A strategy to control transmission of Schistosoma japonicum in China.

BACKGROUND: Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China. METHODS: We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice. RESULTS: After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001). CONCLUSIONS: A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China.

[Efficacy and adverse effects of film coated praziquantel for treatment of schistosomiasis japonica].

OBJECTIVE: To understand the adverse and curative effects of film coated praziquantel for treatment of schistosomiasis japonica. METHODS: A questionnaire survey was conducted among 6 to 65 years old inhabitants from epidemic areas of schistosomiasis japonica in Jiangxi, Anhui and Hubei provinces, while indirect haemagglutination assay (IHA) was also administrated. The Serological positives were tested by Kato-Katz technique. A total of 509 habitats of serological positives and healthy persons were given praziquantel. 460 targets with no relative symptoms were followed up for adverse effect of drugs in one month and efficacy evaluation of praziquantel was carried out in 104 parasitological positives 3 months post-treatment. RESULTS: The 84.7% (144/170) individuals thought film coated tablets were no smell or only with little smell while 92.9%(315/339) targets in control group fell that tablets smelled bad. The total side effect rates of film coated praziquantel group and control group in 1-2 hours post-treatment were 20.30% (27/133) and 83.18% (272/327) respectively. There was significantly different between two groups (chi(2) = 164.316, P < 0.05). The adverse effect rates of film coated praziquantel group in neuromuscular system, digestive system and cardiovascular system were 15.79% (21/133), 9.77% (13/133), 2.26% (3/133) individually which were significantly lower than those of control groups with 81.65% (267/327), 49.24% (161/327), 12.84% (42/327) in corresponding systems (chi(2)(neuromuscular system) = 175.188, chi(2)(digestive system) = 62.601, chi(2)(cardiovascular system) = 12.010, P < 0.05). And the adverse effect rate of allergic reaction of film coated group was no significant difference with control group (2.26%(3/133) versus 0.92% (3/327), chi(2) = 1.315, P = 0.235). One day after treatment, the adverse effect rate of film coated tablets of praziquantel decreased to 3.01% (4/133), significantly lower than that of control group (P < 0.05). There was no significant difference after 2 weeks treatment while the adverse effect rates decreased to 0.75%(1/133), 0.61% (2/327) in film coated praziquantel group and control group respectively (chi(2) = 0.029, P = 0.642). The curative rates 3 months post treatment were 84.91% (45/51) in film coated tablets of praziquantel group and 82.35% (42/53) in control group without significant difference (chi(2) = 1.536, P = 0.215). CONCLUSION: The smell and adverse effects of film coated tablets of praziquantel were decreased significantly and its efficacy for treatment of schistosomiasis japonica was equal to the control tablets. The film coated tablets of praziquantel might be applied in field widely after a further verification.

[Impact of the three gorges dam construction on transmission of schistosomiasis in the reservoir area].

Possible impact of ecological and social environmental changes due to the construction of the Three Gorges Dam on the transmission of schistosomiasis draws great attention of the health authority and publics. This article reviews the situation and progress of research on schistosomiasis transmission in reservoir area from three aspects: the possibility of snail spreading and breeding, imported infection sources and social behavioral factors of the people.

The role of 'passive chemotherapy' plus health education for schistosomiasis control in China during maintenance and consolidation phase.

In order to explore the possibility of further optimising schistosomiasis control during the maintenance and consolidation phase in China, two highly endemic villages were selected to compare the strategy of 'passive chemotherapy' plus health education to that of mass chemotherapy singly. Emphasis was placed on treatment coverage with praziquantel among individuals infected with Schistosoma japonicum and costs incurred for treating an infected person. The results show that the former strategy was almost as good as the latter producing treatment coverage rates among egg-positives of 96.2-97.1% during 2 years, while corresponding rates of 100% were achieved in the village where mass chemotherapy was employed. Importantly, the cost of the former strategy was only about half that of mass chemotherapy, i.e. 49.0% in the first year and 54.6% in the following. Moreover, 'passive chemotherapy' together with health education can conveniently be integrated into the primary health care system making it an attractive strategy for schistosomiasis control during the maintenance and consolidation phase.

An economic evaluation of the national schistosomiasis control programme in China from 1992 to 2000.

