World Schistosomiasis Risk Chart

INTERNATIONAL ASSOCIATION FOR MEDICAL ASSISTANCE 2012 EDITION TO TRAVELLERS For updates go to www.iamat.org

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World Schistosomiasis Risk Chart 2012 EDITION For the description of the disease see IAMAT’s publication BE AWARE OF SCHISTOSOMIASIS.

ALGERIA S.h., d 1, I GUADELOUPE S.m., a 23, VII OMAN S.m., d 46, XIII ANGOLA S.h., S.m., a 2, II, V, IX GUINEA S.h., S.m., e 24, II, IX PHILIPPINES S.j., c 47, XVI ANTIGUA and BARBUDA S.m., g 3, VII GUINEA-BISSAU S.h., c 25, II PUERTO RICO S.m., a 48, VII BENIN S.h., S.m., a 4, I, II, IX INDIA S.h., d 26, VI RWANDA S.m., e 49, VI, IX, XII BOTSWANA S.h., S.m., c 5, II, V, IX INDONESIA S.j., d 27, XV SAINT LUCIA S.m., g 50, VII BRAZIL S.m., c 6, VII, X, XI IRAN S.h., d 28, I SAO TOME and S.h., S.i., f 51, VI BURKINA FASO S.h., S.m., a 7, I, II, IX IRAQ S.h., e 29, I PRINCIPE BURUNDI S.m., c 8, VI JAPAN S.j., g 30, XVII SAUDI ARABIA S.h., S.m., e 52, I, VI, XIII CAMBODIA S.me., d 9, XIX KENYA S.h., S.m., c 31, II, II, V, VI, IX, SENEGAL S.h., S.m., a 53, IV, VI, IX XII CAMEROON S.h., S.i., S.m., a 10, I, II, III, SIERRA LEONE S.h., S.m., e 54, II, IX IV, IX LAOS S.me., d 32, XIX SOMALIA S.h., c 55, VI CENTRAL AFRICAN S.h., S.i., S.m., a, I, II, III, IX LEBANON S.h., g 33, I SOUTH AFRICA S.h., S.m., S.ma., c 56, II, V, IX REPUBLIC LIBERIA S.h., S.m., c 34, II, IX SOUTH SUDAN S.h., S.m., a 57 I, II, IX, XII CHAD S.h., S.m., f 11, I, III, IX LIBYA S.h., S.m., d 35, I, II, VIII SUDAN S.h., S.m., a 58 I, II, IX, XII CHINA S.j., c 12, XV MADAGASCAR S.h., S.m., e 36, VI, IX SURINAME S.m., d 59, VII CONGO (Dem. Rep.) S.h., S.i., S.m., e 13, II, V, VI, IX MALAWI S.h., S.m., a, II, IX SWAZILAND S.h., S.m., a, II, V, IX CONGO (Republic of) S.h., S.m., a 14, I, II, VI MALAYSIA S.j., d 37, VI SYRIA S.h., c 60, I COTE d’IVOIRE S.h., S.m., a, I, II, IX MALI S.h., S.m., f 38, I, XIV TANZANIA S.h., S.m., a 61, I, II, V, VI, IX, XII DJIBOUTI S.m., 15 MARTINIQUE S.m., g 39, VII, X THAILAND S.me., c 62, XIX DOMINICAN REPUBLIC S.m., c 16, VII MAURITANIA S.h., f 40, IV, VI TOGO S.h., S.m., a, II, III, IX EGYPT S.h., S.m., c 17, I, VIII MAURITIUS S.h., g 41, VI TUNISIA S.h., c 63, I EQUATORIAL GUINEA S.i., f 18, III MONTSERRAT S.m., g 42, VII UGANDA S.h., S.i., S.m., a 64, II, VI, IX, MOROCCO S.h., c 43, I ERITREA S.m., c 19, XI, XII XII ETHIOPIA S.h., S.m., e 20, VI, IX, XII MOZAMBIQUE S.h., S.m., a, II, V, IX VENEZUELA S.m., d 65, VII GABON S.h., S.i., f 21, I, III NAMIBIA S.h., S.m., c 44, II, V, IX YEMEN S.h., S.m., a 66, I, VI, VIII, IX, GAMBIA S.h., S.m., a 22, IV, VI, IX NIGER S.h., S.m., e 45, I, XIV XIII GHANA S.h., S.m., a, I, II, IX NIGERIA S.h., S.m., a, I, II, IV, IX ZIMBABWE S.h., S.m., a, II, IX

