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Characteristics of Schistosomiasis in Travelers Reported to the GeoSentinel Surveillance Network 1997–2008

Deborah J. Nicolls^*,, Leisa H. Weld, Eli Schwartz, Christie Reed, Frank von Sonnenburg, David O. Freedman, Phyllis E. Kozarsky for the GeoSentinel Surveillance Network

Among ill returned travelers to Schistosoma-endemic areas reported to the GeoSentinel Surveillance Network over a decade 410 schistosomiasis diagnoses were identified: 102 Schistosoma mansoni, 88 S. haematobium, 7 S. japonicum, and 213 Schistosoma unknown human species. A total of 83% were acquired in Africa. Unlike previous large case series, individuals born in endemic areas were excluded. Controlling for age and sex, those traveling for missionary or volunteer work, or as expatriates were more likely to be diagnosed with schistosomiasis. Sixty-three percent of those with schistosomiasis presented within six months of travel. Those seen early more often presented with fever and respiratory symptoms compared with those who presented later. One-third of patients with schistosomiasis were asymptomatic at diagnosis. Half of those examined for schistosomiasis were diagnosed with infection. Screening for schistosomiasis should be encouraged for all potentially exposed travelers and especially for missionaries, volunteers, and expatriates.

Received November 14, 2007. Accepted for publication July 17, 2008.

Acknowledgments: In addition to the authors, members of the Geo-Sentinel Surveillance Network who contributed data (in descending order) are: Louis Loutan and François Chappuis, University of Geneva, Geneva, Switzerland; Graham Brown, Joseph Torresi, and Karin Leder, Royal Melbourne Hospital, Melbourne, Australia; Jay S. Keystone and Kevin C. Kain, University of Toronto, Toronto, Canada; Gerd-Dieter Burchard, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany; Marc Shaw, Worldwise Travellers Health and Vaccination Centre, Auckland, New Zealand; Vanessa Field, InterHealth, London, United Kingdom; Carlos Franco-Paredes, Emory University, Atlanta, Georgia; Thomas B. Nutman and Amy D. Klion, National Institutes of Health, Bethesda, Maryland; Christina M. Coyle and Murray Wittner, Albert Einstein School of Medicine, Bronx, New York; Lin H. Chen and Mary E. Wilson, Mount Auburn Hospital, Harvard University, Cambridge, Massachusetts; DeVon C. Hale and Stefanie S. Gelman, University of Utah, Salt Lake City, Utah; Philippe Parola, Fabrice Simon, and Jean Delmont, Hôpital Nord, Marseille, France; Giampiero Carosi and Francesco Castelli, University of Brescia, Brescia, Italy; N. Jean Haulman, David Roesel, and Elaine C. Jong, University of Washington, Seattle, Washington; Mogens Jensenius, Ullevål University Hospital, Oslo, Norway; R. Bradley Sack and Robin McKenzie, Johns Hopkins University, Baltimore, Maryland, (Dec. 1997 to Aug. 2007 only); Effrossyni Gkrania-Klotsas, Addenbrooke’s Hospital, Cambridge, United Kingdom; Michael D. Libman and J. Dick Maclean, McGill University, Montreal, Canada; William M. Stauffer and Patricia F. Walker, University of Minnesota, Minneapolis, Minnesota; Bradley A. Connor, Cornell University, New York, New York; Carmelo Licitra and Antonio Crespo, Orlando Regional Health Center, Orlando, Florida; Prativa Pandey, CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal; Elizabeth D. Barnett, Boston University, Boston, Massachusetts; and Alejandra Gurtman, Mount Sinai Medical Center, New York City, New York (Oct. 2002 to Aug. 2005 only).

Financial support: GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by Cooperative Agreement U50/CI000359 from the Centers for Disease Control and Prevention.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. None of the authors had any conflicts of interest.

^* Address correspondence to Deborah J. Nicolls, Division of Infectious Diseases, Emory University, 550 Peachtree Street NE, Suite 7000, Atlanta, GA 30303. E-mail: djn7{at}columbia.edu

DJN and LHW contributed equally to this paper.

Authors’ addresses: Deborah J. Nicolls, Division of Infectious Diseases, Emory University, 550 Peachtree Street NE, Suite 7000, Atlanta, GA 30303, Tel: 404-849-4831, Fax: 404-686-4508, E-mail: djn7{at}columbia.edu. Leisa H. Weld, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30333. Eli Schwartz, Center of Geographic Medicine, Sheba Medical Center, 52621 Tel Hashomer, Israel, Tel: +972 (3) 530-5000; Fax: +972 (3) 530-2011. Christie Reed, Division of Global AIDS, MS E-04, Centers for Disease Control and Prevention, Atlanta, GA 30333, Tel: 404-639-4212, Fax: 404-639-8114. Frank von Sonnenburg, Department of Infectious Diseases and Tropical Medicine, University of Munich, Leopoldstr. 5, 80802 Munich, Germany, Tel: +49 (89) 398844; Fax: +49 (89) 336112. David O. Freedman, University of Alabama at Birmingham, Birmingham, AL. Phyllis E. Kozarsky, Division of Infectious Diseases, Emory University, 550 Peachtree Street NE, Suite 7000, Atlanta, GA 30303, Tel: 404-686-6173, Fax: 404-686-4508.