It is important that all travellers to tropical destinations - including pupils or students on cultural exchange trips - receive accurate travel health advice. A range of travel health issues should be considered for these groups including the risk of exposure to schistosomiasis. The PHPU was recently involved in the coordination of post travel screening for two separate school parties. In addition, NHS Highland public health reported an incident where 21 students required to be screened after one of the party presented to urology with haematuria and a history of exposure to untreated water in Malawi; 13 tested positive for schistosomiasis and of those only two were symptomatic. The incident and conclusions were reported in Journal of Public Health Advance Access, published online in December. Schistosomiasis is a parasitic infection which is present in fresh water in many tropical countries, especially African countries. It is contracted following exposure to untreated fresh water including swimming, paddling, washing, and showering. It is usually asymptomatic but an itchy rash, swimmers itch, can occur at the site of entry. Two to four weeks later fever, diarrhoea, cough, or a rash may develop. Long standing infection can lead to bowel, liver, kidney and bladder problems including bladder cancer.
Travellers are advised to seek pre-travel health advice and, to allow accurate advice to be given, should provide the clinician with as much information as possible about the trip, including arrangements for washing and showering. Travellers to endemic areas should be advised not to bathe, swim or wade in freshwater lakes or rivers.
Those intending to wash or shower, as well as those who swim or paddle, in untreated fresh water will need post-travel screening for schistosomiasis and they should be advised at the pre-travel consultation to attend for screening 8 weeks after return. Screening requires a serum sample - 5mls clotted blood in either a red or yellow-topped tube - obtained after a minimum of 8 weeks since last exposure to be sent to the Scottish Parasite Diagnostic Laboratory. This is the shortest time it takes for worms to mature, reproduce and lay eggs. The test examines levels of Schistosoma antibodies. Results for any new positive cases are phoned directly by the Consultant Clinical Scientist to the GP and a written report is issued for all positive and negative tests. Serologically positive patients should be referred to an infectious disease physician at the Brownlee where further investigation and treatment will be carried out.
See PHPU Pre and post travel advice flowchartScottish Parasite Diagnostic Laboratory
Other useful links for advice/information are listed below:-http://www.nhs.uk/Conditions/schistosomiasis/Pages/Prevention.aspx