The World Bank Loan Project, by far the largest effort in China for schistosomiasis control since control activities were initiated in the mid 1950s, was carried out for a 9-year period commencing in 1992 in the 8 provinces where Schistosoma japonicum remained endemic when the project started. To evaluate its impact, a retrospective economic evaluation was done in 2001. Six representative counties, i.e. Huarong in Hunan province, Qianjiang in Hubei province, Yugan in Jiangxi province, Tongling in Anhui province, Xichang in Sichuan province and Dali in Yunnan province, were selected for the study. The total financial input in these counties from 1992 to 2000 was RMB Yuan 90.334 million with the World Bank loan accounting for 40.9%. Control efforts resulted in reduction of human prevalence rates in the six counties from 0.7-9.0% in 1992 to 0.1-2.7% in 2000. With regard to S. japonicum infection in bovines, a high reduction was observed in Qianjiang, and smaller decreases were noted in four counties, while there was an increase in Dali. In general, the areas infested by the intermediate host snail fluctuated around the initial level. The net benefit-cost ratio was 6.20, which means that this project gained US$ 6.20 for every dollar spent. The correlation coefficients of the net benefit-cost ratio to the human and bovine infection rates at the beginning of the project were 0.55 and 0.66, respectively. It is conceivable that further progress in schistosomiasis control is an important feature for sustained growth of the local economy, particularly in areas where control of the disease has been most challenging.

[Investigation on schistosomiasis japonica infection and preventive knowledge of immigration population in Jinshan District, Shanghai].

OBJECTIVE: To investigate the schistosomiasis japonica infection and preventive knowledge of immigration population in Jinshan District, Shanghai so as to provide the evidence for improving the control work. METHODS: The immigration population from schistosomiasis endemic provinces and local people were screened by serum IHA screening for schistosome infection, and the positives were further examined by Kato-Katz technique and the miracidium hatching method. The schistosomiasis preventive knowledge and behaviors were investigated by questionnaires. RESULTS: A total of 579 were investigated with 348 immigration people and 231 local people, and among them, the male accounted for 72.0% and female accounted for 28.0%. In the immigration population, the main age group was 20-29 (56.0%), and 56.6% of the immigration had an education level at senior middle school or higher. The most proportion of immigration was from Anhui Province (36.2%). There were 4 IHA positive persons (1.15%) in the immigration, and 1 was positive in the stool test, and the schistosome infection rate was 0.29%. There were no positives in the local people. The schistosomiasis preventive knowledge of the immigration was generally poor, and some people' s behaviors of see doctor and medication were incorrect. CONCLUSION: There are schistosome infected persons among the immigration population from schistosomiasis endemic provinces, and their schistosomiasis prevention knowledge was poor, thus there is a schistosomiasis transmission risk.

[Schistosomiasis control effect of measures of replacing cattle with machine for cultivation and forbidding depasturage of livestock on marshlands in marshland and lake regions].

OBJECTIVE: To evaluate the schistosomiasis control effect of the measures of replacing cattle with machine for cultivation and forbidding depasturage of livestock on marshlands in marshland and lake regions. METHODS: The retrospective review and field survey were implemented in the Jiangling and Gongan counties of Hubei Province where were implemented with the measure of replacing cattle with machine for cultivation, and Yuanjiang and Huarong counties of Hunan Province where were implemented with the measure of forbidding the depasturage of livestock on marshlands. The schistosome infection status of human, cattle, and Oncomelania hupensis snails, and schistosome-infested field excreta were surveyed from 2007 to 2013. The effects of the interventions were compared before and after their implementations. RESULTS: The 6 villages of Hubei Province were implemented with the measure of replacing cattle with machine for cultivation, and 7 villages of Hunan Province were implemented with the measure of forbidding the depasturage of livestock on marshlands. From 2007 to 2013, the schistosome infection rates of residents declined from 3.95% to 0.70% (χ2 = 128.376, P < 0.05), with the descend range of 82.53%. The descend ranges of the measures of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands were 83.081% and 81.62% respectively, and there was no significant difference between the two measures (χ2 = 0.132, P > 0.05). The infection rate of cattle decreased from 3.66% in 2007 to 0.65% in 2013, and the descend range was 82.24% (χ2 = 13.692, P < 0.05). The field excreta was surveyed in the snail breeding place in 2013. The investigated area was 157.435 hm2, and 625 samples of field feces of cattle were collected with the density of field excreta of 3.97/hm2, and the positive rate was 1.12% (7/625). The schistosome infection rate of snails and the density of infected snails decreased successively from 2007, and no infected snails were detected from 2011 to 2013. CONCLUSIONS: The schistosomiasis endemic situation are decreased significantly after the interventions of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands. Therefore, schistosomiasis control effect of these measures is notable in the marshland and lake regions.

