SCHISTOSOMIASIS

TUBOLA, VILLAROSA
Topic outline:
● Overview
● Global update
● National status
● History
● Infection and transmission
● Epidemiology
● Signs and Symptoms
● Diagnosis
● DOH PROGRAMS, CONTROL AND PREVENTION
 OVERVIEW
SCHISTOSOMIASIS
● one of 17 diseases classified as neglected
tropical diseases by the WHO
● acute and chronic parasitic disease caused by
blood flukes (trematode worms) of the genus
Schistosoma.
● Three species are highly pathogenic to man
namely: Schistosoma japonicum, S. mansoni and
S. haematobium.
● May cause considerable intestinal, hepatic, and
genitourinary morbidity.
● (WHO) Estimated in 2021, that at least 251.4
million people required preventive treatment
GLOBAL UPDATE
● – The World Health Organization estimates that over 200 Million people are
infected.
● – 20 Million severe disability
● – 120 Million symptomatics
● – 80 Million asymptomatic
● – 207 Million infected in 74 countries
● – Mortality in hepato splenic form related to bleeding from collateral shunting of
blood through esophageal veins exceeds 100,000/year, 280,000 deaths / year
● – Second only to malaria as a major cause of morbidity and mortality from
parasites.
 NATIONAL STATUS
Endemic Areas and Transmission of Schistosoma japonicum in the Philippines
● Remains a public health problem in endemic areas with approximately 12 million
people residing in 28 endemic provinces located across 12 different geographical
zones at risk of S. japonicum infection
● A total of 190 municipalities and 1212 barangays (villages) are currently endemic
● Two new endemic foci reported in the northern (Gonzaga, Cagayan) and central
(Calatrava, Negros Occidental) parts of the country were confirmed in 2004 and
2006, respectively
● Just like in China, bovines, water buffaloes (carabaos) in particular, play a major
role in the transmission with infection prevalence close to 90% in some endemic
barangays.
HISTORY

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● In general, children living in endemic areas initially acquire infection at ∼3–4
years of age—i.e., when they are old enough to walk and come into contact
with infested water.
● A characteristic feature of schistosomiasis infection in human populations is a
convex age–prevalence curve, with low prevalence in very young children,
higher prevalence in older children with a peak at 10–15 years of age, and
declining prevalence in adults.
INFECTION AND TRANSMISSION
● acquired through infection when larva cercariae - released by freshwater snails –
penetrate the skin during contact with infested water
● Transmission occurs when humans suffering from schistosomiasis contaminate
freshwater sources with feces or urine containing parasite eggs, which hatch in
water
● In the body, the larvae develop into adult schistosomes. Adult worms live in the
blood vessels where the females release eggs. Some of the eggs are passed out
of the body in the faeces or urine to continue the parasite’s life cycle. Others
become trapped in body tissues, causing immune reactions and progressive
damage to organs.
Adult Worm
in the
Mesenteric
Vein
 SIGNS AND SYMPTOMS
3. Late-Egg Deposition Stage ( 1-11/2 yrs.)
1. Pre- Egg Deposition Stage
● Urticarial rashes ● Recurrent diarrhea/ dysentery –
● Localized dermatitis, Itchiness ● Marked hepatomegaly
● Cough ● Spleen slightly enlarged
● Fever 4. Frank Cirrhosis ( > 2 yrs.)
● w/ or w/o diarrhea ● Liver size decreased
● Marked splenomegaly
2. Early- Egg Deposition Stage(5th wk) ● Beginning signs of portal hypertension
● Abdominal pain 5. Advanced Cirrhosis
● Bloody Mucoid stools
● Very marked splenomegaly
● Slight hepatomegaly
● Marked emaciation and anemia
● Spleen not yet palpable
● May die of hemorrhage
 SIGNS AND SYMPTOMS
COMPLICATIONS
Urogenital Schistosomiasis
● Hemorrhage from
● Hematuria - classic sign
ruptured esophageal
● WOMEN
varices
○ genital lesions, vaginal bleeding, pain during
● Cerebral Schistosomiasis
sexual intercourse and nodules in the vulva
● Lung Involvement
● MEN
● Secondary Bacterial or
○ can induce pathology of the seminal
Viral Infection
vesicles, prostate and other organs.
● Death
○ long-term irreversible consequences =
infertility
● Advanced cases - Kidney damage and Fibrosis
● Later stages - Bladder CA
 DIAGNOSIS
Parasitological Methods
● Direct Fecal Smear
● Concentration Methods
○ Kato Katz Method
○ FECT = Formalin-ethyl Acetate Concentration Test
○ MIFC = Merthiolate-Iodine-Formalin Concentrations
Immunological Methods
● Antibody Detection
● circumoval precipitin test (COPT)
● ELISA
● Antigen Detection
Indirect Methods
● Ultrasonography
DOH PROGRAMS, CONTROL AND PREVENTION

● National Schistosomiasis Control Commission through Republic Act (RA)

No. 4359 of 1965.
○ Under DOH serve as a liaison agency between the government of the
Philippines and the WHO/UNICEF, and as a coordinating body to
ensure the concerted effort of various agencies concerned in
planning and implementing a comprehensive program for
schistosomiasis control in endemic and potentially endemic areas of
the country.
● Later reconstituted by Presidential Decree (PD) No. 893, 1975 into
Schistosomiasis Control Council that comprised of a governing board, an
executive body and supported with technical staff attached to DOH.
GOALS OF DOH PROGRAM
● Eliminates the following:
○ Schistosomiasis
○ Malaria
○ Filariasis
○ Leprosy
○ Rabies
○ Vaccine preventable diseases
○ Vitamin A deficiency
○ Iodine deficiency disorders
Schistosomiasis Control and Elimination Program in the
Philippines (SCEP)

● which implemented the following strategies: case finding,

treatment using praziquantel, environmental sanitation,
snail mapping and control, health promotion, health impact
assessment, surveillance and monitoring, quality control,
and networking and linkages.
CONTROL AND PREVENTION

A. Mass Treatment
● mass drug-administration programs, is a cornerstone of the
management and control of schistosomiasis
● asymptomatic cases about 80%
● kato thick/katz does not detect light Infections
● reinfection rate high at 180/360 days after treatment
● poor environmental sanitation
● poor utilization of waste
● to prevent other complications
B. Snail Control

1. Agro-Engineering method
● Drainage of waterlogged areas
● Stream channelization
● Seepage control
● Diversion & intercepting channels
● Canal lining
● Drainage & irrigation scheme
● Combined vegetation
● removal & drainage
2. Earth Filling
3. Ponding
4. Chemical Control
● Chemical Molluscicide
● Plant Molluscicide
● gogo bark
● tuba seed
REFERENCES

● Olveda, R. M., & Gray, D. J. (2019). Schistosomiasis in the Philippines: Innovative

Control Approach is Needed if Elimination is the Goal. Tropical medicine and
infectious disease, 4(2), 66. https://doi.org/10.3390/tropicalmed4020066
● Schistosomiasis. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/schistosomiasis
● Center for Health Development.
https://mimaropa.doh.gov.ph/?page_id=379&fbclid=IwAR0Lewbd8RDKceF7rzyY_3i
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