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Schistosomiasis (Bilharzia)

About the author

Bev

Beverley Tompkins

Specialist Travel Health Nurse AFTM RCPS (Glasg)

Beverley is Nomad's Specialist Travel Health nurse. She started nursing in infectious diseases before joining Nomad in 2010 to pursue her career as a Travel Health Nurse. Beverley is an Associate member of the Faculty of Travel Medicine at the Royal College of Physicians and Surgeons, Glasgow and member of the British Travel and Global Health Association. Beverley is very passionate about travel health, when she is not in clinic she enjoys writing articles on the subject and presenting.


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Using the Nomad clinic services gives you a one-to-one experience with a qualified, highly trained, travel health nurse.

The consultation includes:

  • A detailed medical history
  • Risk assessment based on style and length of your trip
  • Advice on preventative measures you can take

Your pharmacy based travel clinic is all very well but for specialist advice at the same or lower cost come to Nomad. This is strongly advised if you are on a more adventurous or complex itinerary, or have special medical needs. Nomad Travel Clinics are specialists in:

  • Last minute travel
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allowing 6-8 weeks for your vaccination programme, you have time to fit in full courses of vaccines where required which provides you with the best possible protection against certain vaccine preventable diseases. If you don’t have time to complete courses before you go, you risk travelling with little or even no protection against sometimes high risk diseases.

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So what is it?

In terms of its impact, Schistosomiasis is second to malaria as the most devastating parasitic infection. Schistosomiasis (also known as Bilharzia) is a parasitic disease caused by flatworms. Larval forms of the parasites are released by freshwater snails in untreated water (lakes and rivers). They burrow through the skin of people who are in contacted with the contaminated water.

An infective person will deposit the eggs in their urine or faeces. These hatch in the water and develop into Lavae that infect freshwater snails. One the larvae have grown and multiplied in the snails they penetrate the skin of people washing, swimming or wading in infected water. They make their way to the lungs and liver to mature into adult worms. These worms deposit large volumes of eggs in the blood vessels surrounding the bladder or intestines causing disease. This disease often shows no symptoms so can go undetected for months and years causing serious health problems.

Where is there a risk?

Many countries have known Shistosomiasis.  Many countries in the African continent are affected as well as countries in Central and South America. Some countries in Asia including Laos and Cambodia have Schistosomiasis. In Europe it is known to be present in some areas of France.

Most travel-associated cases of Schistosomiasis are contracted in sub-Saharan Africa. Infection is spread in rivers and water sources. High risk areas include: Lake Malawi, Lake Victoria, the Omo River (Ethiopia), the Zambezi River, and the River Nile.

How do you contract it?

Swimming, bathing, wading and undertaking water sporting activities in contaminated freshwater (streams, lakes and rivers). Infection cannot be contracted in saltwater such as the sea. Showering in lodges close by infected lakes is also a potential source of infection as water is often drawn directly from lakes themselves. Wading through streams on walking safaris is also a hazard.

Symptoms

Symptoms include tingling skin, rash, fever, headache, muscle ache, bloody diarrhoea/urine, cough, tiredness, and abdominal pain. These symptoms will usually appear within a few days or weeks after being infected. Some will experience no symptoms at all.

Left untreated, the flatworm eggs can cause chronic illness damaging the bladder, genital organs, kidneys, liver and spleen, heart , lungs and intestines. It can cause irreversible damage and cancer.

Prevention

There is no vaccine or any drug available to prevent infection.  Avoid all skin contact with fresh water in countries of risk and avoid engaging in activities in these waters including diving, sailing and windsurfing.  Avoid drinking infected water and showering in nearby lodges. Wear waterproof footwear if possible.

Look, don’t swim even if the tour operator claims that it is safe. Lake Malawi is well known for its water sporting activities with people running them insisting that the water is safe. There are many cases of travellers experiencing severe Schistosomiasis infection.

Treatment

Infection should be treated in a specialist infectious disease unit. Praziquantel is the only drug available that will destroy adult worms. A check up on return home is advised to travellers who may have put themselves at risk.