Is schistosomiasis endemic in Bermuda?

Schistosomiasis is Not Endemic in Bermuda

Bermuda is not an endemic area for schistosomiasis (bilharzia). Based on the most recent guidelines, schistosomiasis is primarily distributed in Africa, the Middle East, South America, Southeast Asia, and China, with no evidence of endemic transmission in Bermuda 1.

Geographic Distribution of Schistosomiasis

• Schistosoma mansoni is found in Africa, the Middle East, and South America 1
• Schistosoma japonicum is endemic in China, the Philippines, and Indonesia 1
• Schistosoma haematobium is primarily found in Africa and the Middle East 2
• Schistosoma intercalatum and S. guineensis are found in Central and West Africa and Madagascar 1
• Schistosoma mekongi is limited to the Mekong River Basin 1

Epidemiological Considerations

• Most cases diagnosed in the UK are acquired in Africa, not from Atlantic islands like Bermuda 1
• Transmission requires specific environmental conditions:
  • Presence of appropriate freshwater snail intermediate hosts 2
  • Contamination of water sources with human waste containing schistosome eggs 3
  • Suitable climate and ecological conditions for snail populations 2

Transmission Requirements

• Schistosomiasis transmission requires:
  • Fresh water exposure in lakes or slow-moving rivers containing infected snails 1
  • Specific snail species that serve as intermediate hosts 2
  • Poor sanitation allowing fecal or urinary contamination of water sources 3

Clinical Relevance for Travelers

• Travelers to Bermuda do not need to be concerned about acquiring schistosomiasis 1, 2
• Risk assessment should focus on travel to known endemic regions in Africa, South America, the Middle East, and parts of Asia 1
• Travelers with eosinophilia returning from Bermuda should be evaluated for other causes rather than schistosomiasis 1

Common Pitfalls to Avoid

• Do not assume all tropical or subtropical regions have schistosomiasis risk 1, 2
• Avoid unnecessary testing for schistosomiasis in patients who have only traveled to non-endemic areas like Bermuda 1
• Remember that schistosomiasis symptoms may appear weeks to months after exposure in endemic areas, potentially creating confusion about where infection was acquired 4

In conclusion, healthcare providers should not include schistosomiasis in their differential diagnosis for patients whose only travel has been to Bermuda, as the parasite is not endemic to this region 1, 2.