A multi-component integrated approach for the elimination of schistosomiasis in the People's Republic of China: design and baseline results of a 4-year cluster-randomised intervention trial.

Despite major successes in its control over the past 50years, schistosomiasis japonica continues to be a public health problem in the People's Republic of China (P.R. China). Historically, the major endemic foci occur in the lakes and marshlands along the Yangtze River, areas where transmission interruption has proven difficult. The current endemic situation may alter due to the closure of the Three Gorges Dam. Considerable environmental and ecological changes are anticipated that may result in new habitats for the oncomelanid intermediate snail host of Schistosoma japonicum (Sj), thereby increasing the risk of transmission. The current national control program for P.R. China involves a multi-component integrated strategy but, despite targeting multiple transmission pathways, certain challenges remain. As the Chinese government pushes towards elimination, there is a requirement for additional tools, such as vaccination, for long-term prevention. Whereas the zoonotic nature of schistosomiasis japonica adds to the complexity of control, it provides a unique opportunity to develop a transmission blocking vaccine targeting bovines to assist in the prevention of human infection and disease. Mathematical modelling has shown that control options targeting the various transmission pathways of schistosomiasis japonica and incorporating bovine vaccination, mass human chemotherapy and mollusciciding could lead to its elimination from P.R. China. Here we present the study design and baseline results of a four-year cluster randomised intervention trial we are undertaking around the schistosomiasis-endemic Dongting Lake in Hunan Province aimed at determining the impact on schistosome transmission of the multi-component integrated control strategy, including bovine vaccination using a heterologous "prime-boost" delivery platform based on the previously tested SjCTPI vaccine.

[Overcoming the global impact of neglected tropical diseases and challenges].

The global impact of neglected tropical diseases has been much more recognized recently. The elimination and eradication of these diseases is significant for achieving the millennium development goals, for societies and for global healthcare. WHO already drew the roadmap to accelerate the work on eliminating and eradicating the selected diseases for 2015 and 2020 respectively. The present review demonstrates the current situation and progress of controlling these neglected tropical diseases and the challenges faced, and emphasizes the action of China.

[Parasitological characteristics, epidemiological and clinical features, and current control approaches for three major kinds of human schistosomiasis].

Schistosomiasis is a tropical disease, which could do serious damage to the people's health, and it hinders the development of the social economy but may be neglected. After a positive control, some countries and regions have blocked the spread of schistosomiasis. However, in the past few years, with the development of social economy, due to the global movement of people, schistosomiasis not only poses a threat to control areas, but also may cause new endemic areas. This article reviews the parasitological characteristics, clinical manifestations, epidemiological situation, and control approaches of three major kinds of human schistosomiasis, schistosomiasis japonica, schistosomiasis haematobia, and schistosomiasis mansoni.

[Evolution of schistosomiasis control and prevention strategies in hilly regions with schistosomiasis endemic in China].

This article expatiates the epidemiological characteristics, the evolution process of control and prevention strategies and measures in hilly regions with schistosomiasis endemic, especially the research progress and obstacle factors existed in the implementation process of the comprehensive strategy focused on controlling infection source, aiming at providing references for the hilly regions to reach transmission interrupted standard.

[River beach contamination index in monitoring of schistosomiasis].

Diseased animals are the main source of infection of schistosomiasis. River beach wild fecal contamination is the direct risk factor for schistosomiasis transmission, and the river beach contamination index has important significance in the schistosomiasis monitoring. This paper reviews the river beach wild fecal contamination to the identification and evaluation of the risk of schistosomiasis transmission.

[Road map for transmission interruption of schistosomiasis in China].

Based on the transmission status of schistosomiasis in People's Republic of China, the challenges and road map for achieving the transmission interruption of schistosomiasis by 2020 in the country was discussed, particularly focused on elimination strategy, surveillance and response approaches, and key technique needs in the three stages, e.g. pre-elimination, elimination and post-elimination stages. Recommendation of strengthening studies on transmission threshold and technological innovation at the low transmission level of schistosomiasis japonica were put forward.