Advancing Schistosomiasis Control: The Quest for Improved Diagnostics

Sarah Hingel , Erik Coumou

Friday, 30/01/2026

Schistosomiasis (SCH) is a neglected tropical disease caused by parasitic worms that inflict long-term damage to major organs such as the bladder, kidneys, reproductive organs, intestine, and liver. More than 250 million people are affected by SCH, and  the majority (85%) of cases are found in Africa. While the World Health Organization (WHO) has set the ambitious goal of eliminating schistosomiasis as a public health problem by 2030, current control methods are inefficient – potentially wasting and even jeopardizing the scarce resources currently available.

The cornerstone of SCH control involves large-scale, periodic mass drug administration (MDA) campaigns with praziquantel, primarily aimed at school-age children. Through a long-standing partnership with WHO, this medicine is donated by Merck and distributed free of charge. However, as the prevalence of SCH can vary substantially, even between neighbouring villages, treating all communities equally can lead to significant medicine wastage. Even worse, unnecessary use can drive pathogens to develop resistance to the medicine, putting its long-term efficacy at risk.

More precise, up-to-date granular SCH disease prevalence and incidence data (in the case of retreatment) are required to ensure these precious medicines can be directed to the areas where they are most needed. However, effective mapping and monitoring depend on accurate diagnosis. The WHO currently recommends microscopy-based methods: Kato–Katz thick smear for intestinal SCH and urine filtration for urogenital SCH. These methods are inexpensive and field-adaptable, but they have important limitations. In low-prevalence or post-MDA settings, microscopy lacks sufficient sensitivity. In addition, microscopy is labour-intensive, requiring trained personnel and repeated sampling over multiple days to achieve acceptable diagnostic accuracy.

For Schistosoma mansoni, a WHO-endorsed alternative test has been available for nearly two decades: the point-of-care circulating cathodic antigen (POC‑CCA) urine test. This rapid diagnostic test (RDT) is substantially more sensitive than microscopy in low-endemicity settings and can be deployed at scale, with a single operator performing up to 100 tests per day. A next-generation version, POC‑CCA3, was introduced in 2025 by Landcent, a Dutch social enterprise. This new test demonstrates improved batch-to-batch consistency, addressing a key limitation of earlier versions, while maintaining diagnostic accuracy. POC‑CCA3 is currently available for research use, including prevalence mapping and impact assessments.

However, SCH remains a multi-species disease. Two forms—intestinal and urogenital—are caused by six different Schistosoma species, with S. mansoni and S. haematobium together accounting for most of the global disease burden. A complementary and even more sensitive test that detects both species would revolutionize SCH diagnosis and help to better target MDA campaigns. Improving the efficiency of MDA could even make it possible to routinely include adults in campaigns, further reducing disease transmission and preventing more serious, life‑altering outcomes.

Progress towards diagnostic tests that can detect multiple species across both forms of SCH is being made. The Diagnostic Technical Advisory Group (DTAG), which was formed as an advisory group to the WHO Department of Neglected Tropical Diseases in 2019, has called for more sensitive diagnostic tools for SCH. In response, FIND and partners are developing an RDT that detects– a byproduct of the SCH parasite, the circulating anodic antigen (CAA) – which indicates the presence of an active infection.

In clinical evaluations conducted in Kenya and the Philippines in 2024 and 2025, target sensitivity and specificity were fully met for one species, while sensitivity estimates for the other two fell just below the minimum target. Based on these promising results, plans are advancing to transfer the test to a manufacturer capable of large-scale production, with the test entering the design-lock phase of development.

However, the success of these efforts and others will hinge on prioritization of the development and implementation of new diagnostic tools by policymakers, funders, and other stakeholders. With investment and commitment, innovative diagnostic technologies could help dramatically reduce the burden of SCH, protect the effectiveness of the existing medicines, and bring the 2030 elimination goal within reach.

 

Sarah Hingel is the Head of the Neglected Tropical Diseases programme and the focal lead for schistosomiasis at FIND.

Erik Coumou is the Head of Diagnostics at Landcent Europe BV.

 

Understanding Schistosomiasis There are two major forms of schistosomiasis – intestinal and urogenital – caused by six species: Intestinal form: S. mansoni, S. japonicum, S. mekongi, S. guineensis, and S. intercalatum Urogenital form: S. haematobium  S.haematobium and S. mansoni together cause the greatest disease burden globally. Diagnostic methods at a glance: WHO recommends microscopy-based methods — Kato-Katz (for intestinal forms) and urine filtration (for urogenital forms) — as well as the circulating cathodic antigen (CCA) test for S. mansoni. POC-CCA3, a rapid test for S. mansoni, is currently available. A CAA-based RDT that detects multiple species is in development.