Recently, the
World Health Organization recognized that efforts to interrupt
schistosomiasis transmission through
mass drug administration have been ineffective in some regions; one of their new recommended
strategies for global
schistosomiasis control emphasizes targeting the
freshwater snails that transmit schistosome
parasites. We sought to identify robust
indicators that would enable precision targeting of these
snails. At the site of the world's largest recorded
schistosomiasis epidemic-the Lower
Senegal River Basin in
Senegal-intensive sampling revealed positive relationships between intermediate host
snails (abundance, density, and
prevalence) and
human urogenital schistosomiasis reinfection (
prevalence and intensity in schoolchildren after drug
administration). However, we also found that
snail distributions were so patchy in space and
time that obtaining useful data required effort that exceeds what is feasible in standard
monitoring and
control campaigns. Instead, we identified several environmental
proxies that were more effective than
snail variables for predicting
human infection the area covered by suitable
snail habitat (i.e., floating, nonemergent vegetation), the percent cover by suitable
snail habitat, and size of the
water contact area. Unlike
snail surveys, which require hundreds of
person-hours per site to conduct,
habitat coverage and site area can be quickly estimated with drone or
satellite imagery. This, in turn, makes possible large-scale, high-resolution estimation of
human urogenital schistosomiasis risk to support targeting of both
mass drug administration and
snail control efforts.