Schistosomiasis and travel medicine

The rise in off-track tourism and the spread of schistosomiasis in previously non-endemic areas results in an increasing number of imported schistosomiasis cases. - Detection of eggs in stool or urine and specific serology supports the diagnosis, however eosinophilia in early infection is low. In travel groups with a single index case all members of the group with similar risk behaviour should be examined since more than 50% of group members with similar risk behaviour are likely to be infected. Asymptomatic, atypical and late presentation of the disease might delay diagnosis. Praziquantel is not effective against immature worms, therefore treatment of returning travellers with single dose praziquantel is effective when started not earlier than 2 months after infection. A combination of praziquantel plus artemether is thought to be effective also in early stages of infection. Vaccination trials in endemic areas are in progress but a single vaccine for travellers covering all schistosoma species will not be available in the near future. Advising the traveller to avoid risk behaviour like wading, bathing and swimming in endemic fresh waters and about the risk of acquiring schistosomiasis through surface or spray water during boat tours will help to reduce imported schistosomiasis.