The efficacy of soap against schistosome cercariae: A systematic review.

Background: Schistosomiasis is a parasitic disease that is endemic in 78 countries and affects almost 240 million people worldwide. It has been acknowledged that an integrated approach that goes beyond drug treatment is needed to achieve control and eventual elimination of the disease. Improving hygiene has been encouraged by World Health Assembly, and one aspect of good hygiene is using soap during water-contact activities, such as bathing and doing laundry. This hygiene practice might directly reduce the skin exposure to cercariae at transmission sites. A systematic review was carried out to investigate the efficacy of soap against schistosome cercariae and to identify the knowledge gaps surrounding this topic. Methodology: Six online databases were searched between 5th and 8th July of 2021. Records returned from these databases were screened to remove duplicates, and the remaining records were classified by reading titles, abstracts, and full texts to identify the included studies. The results were categorised into two groups based on two different protective mechanisms of soap (namely, damage to cercariae and protection of skin). Conclusions: Limited research has been conducted on the efficacy of soap against schistosome cercariae and only 11 studies met the criteria to be included in this review. The review demonstrates that soap has the potential of protecting people against schistosome cercariae and there are two protective aspects: (1) soap affects cercariae adversely; (2) soap on the skin prevents cercariae from penetrating the skin, developing into adult worms and producing eggs. Both aspects of protection were influenced by many factors, but the differences in the reported experimental conditions, such as the cercarial endpoint measurement used and the cercaria numbers used per water sample, lead to low comparability between the previous studies. This review indicates that more evidence is needed to inform hygiene advice for people living in schistosomiasis endemic areas. Author summary: Schistosomiasis affects millions of people living in low- and middle-income countries lacking safe access to water, sanitation and hygiene (WASH). Infection occurs through skin-contact with water containing schistosome cercariae which are released from the snail intermediate hosts. The disease is mainly controlled through drug treatment with praziquantel in humans, but reinfection is possible if contact with cercaria-contaminated water continues. Despite all the efforts that have been made, this disease remains a major public health problem in disease-endemic regions. The use of soap during water contact, as part of good hygiene practice, may be an effective complementary control method as it might reduce the penetration of schistosome cercariae into the skin, thereby reducing the likelihood of reinfection. We conducted a systematic review to summarise previous research into the efficacy of soap against schistosome cercariae, and to identify current knowledge gaps to inform future studies. The information gathered from this review can provide policymakers with preliminary scientific evidence (e.g. the soap types, soap amounts, exposure times that are needed) to further emphasise the importance of effective soap usage in reducing the spread of schistosomiasis. [ABSTRACT FROM AUTHOR]