT gene polymorphisms and Arsenic metabolism to schistosomiasis and/or associated bladder pathology, 119 individualsfrom Eggua in southwest Nigeria were recruited for this study. Screening for schistosomiasis and bladder pathology was done by microscopy and ultrasonography respectively. Wagtech Digital Arsenator was used to assess total urinary arsenic concentrations and thus determine the level of arsenic exposure. The single nucleotide polymorphism AS3MT/Met287Thr T>C (rs11191439) was genotyped using Alelle-Specific PCR. Of the participants who tested positive for schistosomiasis, 33.3% exhibited bladder pathology. Total urinary arsenic concentration in 80% of the participants was above the WHO limit of 0.05mg/L. The Met287Thr allelic distribution conformed to the Hardy-Weinberg equilibrium (X2= 0.161, P> 0.05). Observed allelic frequencies were 0.96 and 0.04 for wild-type T and mutant C alleles respectively. There was no significant relationship between AS3MT SNP, arsenic concentrations and schistosomiasis associated bladder pathology. In conclusion, the community is highly exposed to arsenic, although with a possible genetic advantage of increased AS3MT catalytic activity. However, we see the need for urgent intervention as inter-individual differences in arsenic metabolism may influence the bladder pathology status of individuals in the community. And although urogenital schistosomiasis is waning in Eggua, it is not known what synergy the infection and high arsenic exposure may wield on bladder pathology.

Screening for schistosomiasis among Eritrean refugees: a public health priority

Abstract Issue From 2014 to 2020, 24 422 Eritrean refugees arrived in Switzerland. After they applied for asylum in a federal centre, asylum seekers are allocated to the 26 Swiss cantons, among them Geneva. In the University hospitals of Geneva, the Programme Santé Migrants (PSM) is dedicated to ambulatory care for refugees. Problem 30% of the PSM outpatients are Eritrean. After their arrival in Geneva, asylum seekers get a medical evaluation. We noticed that the Eritrean's health status was poor, due to their long and hazardous migratory journey. Some had a hypereosinophilia and their helminthiasis serologies were positive for schistosomiasis (Schs). We decided to implement a protocol to screen and treat Eritrean patients for Schs. Highlighting this infection among this population was important because: it is a chronic disease which can lead to severe consequences if untreated; 42% of the Swiss refugees are Eritreans; in Switzerland, Praziquantel (PZQ), the treatment of Schs, is not distributed and not refunded by medical insurances. However, our hospital's pharmacy can import PZQ. We analysed 158 medical records of Eritrean patients, to see if the screening protocol was applied. Results Among the 158 patients records 72 were women. Mean age 27. 118 (74.7%) of 158 got a Schs serology. 62 (52.5%) were positive or borderline (PB). 29.6% patients with PB had a hypereosinophilia (HE) > 0.5 G/l, and 59% had HE > 5%. None of the negative had HE > 0.5G/l. 44/62 PB had a stools examination and Schs eggs were present among 61% of the P and 18% of the B. 44 (71%) of the 62 PB got a PZQ treatment. Among not treated, 33% were pregnant women. Lessons 25% of patients did not get the protocol. Electronic warning in the electronic files could help, especially in hospitals with large residents turn over. More than 50% of Eritrean patients had a positive or borderline Schs serology. The treatment (PZQ) is easy to take and effective, but not easily accessible and not free in Switzerland. Key messages Schistosomiasis is a frequent disease among Eritrean migrants. Systematic screening should be implemented among them with quality controls. If positive, they should have access to the treatment. European countries should adapt their drug licences and access to treatment to the diversity of the population, taking into account the epidemiology of diseases in the countries of origin.

Infection Status and Risk Factors Associated with Schistosomiasis among Pregnant Women in Jos, Nigeria

Schistosomiasis is one of the most predominant neglected tropical diseases (NTDs) caused by systemic helminthes, Schistosoma sp. S. haematobium and S. mansoni are the main species that causes infection in the Sub-Saharan Africa causing urogenital schistosomiasis and intestinal schistosomiasis respectively. Schistosoma infection during pregnancy has been linked with low birth weight, still birth, maternal mortality and other adverse effects. The study was undertaken to determine the prevalence and risk factors associated with urinary schistosomiasis among pregnant women attending antenatal care at Plateau Specialist Hospital in Jos North Local Government Area, Plateau State. This study was carried out with a total of 200 samples collected from pregnant women who consented to participate in the study. The urine samples were collected from the consenting pregnant women and screened using POC-CCA urine cassette. Information on socio-demographic and risk factors were collected via structured questionnaire and analysed statistically. Out of the 200 women tested for Schistosoma circulating cathodic antigen, 138 were positive representing 69% (138/200) prevalence of schistosomiasis. None of the demographics nor the risk factors studied in the current research was found to be statistically associated (χ2 > 0.05) with schistosomiasis. Schistosoma infection is prevalent in Jos with 69.0% prevalence among women attending antenatal clinic in Plateau State Specialist Hospital with younger pregnant women (≤ 25 years) having a preponderance of the disease burden than the older women. Routine screening for schistosomiasis for all women attending antenatal care and appropriate treatment should be given. Education and awareness on the mode of transmission and detrimental effect of schistosomiasis is recommended.

Serology- and Blood-PCR-Based Screening for Schistosomiasis in Pregnant Women in Madagascar-A Cross-Sectional Study and Test Comparison Approach.

