The distribution of Mekong schistosomiasis, past and future: preliminary indications from an analysis of genetic variation in the intermediate host.

Neotricula aperta is the only known intermediate host of Schistosoma mekongi which infects humans in Cambodia and the southern tip of Lao PDR. DNA-sequence data (partial rrnL, i.e., mitochondrial 16S large ribosomal-RNA gene) were obtained for 359 N. aperta snails sampled at 31 localities in Cambodia, Lao PDR and Thailand. A nested clade analysis was performed to detect and evaluate any geographical patterns in the observed variation and to identify genetic subpopulations or clades. Coalescent simulations were used to compare different historical biogeographical hypotheses for N. aperta and S. mekongi. A coalescent based method was also used to provide maximum likelihood estimates (MLEs) for effective populations sizes and historical growth and migration rates. Dates were also estimated for phylogenetic events on the gene tree reconstructed for the sampled haplotypes (e.g. the time to most recent common ancestor). N. aperta was found to be divided into two monophyletic clades, a spring-dwelling form of northern Lao PDR and a more widespread larger-river dwelling form of southern Lao PDR and Cambodia; this divergence was dated at 9.3 Ma. The populations with the largest estimated population sizes were found in the Mekong River of Lao PDR and Cambodia; these, together with those of the rivers of eastern Cambodia, appeared to have been the fastest growing populations. Dominant levels of gene-flow (migration) were apparent in a South to North direction, particularly out of seeder populations in the Cambodian Mekong River. The radiation of N. aperta into sub-clades across Cambodia and Lao PDR is dated at around 5 Ma. The findings suggest that historical events, rather than ecology, might best explain the absence of S. mekongi from most of Lao PDR. The public health implications of these findings are discussed, as are pointers for future studies and surveillance.