Swimmer's itch risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Risk Factors
Humans usually become infected with avian schistosomes after swimming in lakes or other bodies of slow-moving fresh water. Some laboratory evidence indicates snails shed cercariae most intensely in the morning and on sunny days, and exposure to water in these conditions may therefore increase risk. The length of time spent swimming is positively correlated with increased risk of infection in Europe[2] and North America,[3] and shallow inshore waters -- snail habitat -- undoubtedly harbor higher densities of cercariae than open waters offshore. Onshore winds are thought to cause cercariae to accumulate along shorelines.[4] Studies of infested lakes and outbreaks in Europe and North America have found cases where infection risk appears to be evenly distributed around the margins of bodies of water[5] as well as instances where risk increases in endemic swimmer's itch "hotspots."[6] Children may become infected more frequently and more intensely than adults but this probably reflects their tendency to swim for longer periods inshore, where cercariae also concentrate.[7] Stimuli for cercarial penetration into host skin include unsaturated fatty acids, such as linoleic and linolenic acids. These substances occur naturally in human skin and are found in sun lotions and creams based on plant oils.