This work was conducted as a cross sectional study to define the disease burden of schistosomiasis in pregnant Madagascan women and to evaluate serological and molecular diagnostic assays. A total of 1154 residual EDTA blood samples from pregnant Madagascan women were assessed. The nucleic acid extractions were subjected to in-house real-time PCRs specifically targeting S. mansoni complex, S. haematobium complex, and African Schistosoma spp. on genus level, while the EDTA plasma samples were analyzed using Schistosoma-specific IgG and IgM commercial ELISA and immunofluorescence assays. The analyses indicated an overall prevalence of schistosomiasis in Madagascan pregnant women of 40.4%, with only minor regional differences and differences between serology- and blood PCR-based surveillance. The S. mansoni specific real-time PCR showed superior sensitivity of 74% (specificity 80%) compared with the genus-specific real-time PCR (sensitivity 13%, specificity 100%) in blood. The laborious immunofluorescence (sensitivity IgM 49%, IgG 87%, specificity IgM 85%, IgG 96%) scored only slightly better than the automatable ELISA (sensitivity IgM 38%, IgG 88%, specificity IgM 78%, IgG 91%). Infections with S. mansoni were detected only. The high prevalence of schistosomiasis recorded here among pregnant women in Madagascar calls for actions in order to reduce the disease burden.

Schistosomiasis prevalence and low-cost diagnostics in rural Northwestern Madagascar: a pilot study

# Background Schistosomiasis is a parasitic disease that affects the health of hundreds of millions of people worldwide. Affordable diagnostic methods are necessary for developing countries to monitor schistosomiasis rates and treat infected individuals, particularly in, Madagascar, a country with the world’s fifth highest rate of schistosomiasis. # Methods We established the prevalence rate of schistosomiasis among the local population served by a clinic in rural northwestern Madagascar. Additionally, we compared different low-cost methods for schistosomiasis detection, including empirical diagnostic methods in use before this study. 500 patients were recruited in this study, of whom 380 received three tests—urine microscopy, point-of-care circulating cathodic antigen (POC-CCA) testing, and urinalysis to screen for *Schistosoma haematobium* and *Schistosoma mansoni*. # Results By combining these modalities, we recorded a schistosomiasis prevalence rate of 64.47%, which was significantly higher than the 4.84% of patients who were diagnosed and treated through previous empirical methods. # Conclusions Our results indicate that screening tests are a necessary component of schistosomiasis control programs. The clinic continued to use urinalysis strip testing and urine microscopy to detect schistosomiasis after this study and decided to discontinue the use of POC-CCA *S. mansoni* urine testing because of cost. Increased awareness of schistosomiasis resulting from this screening program led to the installation of multiple infrastructure projects in local communities to improve access to potable water, demonstrating community benefits of schistosomiasis screening that extend beyond the identification of infected individuals.

The cost-effectiveness of schistosomiasis screening and treatment among recently resettled refugees to Canada: an economic evaluation

Background:Many refugees and asylum seekers from countries where schistosomiasis is endemic are infected with the Schistosoma parasite when they arrive in Canada. We assessed, from a systemic perspective, which of the following management strategies by health care providers is cost-effective: testing for schistosomiasis and treating if the individual is infected, treating presumptively or waiting for symptoms to emerge.Methods:We constructed a decision-tree model to examine the cost-effectiveness of 3 management strategies: watchful waiting, screening and treatment, and presumptive treatment. We obtained data for the model from the literature and other sources, to predict deaths and chronic complications caused by schistosomiasis, as well as costs and net monetary benefit.Results:Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.1%. In our baseline analysis, presumptive treatment was associated with an increase of 0.156 quality-adjusted life years and a cost saving of $405 per person, compared with watchful waiting. It was also more effective and less costly than screening and treatment.Interpretation:Among recently resettled refugees and asylum claimants in Canada, from countries where schistosomiasis is endemic, presumptive treatment was predicted to be less costly and more effective than watchful waiting or screening and treatment. Our results support a revision of the current Canadian recommendations.

Endemic situation of schistosomiasis in national surveillance sites of Zhenjiang City from 2015 to 2019

To analyze the endemic situation of schistosomiasis in national surveillance sites of Zhenjiang City from 2015 to 2019, so as to provide the scientific basis for the consolidation of schistosomiasis control achievements and timely treatment of risk factors. A total of 7 national schistosomiasis surveillance sites were assigned in Zhenjiang City from 2015 to 2019. According to the National Scheme for Schistosomiasis Surveillance (2014 version), Schistosoma japonicum infections were monitored in local residents, floating populations and livestock, and snail habitats were surveyed in Zhenjiang City from 2015 to 2019. The results of schistosomaisis surveillance in Zhenjiang City from 2015 to 2019 were analyzed. There were 15 848 and 7 779 person-times of local residents and floating populations receiving serological screening of schistosomiasis in 7 national surveillance sites of Zhenjiang City from 2015 to 2019, and the seroprevalence rates were 0.95% to 1.75% and 0.14% to 0.91% among local residents and floating populations, respectively; however, no egg-positives were identified. A total of 1 885 herd-times of livestock were detected, and no egg-positives were found. During the 5-year period, snail survey was conducted in snail habitats and suspected snail habitats covering 3 333.79 hm2, and there were 108.71 hm2 snail habitats identified, including 50.97 hm2 re-emerging snail habitats. The density of living snails was 0.007 to 0.125 snails/0.1 m2 from 2015 to 2019, which showed a trend for a rise year by year (χ2 = 2 732.626, P < 0.01); however, no S. japonicum infections were detected in snails. The endemic situation of schistosomiasis has been maintained at a low level in Zhenjiang City, and schistosomiasis control achievements are consolidated. However, snails are widely distributed in the city, and there are still risk factors associated with schistosomiasis transmission. Further integrated interventions require to be reinforced to timely manage the risk of transmission of schistosomiasis and promote the progress towards elimination of schistosomiasis.