Schistosomiasis Risk Code S.h. = Risk of Schistosomiasis caused by Schistosoma haematobium c = present in the country, areas of risk are specified S.i. = Risk of Schistosomiasis caused by Schistosoma intercalatum d = absent from most of the country, risk exists only in restricted S.j. = Risk of Schistosomiasis caused by Schistosoma japonicum areas S.m. = Risk of Schistosomiasis caused by e = present in most of the country, except the areas specified S. ma. = Risk of Schistosomiasis caused by Schistosoma mattheei f = present in the country. Since research data is still fragmen- S. me. = Risk of Schistosomiasis caused by Schistosoma mekongi tary, the extent of the infection cannot be determined; the a = present in the whole country, including urban areas whole country should be considered infected b = present in the whole country, excluding urban areas g = infection under control; possible risk of re-infection

1 Roman numerals refer to the principal specific snail acting as intermediate host (illustrations actual size unless specified):

I Bulinus truncatus XI tenagophila

II Bulinus globosus (Physopsis globosa) XII

XIII Biomphalaria arabica III Bulinus forskalii (No illustration available) XIV Biomphalaria, unkown IV Bulinus senegalensis

XV Oncomelania hupensis V Bulinus africanus (x 2.4 natural size) (Physopsis africana)

VI See text for intermediate snail host XVI Oncomelania quadrasi (x 2.4 natural size)

VII (Australorbis glabrata) XVII Oncomelania nosophora (x 2.4 natural size) VIII

XVIII Ferrissia tenuis (x 6.5 natural size) IX

XIX Tricula aperta X Biomphalaria straminea (No illustration available)

