RESUMO
China has had a long history against schistosomiasis japonica. The most serious prognosis of chronic schistosome infection is hepatic fibrosis, which develops into advanced schistosomiasis if the process is not effectively controlled. After a more than seven decades endeavor, China has gained remarkable achievements in schistosomiasis control and achieved transmission control nationwide (infection rate of schistosomes in residents and domestic animals both less than 1%) by 2015. However, new advanced schistosomiasis cases emerge annually in China, even in areas where the transmission of schistosomiasis had been interrupted. In the present study, the residents (>5 years old) in a schistosomiasis endemic village were examined for schistosomiasis every year during 1995-2019 by the modified Kato-Katz thick smear method and/or miracidium hatching technique. Residents who were identified to have an active infection method were treated with praziquantel at a dose of 40 mg/kg body weight. Ultrasonography was carried out to assess the liver morbidity related to schistosomiasis in 1995 and 2019, respectively. The prevalence of schistosomiasis among residents presented a downward trend annually, from 17.89% (175/978) in 1995 to 0 (0/475) in 2019. Among 292 residents who received ultrasound scan both in 1995 and 2019, 141 (48.29%) presented stable liver damage, while liver fibrosis was developed severely in 86 (29.45%) and reversed in 65 (22.26%) residents. Univariate and multivariate analysis showed that anti-fibrosis treatment was the protective factor against schistosomiasis hepatic fibrosis. Males, residents aged 38 and above, fishermen, and people who did not receive anti-fibrosis treatment were groups with higher risk of liver fibrosis development. Our results revealed that although the infection rate of schistosome dropped significantly in endemic areas, liver fibrosis was still developing among some residents, even though they had received deworming treatment. Liver protection/anti-fibrosis treatment should be administered in endemic regions and regions with historically uncontrolled transmission to slow down the deterioration of hepatic fibrosis among patients in schistosomiasis endemic areas.
RESUMO
Antibody-based diagnostic methods for detecting infection with Schistosoma japonicum have been developed and integrated into the national control program in China; however, the utility of these methods compared with conventional coprological methods remains unclear. In two consecutive years, we compared the performance characteristics of Kato-Katz with a commercially available enzyme-linked immunosorbent assay (ELISA) that detects anti-egg antigen IgG antibodies in a high prevalence, low intensity village in China (1025 subjects in 2005 and 652 subjects in 2006). In comparison with Kato-Katz based on duplicate stool specimens, each read in triplicate, the sensitivity of IgG-ELISA was high, ranging from 79.3% to 87.4% but with a relatively low specificity of 38.9% to 53.5%. The positive predictive value ranged from 20.8% to 24.6% while the negative predictive value ranged from 93.1% to 94.4%. When analyzed as continuous variables, there was a poor correlation between EPG (eggs per gram feces) and antibody level in both years (r(2005)=0.23 and r(2006)=0.41). We detected a trend toward reduced sensitivity at lower infection intensity as measured by Kato-Katz in 2005 (P=0.262) and 2006 (P=0.287). We evaluated changes in antibody levels and the prevalence of positive antibody in the cohort of subjects examined in both 2005 and 2006 (n=565). The prevalence of positive antibody but not the continuous antibody level, decreased in individuals who were uninfected at both time points or who transitioned from infected to uninfected as assessed by Kato-Katz. In this cohort, the distribution of antibody levels measured in 2006 among individuals who were positive by Kato-Katz in 2006 broadly overlapped with the distribution of antibody levels in individuals who were negative by Kato-Katz in both 2005 and 2006. Our results indicate fairly poor performance characteristics of the anti-egg antigen IgG-ELISA for the detection of active infection with S. japonicum in our community based sample and are in contrast with other reports based on more selected populations. The high prevalence but low intensity of S. japonicum in our study community reflects the evolving epidemiology of schistosomiasis in communities receiving intermittent treatment with praziquantel in China. We suggest marked caution in implementing anti-egg antigen IgG-ELISA based diagnosis for either individual level diagnosis or population-based targeting for national control programs.