Hybridisation in urogenital schistosomiasis (HUGS): A multidisciplinary longitudinal population study revealing the transmission biology, epidemiological impact and clinical importance of Schistosoma haematobium-hybrids in Malawi

Despite ongoing control, rural African communities typically suffer from schistosomiasis, a snail-borne parasitic worm disease. New unknowns are now emerging about the worms that cause urogenital schistosomiasis, a specific disease form afflicting millions and linked with predisposition towards HIV infection. In Malawi, abrupt changes in the genetic makeup of worms demonstrate, contrary to common assumptions, abilities to mate successfully with related worms in livestock. Hybrid worms are important, perhaps causing heightened disease and being more resilient to current control. Using state-of-the-art molecular and spatial surveillance methods, our 4-year study will specifically address these issues; as set against ongoing control, we will examine disease-dynamics in humans, snails and livestock. We seek to determine hybrid transmission pathways, clinical importance and wider health impacts in two exemplar Malawian communities, where two known hybrids are endemic. We will therefore judge if international red-flagging is needed with urgent revision of current control policies and practices.