1 = 5 = BOTSWANA Southeastern region: Espírito Santo, Minas Public health control programs have reduced Infection with S. haematobium is present Gerais, Rio de Janeiro. the incidence of Schistosomiasis, however along the Limpopo River valley and its Southern region: Paraná (including localized two active localized infections are present in tributaries. Localized infections with S. risk of infection at Iguaçu Falls), Santa the municipality of Khemis el Khechna (El haematobium exist in Mabule (on the Molopo Catarina. Hamiz River dam) in the province of River, Southern district), Francistown (North- 7 = BURKINA FASO Boumerdès, and in the oases of , , East district), Xhumo and Nata (Letlhakane S. haematobium infection is endemic and (Tassili-n-Ajjer National Park) in district), Pandamatenga, Kasane, and throughout Burkina Faso. S. mansoni the province of . Kavimba (Chobe district), as well as Maun, infection is present in the southwestern 2 = ANGOLA and Tsao (Ngamiland). regions of Hauts-Bassin and Sud-Ouest, and Infection with both S. haematobium and Infection with S. mansoni is endemic in the isolated infections exist in Volta Noire, as well S. mansoni is endemic throughout Angola. A northern districts of Okavango and Chobe, as Centre-Ouest and Est. recent outbreak has been reported in the area particularly along the Okavango River and 8 = BURUNDI of Kindege (N’zeto district) in the northern marshlands, and in the villages along the S. mansoni is endemic along Lake Tanganyika province of Zaire. S. haematobium is Chobe River. and the plain Rusizi, including the capital Bujumbura. Infection is also present in all predominant in the western half of the Note: The districts of Kgalagadi, Ghanzi and country while S. mansoni is more prevalent in villages situated around Lake Cyohoha and Central—Serowe (Kalahari Desert) are risk eastern regions. Lake Rwihinda. Additional snail intermediate free. 3 = ANTIGUA AND BARBUDA hosts: Biomphalaria choanomphalia and Antigua has only seasonal streams; however, 6 = BRAZIL Biomphalaria stanleyi. the intermediate host is present in human Although public health control programs are Note: The highlands of central, eastern and built pools, canals and reservoirs and ongoing and infection rates have been southern Burundi are risk free. potentially infected with S. mansoni. Public reduced, endemic areas with S. mansoni are 9 = CAMBODIA health authorities report no human cases present in rural and suburban areas of the Known endemic areas are present in the from the known foci of infected areas of following states - especially around the northeastern part of Cambodia affecting the Sweet’s, Liberta, Bendals and the areas numerous human-built water bodies and province of Stung Treng in the Stung Treng surrounding the settlement of John Hughes. irrigation systems: District (Mekong River areas), and in the 4 = BENIN Northern region: Rondônia, Pará. province of Kracheh (Kratie): in towns and S. haematobium is endemic throughout Northeastern region: Alagoas, Bahia, Ceará, villages along the Mekong River. Benin. S. mansoni is present in the areas Maranhão, Paraíba, Pernambuco, Piauí, Rio Public health treatment programs have of Bénassi, Parakou (Bourgou region), Grande do Norte, Sergipe. reduced infection rates, however, the lack of Natitingou (Atakora region), Savalou (Zou Central-West region: Federal District improved sanitation and living conditions region), and Cotonou on the Atlantic coast. (Brasília), Goiás. makes re-infection a continuous problem. 