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Assessment of Schistosomiasis in the Dominican Republic

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Assessment of Schistosomiasis in the Dominican Republic 18. Bednarsch, H., and Connelly, G.: Preliminary report on 26. Kiyak, H. A., and Mulligan, K.: Behavioral research re- fluoride mouthrinse programs of state and local health de- lated to oral hygiene practices. Paper presented at Dental partments. Paper presented at 112th Annual Meeting of the Plaque Control Measures and Oral Hygiene Practices American Public Health Association, Anaheim, CA, Nov. Workshop. Bethesda, MD, Feb. 26-28, 1985. 11-15, 1984. 27. National Center for Health Statistics: Dental visits, volume 19. Proceedings. National Institutes of Health Consensus De- and interval since last visit, United States, 1978 and 1979. velopment Conference. Dental sealants in the prevention of DHHS Publication No. (PHS) 82-1566. Vital Health Stat tooth decay. J Dent Educ 48 (supp): 1- 133, February 1984. [10] No. 138 (1982). 20. Tysowsky, G., and Frazier, P. J.: Pit and fissure sealants: 28. Castaldi, C. R.: Injuries to the teeth. In Sports injuries, the manufacturers' marketing strategies. Paper presented at unthwarted epidemic. PSG Publishing Company, Inc., Lit- 112th Annual Meeting of the American Public Health As- tleton, MA, 1981, pp. 147-157. sociation, Anaheim, CA, Nov. 11-15, 1984. 29. 1985 Cancer facts and figures. American Cancer Society, 21. U.S. General Accounting Office: Reducing tooth decay- New York, 1985. more emphasis on fluoridation needed. HRD-79-3. U.S. 30. Harper, S.: In tobacco, where there is smokeless fire. Ad- General Accounting Office, Washington, DC, Apr. 13, vertising Age 51: 85 (1980). 1979. 31. Mecklenberg, R.: Statement on smokeless tobacco by Chief 22. O'Neill, H. W.: Opinion study comparing attitudes about Dental Officer, USPHS. Presented at Massachusetts State dental health. J Am Dent Assoc 109: 910-915, December Health Department Hearings on Smokeless Tobacco, Bos- 1984. ton, Feb. 6, 1985. 23. Prevention in the dental office: results of a preventive den- 32. Promoting health/preventing disease. Public Health Service tistry survey. J Am Dent Assoc 108: 809-817, May 1984. implementation plans for attaining the objectives for the 24. The Iowa survey of oral health: 1980. A joint project of the nation. Public Health Rep 98: (supp) September-October University of Iowa College of Dentistry and the Iowa Den- 1983. tal Association, Iowa City, IA, 1982. 33. Zwick, D.: Establishing national health goals and stan- 25. Douglass, D. W., Gillings, D., Sollecito, W., and Gammon, dards. Public Health Rep 98: 416-425, September-October M.: National trends in the prevalence and severity of the 1983. periodontal diseases. J Am Dent Assoc 107: 403-412, Sep- tember 1983. Assessment of Schistosomiasis Medical Director of Health Region V, Dominican Republic; Dr. Amaury Mendez Silfa, Director of the Hato Mayor Health Sub- in the Dominican Republic center; Dr. Rafael Brugal Montoya, former Director, Center for Eradication of Bilharzia (CEB); Mauricio Abad, CEB Techni- cian. In San Juan, Puerto Rico, the following persons assisted in CURT R. SCHNEIDER, PhD analyzing stools: Wilda B. Knight, Myriam Velez, Gilda P&rez ROBERT A. HIATT, MD, PhD Oronoz, and Rafael Hernandez Col6n. The work was supported EMILE A. MALEK, PhD by USAID contract AID-SOD-PDC-C-0162. Tearsheet requests to Dr. Ruiz-Tiben, Division of Parasitic ERNESTO RUIZ-TIBEN, PhD Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333. The authors were consultants to the U.S. Agency for Interna- tional Development (USAID) and members of the 1980 ad hoc field team. Dr. Schneider is currently Public Health Team leader Synopsis ..................................... with the University of Michigan Gambia River Basin Studies and Visiting Research Scientist at the Center for Research on Eco- Active transmission of intestinal schistosomiasis nomic Development, University of Michigan; Dr. Hiatt is is currently limited to the southeastern part of the Epidemiologist with the Department of Medical Methods Re- Dominican Republic. A population-based stool sur- search, the Permanente Medical Group, Oakland, CA; Dr. Malek is Director of the Laboratory of Schistosomiasis and Medical vey in 1980 detected 4 asymptomatic individuals Malacology of the Tulane University Medical Center, New Or- among 114 selected at random in 2 towns and a leans; Dr. Ruiz-Tiben is Chief of the Helminthic Diseases rural community in El Seibo Province. Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta. Logistic and The distribution of the transmitting snail, Biom- material support were provided by Dr. Oscar Rivera, Health and Nutrition Officer, USAID, Santo Domingo. phalaria glabrata, considerably exceeds that of The following persons contributed information for this report: Schistosoma mansoni, extending to the National Mercedes Vargas de G6mez, Faculty of Science, and Dr. Jes6s District and capital city ofSanto Domingo and well M. Alvarez Vicioso, Faculty of Plant and Veterinary Sciences, into certain central valley provinces. There is evi- Autonomous University of Santo Domingo; Anayomeda L. dence that transmission sites have shifted during Moreta, Director of the Aquatic Area, Botanical Garden, Santo Domingo; Dr. Jose M. Herrera, Liaison Loan Coordinator, Sec- the past three decades because of urban develop- retaria de Estado de Salud Publica y Asistencia Social (SES- ment, molluscicidal activities and, perhaps, intro- PAS), USAID, Santo Domingo; Dr. Gilberto A. Rivera Ortiz, duction of competing mollusks. 