Socioenvironmental factors associated with Schistosoma mansoni infection and intermediate hosts in an urban area of northeastern Brazil

Abstract

Schistosomiasis, which is caused by trematodes of the genus Schistosoma and by the species Schistosoma mansoni in Brazil, is transmitted primarily by Biomphalaria glabrata mollusks. Infections occur in humans and mollusks in freshwater environments contaminated with feces from infected humans. This study aimed to evaluate potential foci of schistosomiasis based on the identification of infection sites for the snails, factors that increased the human infection probability of S. mansoni infection, and the relationship of the disease with abiotic, biotic, and sociocultural factors. The study was conducted in an urban area on the northeast coast of Brazil; this location was chosen based on the following factors: the presence of B. glabrata, nearby freshwater, and the absence of sewer treatment. A parasitological analysis was performed to evaluate infections of the mollusks and residents inside the perimeter defined by the collection points. Questionnaires were applied to obtain demographic data and to identify behaviors that led to human infection. To verify the contamination of freshwater by human feces, a microbiological analysis of the water was performed at the mollusk collection points to determine the rate of contamination with fecal coliforms. A total of 10,270 B. glabrata mollusks were collected between August 2013 and August 2014, of which 8.8% were positive for S. mansoni; the prevalence ranged from 0 to 34.5% over the study period. A total of 232 coprological samples from the residents were analyzed. The S. mansoni infection prevalence rate was 16.4%, and the S. mansoni parasitic load in the infected residents was 54.9 eggs per gram of feces on average. Males were more affected by the parasite, especially in the 8-17-year-old age range. Thermotolerant coliforms were observed at the mollusk collection sites, which indicated that freshwater and sewage were in continuous contact. This contamination indicated poor sanitary conditions, as was previously observed, which could be combined with detrimental behavior due to the residents' habits. These conditions cause a predisposition for both intermediate and definitive infections of the hosts by creating a socioenvironmental scenario that is conducive to the formation and maintenance of potential schistosomiasis foci. This and similar areas deserve special attention from the government with an aim of improving sanitation services and local resident knowledge to prevent future contamination.

Prevalence of Schistosoma mansoni and S. haematobium in Snail Intermediate Hosts in Africa: A Systematic Review and Meta-analysis

“…The overall pooled prevalence of schistosome cercaria was nearly 6% among freshwater snails in Africa. This finding is slightly lower than 9% reported from freshwater snails in Brazil [ 75 ]. In contrast, a lower prevalence of infected snails was observed from Indonesia [ 76 ] and Brazil [ 77 ].…”

A systematic literature review of schistosomiasis in urban and peri-urban settings

“…Overall, certain factors were found to be significantly associated with a lower or higher risk of infection in urban areas: Distance from the individuals home to a freshwater access point in which disease-relevant mollusc species were present [ 5 ], abstaining from or swimming in open freshwater bodies [ 28 , 35 – 37 ], as well as the profession of the parents, and socioeconomic status [ 38 – 40 ].…”

“…Prevalence and transmission of the different types of schistosomiasis are typically associated with poor environmental and sanitary conditions, thus usually affecting people living in unfavorable socioeconomic conditions [ 5 , 6 ]. Due to environmental degradation and climate change, leading to warmer, tropical temperatures, and shifting rainfall patterns, there may be a change and even increase in the geographic and periodic distribution of Schistosoma spp.…”

“…Due to environmental degradation and climate change, leading to warmer, tropical temperatures, and shifting rainfall patterns, there may be a change and even increase in the geographic and periodic distribution of Schistosoma spp. infections [ 5 , 7 ]. Hotez [ 8 ] draws attention to “new global hot zones for emerging and parasitic diseases” due to combined forces of climate change, urbanization, and poverty, possibly explaining why we are already seeing emergences of NTDs in wealthy G20 countries, for example, urogenital schistosomiasis in Corsica, France [ 8 , 9 ].…”

Factors Associated with Schistosoma mansoni Infestation in Northeast Brazil: A Need to Revisit Individual and Community Risk Factors

“…Specific programs are required in each affected area for its control and elimination. 50 In addition, longterm screening for subclinical infestations is required, considering severe forms of the disease are not as prevalent as they once were. Finally, there is a high frequency of noncommunicable diseases such as hypertension, overweight, and obesity in a poor population, indicating the need for interventions to promote dietary knowledge, attitudinal, behavioral, and nutritional changes in people.…”