2 10 = CAMEROON intestinal schistosomiasis to Somalia and to 26 = INDIA S. haematobium is highly endemic in the two Djibouti. Risk is limited to the area around Gimvi in northern provinces (Sahel regions) with 16 = DOMINICAN REPUBLIC Ratnagiri district (Maharashtra) in the hills localized infections present in all other Risk is present throughout the country with along the Konkan coast south of Mumbai provinces (except in Northwest province). the highest infection rates reported from the (approximately 16km from shore). Snail Similarly, S. mansoni is highly endemic in the eastern interior regions in the provinces of intermediate host: Ferrissia tenuis. northern provinces with localized infections Hato Mayor, El Seibo, and Altagracia (in the 27 = INDONESIA existing in all provinces. area of Higüey). Only the centre of Sulawesi is considered Localized infections with low incidence 17 = EGYPT endemic. Risk is present in the Lindu valley rates of S. intercalatum are present in the Infection with S. haematobium is endemic and localized around Lake Lindu (villages of provinces of Centre and Littoral. throughout southern Egypt, including the El Anca, Langko, Tomado, and Puroo), and in 11 = CHAD Faiyum area. In northern Egypt, including the the Napu valley (about 50km southeast S. haematobium and S. mansoni are Suez Canal zone, S. mansoni infections of Lindu valley) affecting Wuasa, Maholo, endemic throughout the southern half of are endemic with localized transmission Winowanga, Alitupu, and Watumaeta. Chad. In the arid north, S. mansoni infection occurring in southern Egypt. Snail intermediate host is a subspecies: is present in and around the of Faya- Egypt is one the most highly infected Oncomelania hupensis lindoensis. Largeau. High prevalence of infection occurs countries and although public health control Public health control programs are ongoing in all highly populated areas of the south and programs are ongoing, and have reduced and have reduced infections rates, however southwestern districts. infection rates, re-infection is a continuing re-infection remains a continuous problem. Note: The status of Schistosomiasis infection problem in rural areas due to lack of 28 = IRAN in many areas of the east and north of the improvement in sanitation conditions. Public health control programs are ongoing country is unknown, therefore, travellers 18 = EQUATORIAL GUINEA and have interrupted transmission, but should consider all oases, temporary, and S. intercalatum infection is present in the continous vigilance is needed to prevent re- permanent water bodies as infected. area of Bata. infection since the host snail continues to 12 = CHINA 19 = ERITREA exist in formerly infected areas. Extensive control programs have suc- S. mansoni is endemic in the regions (zobas) S. haematobium is present only in the cessfully eradicated S. japonicum from many of Gash Barka, Anseba (especially the plains of the province of Khuzestan on the previously endemic areas. irrigation projects), Debub and Maekel. Only southwestern border with Iraq. The following Risk of infection is present in the following rare cases are reported from the Northern areas are affected: Dasht Mishan, areas: and Southern Red Sea regions. Public Khorramshahr, Khuzestan, Hamidieh, Ahwaz Central and lower Chang (Yangtze) River education programs are ongoing. and the extensively irrigated areas of Dezful, valley (including tributaries and adjacent 20 = ETHIOPIA Shushtar, Mian Ab, Haft Tappeh, including lakes) - The area extends from the city of The capital Addis Ababa and the surrounding the area of Sardasht. The infection does not Yicheng in Hubei province to the rural areas highland area is risk free. extend beyond the Zagros Mountains to the surrounding Shanghai in the east on the S. mansoni infection is widespread east. mouth of the river. To the north, this endemic throughout Ethiopia, including the Awash, 29 = IRAQ area extends in Jiangsu province to the areas Blue Nile, and Omo valleys, but is not present S. haematobium is endemic along the entire of Lake Gaoyou, in Anhui province to the in the Ogaden region. S. haematobium is Euphrates and Tigris (as far north as area of Lake Chao (south of Hefei). present in the lower Awash valley, in some Samarra) river systems, their tributaries, Hubei - The area surrounding Wuhan, localized areas in western Ethiopia, and irrigation canals, marsh areas, including including all lakes and rivers are infected as along the Sebele River in southern Ethiopia urban areas. Isolated infection exists in the far north as Xiangfan. In the south, Lake (Ogaden). Additional intermediate host for northern province of Mosul in the area of Tall Dongting and the area of Changsha in Hunan S. haematobium: Bulinus abyssinicus. Kayft. province are affected. 