Increasing prevalence of genitourinary schistosomiasis in Europe in the Migrant Era: Neglected no more?

Schistosomiasis is a trematode infection that is still spreading through Africa [1,2,3]. It is responsible for urogenital (S. haematobium [SH]) and intestinal/hepatic (S. mansoni and other species) complaints and chronic morbidity [4]. Currently, more than 700 million people live in endemic areas [3]. The World Health Organization's strategic plan for 2012-2020 for schistosomiasis is aimed at controlling morbidity by 2020, eliminating SH infection as a public health problem, and interrupting transmission in select areas by 2025 [5]. These plans are, however, in peril, owing to changes in the epidemiology of SH infection over the last two years. First, campaigns aimed at controlling schistosomiasis through mass drug administration (MDA) have recently been shown to fail at reaching the target population. In 2012, a coverage rate of only 16% of patients needing treatment for schistosomiasis was reported [6]; lack of coverage was reported in 44% of the study population in 2016 [7]. Health education programs and water snail (intermediate host) eradication campaigns, although proven to be effective in reducing the risk of new infections from the 1960s to the 1980s, are no longer actively pursued [5]. Second, the recent rise in the northbound migratory flux from Africa through the Mediterranean basin is steadily contributing to an expansion of the areas where schistosomiasis may be diagnosed. Indeed, within the current migratory flux to Italy and other Mediterranean countries, the most representative nations of origin (The Gambia, Mali, Nigeria, and Sudan) are countries with high endemicity of urogenital schistosomiasis [8,9,10].