Clinical Updates
7 September 2007
Schistosomiasis in travellers returning from Tanzania
The GeoSentinel global surveillance network have reported cases of schistosomiasis (Bilharzia) in Israeli and German travellers returning from Tanzania [1].
Two separate groups of Israeli tourists, totalling 28 people, visited Tanzania in April 2007. Four weeks after the groups returned to Israel, one of the travellers presented with fever, urticaria, cough and eosinophilia; a clinical diagnosis of acute schistosomiasis was made. The rest of the travellers were then investigated. Of the 25 travellers with fresh water exposure (the risk factor for acquiring schistosomiasis), 23 were infected as determined by antibody testing and 17 of them were symptomatic. The only reported freshwater contact was a swimming pond at the Kisima Ngeda tented lodge near Lake Eyasi in Ngorongoro district, Arusha Region, Tanzania. Although most of the travellers were infected with Schistosoma mansoni, two were infected with both S.mansoni and S. haematobium.
An asymptomatic German traveller was seen at a healthcare facility in Munich in March 2007 following a two month stay in Africa. They were found to have eosinophilia and testing demonstrated S. mansoni parasites. The only reported exposure to freshwater was the swimming pond at Kisima Ngeda. A large number of travellers have presented to health care facilities in Munich over the last month and exposure histories of those individuals are currently being investigated.
Following the report of schistosomiasis in travellers returning from the Kisima Ngeda tented lodge, the hotel has ceased all swimming activity in the pond.
Advice for travellers
This outbreak is a reminder that travellers are at risk of schistosomiasis infection if they are exposed to untreated fresh water in endemic areas. There is no vaccine available for schistosomiasis and no chemoprophylaxis. Travellers should avoid swimming, wading or bathing in freshwater in endemic countries. Adequate chlorination will kill schistosomes, therefore there should be no risk in well maintained swimming pools. Schistosomiasis cannot be contracted through sea water.
Asymptomatic travellers who may have been exposed to schistosomiasis, those found to have eosinophilia, and those who return ill from endemic areas, should seek a medical opinion and screening for schistosomiasis be considered.
References
ProMED-Mail. Schistosomiasis – Tanzania (Lake Eyasi). 4 September 2007. Accessed 7 September 2007. Available at: http://www.promedmail.org/pls/promed/f?p=2400:1001:7436228
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Links
NaTHNaC. Travel Health Information Sheet. Schistosomiasis. Available at: http://www.nathnac.org/pro/factsheets/schisto.htm
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