21 = GABON Note: The mountainous regions of the Jiangxi - The infection is present around Infection with S. haematobium and northeastern part of the country bordering Lake Poyang, along the valleys of the Gan S. intercalatum occurs in all populated Iran, namely the provinces of Irbil, Kirkuk, and river and extending as far south as regions of Gabon. S. haematobium is more Sulaymaniyah are risk free. Fengcheng and Fuzhou. prevalent in the western half of the country 30 = JAPAN Zhejiang - The infection is present in the while S. intercalatum is predominant in the Schistosomiasis has been brought under northern three-quarters of the province, eastern half. No data is available from the control due to improved sanitation and including the area of the bay of Hangzhou. northeastern interior. irrigation systems, and widespread Fujian - Localized infection exists in the area 22 = GAMBIA elimination of the snail intermediate host. of the coastal town of Xiapu (Sandu Bay). S. haematobium is endemic along the S. japonicum in Japan is a zoonosis Sichuan - The infection is present in a large Gambie valley. Snail intermediate host for S. (infection of ) limited to the Kofu area surrounding Chengdu (approximately haematobium: Bulinus jousseaumei and basin, with and rodents being the 200km radius), and along the lower Yalong Bulinus guernei. S. mansoni is present in major parasite vectors. river valley in the areas surrounding Zhaojue, some villages south of Banjul along the 31 = KENYA Xichang, and Hexi. border with Senegal. Both S. haematobium and S. mansoni are Yunnan - The risk of infection is present in 23 = GUADELOUPE endemic in Kenya, especially in irrigated the northwestern corner of the province, The entire island of Grande Terre is infected. agricultural zones and densely populated including the Jinsha (Yangtze) and the All densely populated coastal areas of Basse rural and suburban areas around Lake Lancang (Mekong) river valleys, as well as Terre are also infected, with only the interior Victoria (Kavirondo Gulf and Nyakach Bay), the area of Er Lake and as far south as the highland forest areas free of risk. No data is the islands of Mfangano and Rusinga, area of Weishan. available from the islands of Marie-Galante Kisumu, and Kano Plain. 13 = CONGO, Dem. Rep. and La Désirade. Risk of infection is also present on the plains High rates of infection with S. mansoni 24 = GUINEA to the east, northeast, and north of Nairobi, (prevalent species) are reported from all S. haematobium and S. mansoni are especially in the districts of Kitui and provinces except in Bandundu and Kasai endemic throughout Guinea except for the Machakos; in the lower valley of the Tana Oriental provinces. Additional snail administrative regions of Conakry, Boffa, river in the southeastern part of Kenya intermediate hosts for S. mansoni: Dubréka, Télimélé, and Pita (coastal and extending from the towns of Garissa to Biomphalaria choanomphala, Biomphalaria western part of the country). Galole; the Indian ocean coastal areas from smithi and Biomphalaria stanleyi. 25 = GUINEA-BISSAU Lamu to the border with Tanzania, including 14 = CONGO, Republic of S. haematobium is highly endemic through- the areas of Mombasa; Lake Jipe and S. haematobium and S. mansoni are endemic out the northern half of the country, surrounding areas, including Taveta, throughout the country, with S. haematobium particularly in the valleys of the Cacheu and Wundanyi, and Voi. Localized infection exists being predominant. Snail intermediate host Gêba rivers, and along the border with in Wajir and W. Bor in North Eastern for S. mansoni: Biomphalaria camerunensis. Guinea. province, and Kimilili in Western Province. 15 = DJIBOUTI Note: Risk is not present along the saltwater The full extent of the infection is unknown. Refugee movements and population dis- marsh and mangrove areas of southwestern Additional snail intermediate hosts: Bulinus placements in the Horn of Africa introduced Guinea-Bissau and the outlying islands. ugandae, Bulinus tropicus and Bulinus