524 Public Health Reports In spite of intermittent control activities, the that the potential for new transmission foci is as conibination of domestic and recreational use of great today as it was 10 years ago. This potential streams with consequent fecal contamination, and transmission of S. mansoni is a continuing threat to the extended distribution of B. glabrata indicates public health in the Dominican Republic. THE GEOGRAPHIC DISTRIBUTION of human schis- review available data and to conduct a limited field tosomiasis in the Caribbean region is notoriously survey for human cases and for snail hosts. The irregular and follows the inconstant distribution of work commenced on July 8 and ended on August the intermediate snail host, Biomphalaria glabrata. 14, 1980. Although of limited scope, the fieldwork The island of Hispaniola contains a focus of schis- generated data that will be of interest to public tosomiasis in the southeastern part of the Domini- health authorities in Santo Domingo and to can Republic. Prevalence of infection appears to be parasitologists interested in the epidemiology of low; indeed, the endemicity of the infection was schistosomiasis. The new data are presented in this denied for many decades, and the origin of the paper. handful of cases in the older literature was disputed (1). Materials and Method Undisputed autochthonous infections with Schis- tosoma mansoni were first reported in the Domini- Parasitological studies. Barrios in two towns and one can Republic in 1947 (2). Subsequent reports of rural locality in southeastern Dominican Republic cases, although sparse, have been persistent. The were selected for the stool survey; the two barrios principal focus has always been the town of Hato of these towns had been known to be either foci of Mayor, El Seibo Province (3-5); see map for this infection in the recent past or contiguous to such and other locations mentioned in the text. For sev- areas. The size of samples was mediated by the eral decades, Hato Mayor was thought to constitute relatively short time available to conduct the sur- the sole focus of these infections in the country, but vey. after 1972 they were documented in the provincial Barrio Gauley in Hato Mayor, the town known to capitals of El Seibo and Higuey (6). Reports of be the prime focus of transmission in the country, is cases in the nearby localities of Miches and Nisibon close to the Magua River, much used by the barrio exist but remain unverified. residents for washing, bathing, and defecation. A Schistosomiasis was officially perceived as a pub- tributary of the Magua, the caniada Gauley, passes lic health problem in El Seibo and La Altagracia directly through the barrio. Provinces with the inception of the Center for Barrio Ginandiana is in the northernmost sector Eradication of Bilharzia in 1970. After this date, of the provincial capital of El Seibo, adjacent to the central records were maintained of the cases de- El Seibo River. On the first day of the survey about tected by the routine coprologic examination 50 people were seen bathing and washing clothes in method of Hoffman and coworkers (7). Regretfully, the river, the edges of which showed evidence of the denominators for all subsequent data were indiscriminate defecation. A tributary, the caniada based on attendance at the clinic rather than on the Ginandiana, in which infected B. glabrata snails population as a whole (table 1). However, a trend had been found earlier in the year, ran through the seemed to be indicated, that is, an apparent decline barrio. The discovery of these infected snails was in incidence in the clinical group (most of whom, it made by Mercedes Vargas de Gomez. seems, had come to the clinic with symptoms only Batey Guaiquia, the rural site, is a permanent casually related to those of schistosomiasis). Health cowboy camp 12 kilometers east of Hato Mayor on officials could only speculate whether this trend the road to El Seibo, adjacent to the Guaiquia might parallel a similar decline in incidence in the River. Although the residents, employees of the overall population and, if so, the reason for it. Gulf and Western Corporation, and their families The U.S. Agency for International Development had piped water and pit latrines, they bathed daily (USAID) was asked in 1980 to make an up-to-date in the Guaiquia, and evidence of human fecal con- assessment of the schistosomiasis situation in the tamination at the main bathing site was found. B. Dominican Republic and to recommend possible glabrata snails were not seen here, although the interventions.
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