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156 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** Burden and distribution The distribution of schistosomiasis is focal, since transmission depends on specific snail hosts and infective human activities (Fig. 4.14.1). Endemicity changes with the environment, water development schemes, migration, control interventions and snail host distribution (2). Fig. 4.14.1 Distribution of schistosomiasis, worldwide, 2012 High (prevalence > 50%) Moderate (prevalence 10% 49%) Low (prevalence < 10%) Countries requiring evaluation of schistosomiasis status in order to verify if interruption of transmission has been achieved Non-endemic countries Not applicable Morbidity due to schistosomiasis was discussed in the second WHO report on NTDs. There is acceptance of the plausibility that genital schistosomiasis is a risk factor for HIV and contributes to progression to AIDS, and of the need to advocate inclusion of schistosomiasis treatment in HIV preventive interventions. In addition to school-age children and adults, preschool children are also a risk group for schistosomiasis. An estimated 249 million people required preventive chemotherapy for schistosomiasis in 2012, 93% of them in sub-Saharan Africa (3). Scale up of treatment is still slow in the 10 highest burden African countries where 70% of affected people live (Table 4.14.1). Control of morbidity should focus on 52 countries with moderate and high transmission. The status of transmission in 26 additional countries will be determined in order to implement elimination programmes or verify the interruption of transmission. In the Region of the Americas, transmission has probably stopped in some countries and could be interrupted by enhanced efforts where it is low.
*** THE DISEASES − CHAPTER 4 157 Table 4.14.1 Number of people requiring preventive chemotherapy for schistosomiasis and number treated in 2012 in the 10 highest-burden countries in the African Region Country Number of people requiring preventive chemotherapy (PC) Number of people treated Coverage* (%) Nigeria 60 622 091 3 247 696 5.36 Ethiopia 22 092 015 0 0 Democratic Republic of the Congo 18 026 622 0 0 Mozambique 13 456 367 1 314 383 9.77 Kenya 11 762 213 0 0 United Republic of Tanzania 10 135 069 3 134 150 30.92 Cameroon 9 922 513 2 149 500 21.66 Uganda 8 624 509 1 604 434 18.6 Malawi 6 782 369 3 161 535 43.10 Ghana 6 632 462 1 975 117 29.78 Total 168 056 230 16 586 815 * Coverage is calculated as the number of people treated in need of PC out of the population requiring PC. The numerator does not include the number of people treated in areas where PC is not required. In the Eastern Mediterranean Region, control has been successful. Transmission is high in Somalia and Sudan and in Yemen where a robust national control programme is implemented. Transmission could be interrupted in the focus in Indonesia, the only endemic country in the South-East Asia Region, with enhanced interventions, including water, sanitation and hygiene (WASH), and snail control. In the Western Pacific Region, S. japonicum infection has been successfully controlled in China but remains highly prevalent in the Philippines. Morbidity associated with S. mekongi has been controlled in Cambodia but highly endemic foci persist in the Lao People’s Democratic Republic (4). Progress towards Roadmap targets Regional elimination in the Eastern Mediterranean Region is unlikely to be achieved in 2015 as scale up of schistosomiasis control still has to be sustained in Sudan and Yemen. In the Lao People’s Democratic Republic and the Philippines, efforts to interrupt transmission are compromised by reservoir hosts and little investment in WASH interventions. Elimination in the Americas by 2020 is a feasible goal provided political will and resources are available to meet the target. The status of schistosomiasis in Algeria and Mauritius has yet to be determined as outlined in the Strategic Plan for NTDs in the African Region (2014–2020).
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