3 nasutus for S. haematobium, and Biomphalaria 39 = MARTINIQUE Infection has not been reported from the choanomphala for S. mansoni. Public health control measures have brought northern desert area of Agadez. 32 = LAOS the infection under control, however 46 = OMAN Risk of infection is present on Không Island continuous vigilance is needed to avoid re- Risk of infection exists in the region of the in the Mekong River in the southwest part of infection as the snail hosts are still present. Dhorfar affecting the areas of Salalah, Arazat, the country bordering Cambodia, and further 40 = MAURITANIA Mirbat and Taqah. north on the Mekong River in the districts of Risk of infection with S. haematobium exists 47 = PHILIPPINES Pakxé and Bassac. in all regions, including the capital Risk of infection is present in the following 33 = LEBANON Nouakchott, except in Dakhlet Nouadhibou. regions: The infection has been brought under control The highest infection rates are reported from Luzon - In the areas of Sorsogon in the since no cases of locally human acquired populated areas along the Sénégal River, the Irosin-Juban valley on the southern tip of the schistosomiasis have been reported. Karakoro River valley including the island. However, caution should be taken when in settlements along their tributaries and Mindoro - In the area surrounding Lake the area of the Litani River delta near As diversion canals, and from the Adrar Naujan, including the villages of Pola, Sarafand between Sur (Tyre) and Sayda mountain region in the cenre of the country. Victoria, and Naujan. (Sidon) since the snail host is still present. The nomadic life of Mauritanian herdspeople Samar - Along the entire western coastal 34 = LIBERIA facilitates the spread of the infection. area from Allen to Basey, and along the The interior regions of Liberia are heavily Travellers should consider all oases and northern coast from Lavezares to Palapag, infected with both S. haematobium and settlements as infected. Additional snail extending south to Las Navas. S. mansoni. intermediate host: Bulinus truncatus rohlfsi. Leyte - The entire island is infected except Note: The coastal regions of the country are 41 = MAURITIUS the southern quarter (the area south of Julita risk free, specifically the counties of Grand Public health control programs have brought and Mac Arthur). Cape Mount, Montserrado, Grand Bassa, the infection under control, however contin- Bohol - In the northern coastal areas of Sinoe, Maryland, and Grand Gedeh. uous vigilance is need to avoid re-infection Talibon and Trinidad. 35 = LIBYA as the snail host is still present in the formerly Mindanao - In all villages along the Bay of The regions of Tripoli and Cyrenaica are risk endemic districts of Pamplemousses, Port Panquil from Dipolog to Lala (provinces of free, except for two localized areas of risk Louis, and Grand Port. Misamis Occidental and Lanao del Norte); in near the Mediterranean coast, one at Darnah Snail intermediate host for S. haematobium: all villages in the Agusan River valley from (S. haematobium) located halfway between Bulinus cernicus. Butuan to Compostela; in the northern Benghazi and the border with Egypt, and the 42 = MONTSERRAT coastal peninsular area from Butuan to Tago other at Tawurgha (S. mansoni), an oasis Public health control programs have brought including the area around Lake Mainit; in the located south of Misratah. the infection under control, however area around Davao and the Penal Colony on S. haematobium is highly endemic in the continuous vigilance is needed to avoid re- the Bay of Davao. Additional localized central part of Fezzan around Sabha, mainly infection since the snail host is still present in infections are present in Malaybalay, in areas along the wadis of Buanis, Shati, the formerly endemic areas of Trants, Farms, Maramag (province of Misamis Oriental), and Ajal, and Hufra. Risk is also present in the Bethel, Bramble, and Tuitts. Pikit (province of Cotabato). oases of Ghat, El Feuet, and Albirkah on the 43 = MOROCCO 48 = PUERTO RICO southwestern border with Algeria. Public health control programs are ongoing Low rates of infection have been reported 36 = MADAGASCAR and have reduced infection rates, however from all parts of the island. Risk of infection The infection is highly endemic in most areas risk is still present in the following areas: is also present on the islands of Vieques and In the north, infection is present in the of Madagascar except for the most