The Egyptian Ministry of Health and Population (MoHP) has announced plans to accelerate elimination of schistosomiasis (commonly known as bilharzia) by injecting an equivalent of US$ 2 million a year for a period of five years.
The project - equivalent to US$ 10 million- is funded by the Government of Egypt and will enable the implementation of a multi-year schistosomiasis elimination plan with support from the World Health Organization (WHO).
“The decision to switch from control to elimination follows latest data showing rates of infection have dropped to a record level of less than 0.2% in all formerly endemic regions” said Dr Amr Kandeel, Chief of Preventive Affairs, MoHP. “The data result from last year’s massive screening of more than 30 million people which revealed slightly above 50 thousand cases.”
Both intestinal and urogenital forms of schistosomiasis are transmitted in Egypt. Intestinal schistosomiasis (S. mansoni) is prevalent in the Nile Delta while urogenital schistosomiasis (S. haematobium) in the Nile valley south of Cairo, down to Aswan and beyond.
Measures currently being implemented focus on most affected areas only and include treatment of schools and communities, snail control, environmental management and health education. However, these are not deemed sufficient to break the transmission cycle. In addition, transmission may be occurring in areas that are not targeted by the interventions.
“We are aware that stool or urine examinations are not sensitive enough to detect all infections, so we are now remapping with new tests to identify all areas where transmission is still ongoing, although at very low levels” said Dr Ayat Haggag, Undersecretary for Endemic Diseases, MoHP. “We aim to target all such areas to break the cycle”.
The new elimination strategy involves a scale-up of large-scale treatment in all areas of residual transmission by targeting entire populations to wipe out the parasite. More than 6 million people are expected to be treated in 2017. The MoHP also plans to intensify snail control and other complementary public health interventions such as expanding access to safe water, sanitation and health education as well as social mobilization.
“Large-scale funding for neglected tropical diseases is not so common. The Government of Egypt has made a substantial investment in line with the call for domestic financing of NTDs and WHO will advocate with global partners to help fill any outstanding gap” said Dr John Jabbour, WHO Representative in Egypt.
A strong monitoring and evaluation component will enable a reclassification of areas from endemic to non-endemic, and will trigger the start of post-intervention surveillance.
Egypt is aiming at further decreasing and eventually interrupting transmission of schistosomiasis.
The disease
Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Transmission occurs when people suffering from schistosomiasis contaminate freshwater sources with their excreta 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.
The parasite that causes the disease was first described by Theodore Bilharz at the Kasr-al-Aini hospital in Cairo in 1852.