By Zheng Qi 2020-12-15

For decades, schistosomiasis was seen as a persistent, hard-to-manage neglected tropical disease that left millions of people in endemic regions facing lifelong progressive organ damage with few accessible solutions. Today, the answer to whether it can be treated is a resounding, evidence-backed yes: all clinical forms of schistosomiasis, including intestinal, urogenital, and even many early-stage cases with atypical organ involvement, can be effectively treated with praziquantel, the World Health Organization’s globally recommended first-line medication for the condition. This oral drug has been the gold standard for schistosomiasis care for more than 40 years, and it has earned its reputation as one of the most reliable public health tools against parasitic infections, thanks to its three defining strengths: high effectiveness against all major Schistosoma species, an excellent safety profile that makes it suitable for use in children as young as two years old, and an extremely low cost that puts it within reach of even the most resource-limited rural health systems.

Unlike older antiparasitic drugs that required long, multi-day treatment courses and carried significant side effects, praziquantel works in a short, simple regimen, usually just one or two doses taken over a single day. It targets the adult schistosome worms living in the body’s blood vessels, paralyzing them so they detach from the vessel walls, are carried away by the bloodstream, and are safely broken down and eliminated by the liver. For most patients, the treatment causes only very mild, temporary side effects — such as slight dizziness or mild abdominal discomfort that lasts a few hours — which are usually far less severe than the symptoms caused by the infection itself. This high level of safety means it can be safely administered even in large-scale community campaigns, without requiring complex pre-treatment medical testing that would be impossible to roll out across remote endemic areas.

One common concern many communities raise is the risk of re-infection after treatment, which is a very real possibility for people who continue to live in areas where they have regular contact with infested freshwater for daily work, chores, or play. But even when re-infection happens, timely repeated treatment delivers enormous long-term benefits: it drastically diminishes the risk of developing severe, life-altering complications, and in many cases, it can even reverse existing early organ damage. For children in particular, starting praziquantel treatment early and repeating it on a regular schedule before chronic inflammation has caused permanent scarring can prevent the anaemia, stunting, and cognitive impairment that we previously discussed, allowing them to catch up on physical growth and regain their full learning potential at school.

As the core of its global schistosomiasis control strategy, the WHO does not rely only on individual patient treatment to fight the disease. Instead, it focuses on reducing population-level disease burden through periodic, targeted large-scale preventive chemotherapy campaigns, which deliver praziquantel regularly to all at-risk groups — including school-aged children, agricultural workers, fishing communities, and women who regularly perform domestic chores in infested water. This proactive, population-wide approach does not wait for people to develop obvious symptoms before offering care, and it has already helped bring schistosomiasis treatment to more than 300 million people across Africa and other endemic regions in the past two decades, moving the world steadily closer to the long-term goal of eliminating this preventable disease as a public health threat.

Edited by: Secretariat of the Asia-Pacific Network for Drug and Diagnostics Innovation
Produced by: Zheng Qi
Reviewed by: Zhang Haobing
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