Editorial: Role of Diagnostics in Eliminating Schistosomiasis as a Public Health Problem: Trend and Need

Nilanjan Lodh^1*James Mwansa²Moses Chimbari³

• ¹Marquette University, Milwaukee, United States
• ²Lusaka Apex Medical University, Lusaka, Zambia
• ³University of KwaZulu-Natal, Durban, South Africa

The World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) 2021-2030 specifically targeted the global elimination of schistosomiasis as a public health problem 1 . Schistosoma mansoni and S. haematobium are the two major human schistosome species in Africa. They are often sympatric, and their concurrent chronic infection is debilitating. Schistosome infections can lead to various complications, including liver fibrosis, bladder damage, and urogenital problems in both adults and older children, thus increasing the overall burden of the disease in a community. The primary disease control intervention strategy has been Mass Drug Administration (MDA), via the only available drug Praziquantel (PZQ), commonly used to treat both above-mentioned human schistosome species. Diagnostic sensitivity is critical for the assessment of the effectiveness of MDA programs 2 . WHO also emphasizes the need for diagnostic tests with high specificity and improved sensitivity 3,4,5 .Currently, most studies detect S. mansoni infection by using direct examination methods, such as Kato-Katz (KK), based on stool smears, or the stool centrifugation process, or the circulating cathodic antigen (CCA) test based on urine. For S. haematobium, urine filtration microscopy and haematuria (blood in urine) have traditionally been used. However, these tests are insensitive, time-consuming, and expensive, especially in low levels of infections 6,7 because of MDA. The accurate disease burden, cure rate, and overall disease prevention could provide advocacy for the inclusion of all age groups in the schistosomiasis MDA program, which can result in timely and effective management of the disease. Schistosomiasis has been a significant public health issue in Senegal for nearly four decades. Kane et. al. stated that while mass drug administration (MDA) with praziquantel is the main control strategy, shortages of the drug limit its availability for all at-risk groups. In regions with permanent water bodies and constant water contact, reinfection is common, making it difficult to sustain progress after treatment. Despite nearly 10 rounds of MDA over the past 20 years, maintaining low prevalence remains a major challenge.WHO aims to eliminate schistosomiasis as a public health problem by 2030, as outlined in its roadmap for NTDs. Achieving this goal requires highly sensitive and specific diagnostics, particularly for detecting low-level, chronic, and asymptomatic infections that current commonly used methods, such as KK and urine filtration, often miss. These limitations obstruct accurate assessments of disease burden, treatment outcomes, and ongoing transmission, especially in communities undergoing MDA with praziquantel. Numerous studies emphasize the need for better diagnostics. For instance, Belgian students exposed to a single freshwater source in Rwanda tested positive months later, despite being asymptomatic, highlighting the shortcomings of standard tests. In Tanzania, repeated MDA lowered prevalence, but constant hotspots illustrated the requirement for improved surveillance using accurate diagnostic tools. In Ethiopia,