Contemporary challenges of Schistosomiasis mansoni in Brazil: a review of epidemiological indicators, SUS protocols, and control strategies (2010–2026)

This scientific review analyzes the contemporary epidemiological landscape and public health management of Schistosomiasis mansoni in Brazil for the 2024–2026 triennium. The main objective of this study is to provide multiple diagnostic and environmental engineering dimensions, extending beyond normative official manuals to analyze systemic surveillance vulnerabilities, detection biases, and the chronic morbidity legacy in an aging population. Despite decades of control initiatives, Brazil remains the primary endemic epicenter in the Americas, currently transitioning from a morbidity control paradigm toward the World Health Organization’s goal of total transmission interruption. This study examines a paradoxical epidemiological transition where declining aggregate national prevalence is counterbalanced by the entrenchment of the disease in high-endemicity “pockets” in the Northeast and Southeast Regions. We evaluate the critical demographic shift toward an aging population presenting with severe chronic “legacy burdens,” such as Symmers’ pipe-stem fibrosis and portal hypertension. Within the scope of the Unified Health System (SUS), this review assesses the strategic shift toward high-sensitivity diagnostics, including point-of-care circulating cathodic antigen (POC-CCA) and molecular assays, to identify asymptomatic carriers. Furthermore, the analysis highlights the necessity of Integrated Environmental Engineering (IEE) and the Brazilian Legal Framework for Sanitation as definitive structural interventions to sustain elimination. We conclude that achieving the 2030 elimination target requires an unwavering “One Health” commitment, integrating rigorous clinical follow-up for chronic patients with universal sanitation and proactive malacological surveillance. Schistosomiasis, popularly known in Brazil as “barriga d’água,” remains a persistent public health threat despite decades of combat efforts. While the country has successfully reduced the number of deaths and severe acute cases, the disease has adapted and has found “pockets” of transmission in urban peripheries and coastal areas, where a lack of sanitation and clean water keeps the parasite in circulation. Our study highlights a concerning shift: the disease is now heavily affecting older people who have carried the infection for years, leading to severe liver and intestinal complications that are difficult to treat in advanced stages. We argue that simply providing medication is not enough to eliminate schistosomiasis. True eradication requires a “One Health” approach—an integrated strategy that combines high-sensitivity diagnostic tests with massive investments in basic sanitation and environmental engineering. By changing the environments where the snail hosts thrive and ensuring that every citizen has access to treated water, Brazil can ultimately break the cycle of poverty and disease, meeting the global goal of eliminating schistosomiasis as a public health problem by 2030.