Distribution of the schistosome intermediate snail host Biomphalaria pfeifferi in East Africa's river systems and the prevalence of Schistosoma mansoni infection.

Background: There is a need for current and more detailed information on the distribution of Biomphalaria pfeifferi snails in East Africa's river systems. B. pfeifferi is arguably the most important snail intermediate host in the transmission of schistosomiasis, a disease ranked second to malaria in terms of tropical diseases of public health importance.

Methods: We assessed the occurrence and geographical distribution of B. pfeifferi snails in Kenya, Uganda and Tanzania. Maximum entropy modelling was used to predict the potential distribution of B. pfeifferi snails and malacological surveys were conducted guided by MaxEnt predictions and information from previous studies. Malacological surveys were conducted at a total of 172 sites, including streams, rivers, dams, irrigation schemes and springs over a 3-y period from 2018 to 2020, with geospatial, ecological and physicochemical information recorded for each site.

Results: B. pfeifferi snails were found at 23 of the 172 sites and inhabited a variety of habitat types. Of the 23 sites where B. pfeifferi snails were found, 15 (65.2%) were streams, 3 rivers (13.04%), 2 dams (8.7%), 2 springs (8.7%) and 1 an irrigation scheme (4.35%). B. pfeifferi abundance showed a significant positive correlation with increasing water temperature and decreasing water depth. In Kenya, B. pfeifferi snails were found around the Lake Victoria basin, the Mwea irrigation scheme and in parts of the former Eastern Province of Kenya. In Uganda, B. pfeifferi snails were found in Jinja District, Ntoroko District and Soroti District. In Tanzania, B. pfeifferi snails were found in the Iringa, Tabora and Kigoma Regions. We observed moderate to high prevalence of Schistosoma mansoni infection, with S. mansoni-infected snails found at 11 of 23 sites and with an average prevalence of 24.9% at infected sites. In Kenya, S. mansoni-infected snails were found in the Lake Victoria basin (22.5% prevalence at infected sites) and the former Eastern Province (13.5% prevalence at infected sites). In Uganda, infected snails were found in Ntoroko District (100% infected) and Soroti District (20% infected). In Tanzania, infected snails were found in the Kigoma Region, with a prevalence of 10% at the infected site.

Conclusion: This information on the distribution of B. pfeifferi snails and S. mansoni infection in East Africa's river systems can aid in developing better prevention and control strategies for human schistosomiasis. Regular surveys of the river systems for snail intermediate hosts followed by molecular detection of schistosome infection could form a basis for the development of a prompt and cost-effective surveillance system for schistosomiasis in the region.