northern Culebra, both located off the eastern coast province of Tétouan affecting the areas of tip of the country (canton of Antsiranana) and of Puerto Rico. Dar Chaoui, Souk Tnine de Sidi el Yamani, the following cantons of the northeastern 49 = RWANDA Larache, Tleta Rissana, El Rhedira, and Souk coast: Maroantsetra, Mananara, Soanierana- The eastern highland areas, including lakes Tolba; in the province of Kenitra, the areas of Ivongo, Andilamena, Ambatondrazaka, and Bugesera, Mugesera, Muhazi, Kagera, and Arbaoua, Lalla, Mimouna, Karia Aouda, Manjakandriana. The cantons of Anjozorobe, the valleys of Akagera and Kagitumba are Moulay Bousselham, and Gnafda are Amdramasina, Abatolampy, Betafo, and risk free. infected; in the province of Nador, the areas Antsirabe in the interior of the country are Note: Risk of S. mansoni is present in the of Nador town, Segangane, Mont Arouia, also risk free. western half of the country, including the Zaïo, Hassi Berkane, and Ras el Ma are S. haematobium is prevalent in the northern Kigali area, Lake Kivu, Lake Ruhondo, Lake infected; and in the Province of Oujda, the and western parts of Madagascar while areas of Aklim, El Aïoun, Jerad, and Ain Bulera, and Lake Cyohoha areas. S. mansoni is predominant in the eastern and Benimathar are infected. Additional snail intermediate hosts: southern parts. Madagascar has a high S. haematobium is endemic throughout the Biomphalaria choanomphala, Biomphalaria incidence of internal migration which southern half of Morocco, with high stanleyi, and Biomphalaria smithi. facilitates the spreading of Schistosomiasis. incidence rates of infection especially in the 50 = SAINT LUCIA Travellers should consider the entire country irrigated agricultural areas of Beni-Mellal, El Projects for total eradication of as infected. Addtional snail intermediate host Kelaa des Srarhna, Marrakech, Agadir, Schistosomiasis are in progress and risk of for S. haematobium: Bulinus obtusispira. Taroudant, Tiznit, the Anti Atlas and Haut infection is low. However, travellers should 37 = MALAYSIA Atlas regions of Ouarzazate and Er Rachidia. still consider all fresh water bodies infected. Known areas of risk are present in the region Travellers should consider all oases, 51 = SAO TOME and PRINCIPE of Fort Betau (Pahang state) along the Kapor settlements and temporary water bodies in Infection with S. haematobium was River (tributary to the Pahang) in central southern Morocco as infected. introduced on the island of São Tomé by Malaysia, east of Kuala Lumpur, and in two 44 = NAMIBIA workers from the African continent during the camps of the Orang Asli Indigenous group: Risk of infection is present only in the north construction of major irrigation projects. The Pos Iskandar and Bukit Lanjan (east of of the country along the border with Angola, infection seems to be localized around the Kuala Lumpur). Snail intermediate host: Zambia, and Botswana (Kavango and Caprivi capital São Tomé, but the extent of the Robertsiella kaporensis. Strip), affecting the villages along the infection has not been determined. The snail 38 = MALI Okavango, Chobe, and Zambezi rivers. intermediate host has not been identified. The entire southern half of Mali (south of 45 = NIGER 52 = SAUDI ARABIA Lake Faguibine) is endemic with both High rates of infection with S. haematobium S. haematobium and S. mansoni (predominant) S. haematobium and S. mansoni, especially have been reported from all populated areas are highly endemic throughout Saudi Arabia in the highly populated areas of the Niger and in the southern part of the country, especially except in the Al Ahsa’ Plain on the Persian Senegal river basins and their tributaries. from the Niger River basin and surrounding Gulf, the An Nafud desert (north) and the High incidence rates of infection have been areas including the capital Niamey, and from southern region of Ar Rub’al Kahli. Travellers reported from the urban areas of Bamako, the departments of Niamey, Dosso, Tahoua, should consider all oases, watering holes, Ségou, and Mopti regions. No information is Maradi, Zinder and Diffa. irrigation canals and open wells available from the Gao area and the northern Localized infection with S. mansoni is infected. Additional intermediate hosts for desert regions. Travellers should consider present in the region of Gaya in the southeast S. haematobium: Bulinus beccarrii and the entire country as infected. corner of Dosso on the border with Benin. Bulinus reticulatus wrighti.

