Schistosomiasis outbreak in Essuekyir, Cape Coast Metropolis, Ghana, January 2023

Introduction: On 4th January 2023, a 14-year-old boy was hospitalised for schistosomiasis-related severe anemia in Essuekyir. Data reviewed revealed 11 additional cases that was unusually higher than expected for the period. We investigated to determine the magnitude of the outbreak, assess risk factors, and implement control measures. Methods: We reviewed medical records and conducted community case searches after stakeholder engagement. A suspected case was any resident with bloody urine between 1st October 2022 and 13th January 2023. Urine from suspected cases was examined microscopically for Schistosoma ova. Demographic, clinical, and exposure information were collected. Community inspection of water, and sanitation facilities was conducted, while directly observing residents' contact with the river, which we hypothesized as a source of infection. Kakum River was examined for snails. An unmatched 1:1 case-control study was conducted from 11th through 17th January 2023. Attack rates and odds ratios at 95% confidence levels were calculated. Results: Of 118 suspected cases, 94.1% (111/118) were confirmed. The mean age of cases was 12±5.4 years. Majority, were males (77.5%(86/111)) and pupils (85.6%(95/111)). Among residents, 62.5%(125/200) practiced open defecation. Household and community attack rates were 23.4%(84/359) and 5.6%(108/1912) respectively. River exposure through swimming (aOR=5.0,95%CI:1.7-14.5), fishing (aOR=2.1,95%CI:1.1-4.0), and drawing water (aOR=2.9,95%CI:1.4-6.4) increased the odds of infection. The Kakum River, which residents frequently contacted, is the source of infection as some snail species were recovered from it. Conclusion: Male children were mainly affected. Exposure to Kakum River was the predominant risk factor. Cases were treated with praziquantel, and residents were educated to avoid nonessential contact with the river or wear protective boots. Triennial praziquantel mass administration by Ghana Health Service was recommended.