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Monitoring schistosomiasis and sanitation interventions—The potential of environmental DNA

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Abstract Transmission of schistosomiasis, a human parasitic disease, is intrinsically linked to inadequate water, sanitation, and hygiene (WASH) facilities and/or their use. The mainstay of control is population‐based chemotherapy. Globally, each year, 240 million people are estimated to require this preventative treatment. However, for long‐term, sustainable control of this disease, supplementary WASH improvements are required to prevent (re)infection of humans (provision of safe water) and transmission from humans to the environment (improved sanitation). While there is established methodology for monitoring transmission in human populations, presently methods for monitoring the impact of WASH interventions, in particular sanitation, on environmental transmission are lacking. Development of such becomes paramount as integrated control programs combine drug treatments with enhanced WASH facilities and behavior change interventions, with uptake likely correlated to a reduction in fecal matter, and schistosome eggs, in the environment but any impact on infection levels in humans taking longer to become apparent. This article reports and critiques the methods currently used to monitor schistosomiasis in freshwater and soil environments and explores how environmental DNA could be used to better understand and monitor environmental contamination in relation to sanitation. Stronger evidence is required to understand how different sanitation interventions serve to limit the environmental transmission of the parasite and their relative effectiveness in preventing disease. This article is categorized under: Engineering Water > Methods
The lifecycle of Schistosoma mansoni. Exposure to the parasite occurs due to human contact with cercariae infested water, the cercariae are shed by infected snails. The host snail habitat can become contaminated by human feces contained S. mansoni eggs due to inadequate sanitation. The free‐living lifestages of the parasite release environmental DNA (eDNA) into the environment. The transmission of S. mansoni can be disrupted with adequate water, sanitation and hygiene (WASH) measures, that break the parasite's lifecycle
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Summary of schistosomiasis detection techniques available to sample freshwater and environments interfacing with sanitation. Sampling of the aquatic environment can consist of collecting snails, collecting water from the snail habitat, and collecting solid matrices associated with sanitation such as wastewater sludge and soil. Traditional methods to identify and quantify the parasite in environmental samples have relied upon microscopic techniques
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