4 53 = SENEGAL the eastern part of the state (on the border around Khatuniyah (close to the Iraq border). S. haematobium is endemic along the entire with Swaziland). 61 = TANZANIA Sénégal River valley including the area of High rates of infection are present in Kwa Additional snail intermediate hosts: Bulinus Lake Guiers, in the western regions of Cap Zulu and the entire plain and coastal areas of nasatus for S. haematobium, and Biomphalaria Vert (including Dakar), Thiès, Dioubel and Natal (limited to the west by the Drakensberg choanomphala for S. mansoni. Sine Saloum, and in the two southern mountains). This endemic area extends 62 = THAILAND provinces of Sénégal Oriental and south into Transkei to the area of Port St. Infection with S. mekongi is limited to two Casamance. Additional snail intermediate Johns. areas: The first is present in the region of hosts for S. haematobium: Bulinus Localized areas of infection are present in Chongmek (near the confluence of the Mae jousseaumei and Bulinus guernei. Ciskei in the area of East London, and in Nam Mun and the Mekong rivers) in Ubon S. mansoni is endemic in areas along the Eastern Cape in the area of Uttenhage, north province on the border with Laos; the second border with Guinea in (Sénégal Oriental of Port Elizabeth. Localized infections also is present in the southern province of province), in two localized areas at Kolda and exist in the lower Orange River in northern Nakhon Si Thammarat in towns located in Bignona (Casamance province); and in two Cape Province along the border with the cantons of Chawang, Chang Klang, and localized areas in the north at Fatick (Sine Namibia. Toong Song. Saloum) and at Fandène-St. Marcel (Thiès). Note: S. matthei is mainly an infection of 63 = TUNISIA 54 = SIERRA LEONE animals and rarely transmitted to humans. Extensive control measures have reduced An approximate 100km deep coastal strip is 57 = SOUTH SUDAN the once extensive endemic area. Low risk free of infection. S. haematobium and S. mansoni are endemic infection areas are located in the the Note: Both S. haematobium and S. mansoni throughout all of South Sudan, although Governorate of Gabès (El Hamma, Zarat, and are highly endemic in the interior of Sierra S. mansoni cases are predominant. Matmata) and the Governate of Gafsa (Ouled Leone. 58 = SUDAN Tlijane, and Ouled Majed). 55 = SOMALIA S. haematobium and S. mansoni are endemic 64 = UGANDA S. haematobium is highly endemic in the throughout all populated areas of Sudan Additional intermediate snail hosts: Bulinus southern provinces of Hiran, Benadir, Lower except for the province of Red Sea (al-Bahr al- nasutus for S. haematobium and Biomphalaria Jubba, and Upper Jubba, especially in the Ahmar). S. haematobium is predominant in the choanomphala for S. mansoni. irrigated agricultural areas of the Shabeelle north and west, while S. mansoni is prevalent 65 = VENEZUELA and Jubba river valleys. Snail intermediate in the east. Risk of infection is limited to the highly host: Bulinus abyssinicus. 59 = SURINAME populated agricultrual areas surrounding Note: The northern provinces of North West, Risk of infection is present in the central part Lake Valencia (states of Carabobo and North East, Migiurtinia and Mudugh are free of the coastal region in the cultivated swamp Aragua), extending from Valencia in the west of infection. and shell sand bar areas surrounding to La Victoria in the east, and southwards to 56 = SOUTH AFRICA Paramaribo. This endemic region extends Manuare, Belen, and San Juan de los Morros S. haematobium (predominant) and S. mansoni from the delta area of the Commewijne River (Guárico state). Localized infections are are highly endemic in the northeastern part to the marsh areas north of Wageningen present in the following areas: Federal of South Africa, particularly in Northern (Nickerie district). District in Caraballeda and Rosalia; State of Transvaal (including Bophuthatswana, 60 = SYRIA Miranda in Cúa on Río Tuy and Guatire on Venda, and Kruger National Park) extending Risk of infection with S. haematobium is Río Caucagua; and in the centre of the state from the Limpopo River basin and its present in the northeastern part of Syria of Aragua in Boca del Negro. tributaries south to the northern part of the along the Belikh and lower Euphrates river 66 = YEMEN Witwatersrand mountains. basins. In the Ar Raqqah sector, the infection All populated areas of Yemen are highly In Southern Transvaal, the infection is extends from Tall al Abyad along Wadi Belikh endemic with both S. haematobium and present in the northwest: Marico, and from the Euphrates River to Khamisia, S. mansoni. Travellers should consider all oases, Swartruggens, and Rustenburg districts with continuing in the Dayr az Zawr sector along open wells and temporary water bodies in localized infections in the southwest at the Euphrates River to Abu Kamal on the the desert areas infected. Additional snail Koster, Wolmaransstad and Bloemhof on the border with Iraq. In the Al Hasakah sector, intermediate hosts for S. haematobium: Vaal River; and in the Piet-Retief district in the infection is limited to a localized area Bulinus beccari and Bulinus wrighti.

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