Status of schistosomiasis elimination in the caribbean region

Schistosomiasis elimination status in the Caribbean is reviewed with information on historical disease background, attempts to control it and current situation for each locality in the region where transmission has been eliminated (Sint Maarten, Saint Kitts, Vieques), eliminated but not yet verified (Puerto Rico, Dominican Republic, Antigua, Montserrat, Guadeloupe, Martinique) and still ongoing (Saint Lucia, Suriname). Integrated control initiatives based on selective and mass treatment and snail control using environmental, chemical and biological methods along with public service improvements (housing, safe water, sanitation) and changes in demography (urbanization) and economy (change from sugarcane and banana production to tourism) have resulted in reduction in the burden of schistosomiasis over the past century. Introduction of Biomphalaria-competitor snails into the region as a cost-effective, low maintenance control method appears to have had the most sustainable impact on transmission reduction. A regional inventory of B. glabrata, other Biomphalaria species and Biomphalaria-competitor snails as well as investigation of possible animal reservoir hosts in persisting endemic areas would be helpful for control. Elimination of schistosomiasis appears achievable in the Caribbean. However, a regional surveillance and monitoring program is needed to verify elimination in the various localities and identify and monitor areas still endemic or at risk.