Field validation of different intervention modes for the potential transmission risk of schistosomiasis during post-transmission interruption phase.

OBJECTIVE: Precision interventions have been proposed in transmission-interrupted areas to further reduce the potential transmission risk of schistosomiasis. This study aimed to evaluate the effects of different interventions modes for potential transmission risk control. METHODS: Three groups of schistosomiasis-endemic villages were selected in Jiangling county, Hubei province. After baseline surveys in 2020, three intervention models were employed in 2021 and 2022. In Model 1, Oncomelania hupensis snail control in key settings and an integrated strategy with an emphasis on the infectious sources managing was employed. In Model 2, an integrated health education-led strategy with an emphasis on infectious source management was employed. In Model 3, only the integrated strategy with an emphasis on infectious source management was employed. The effects of the different intervention models were examined with multiple indicators after 2 years of intervention using the entropy-weighted technique for order of preference by similarity to ideal solution (TOPSIS), rank-sum ratio (RSR) and fuzzy combination model of entropy-weighted TOPSIS and RSR. RESULTS: Entropy-weighted TOPSIS modeling showed that the Ci values of Model 2 were 0.4434, 0.2759, and 0.3069 in the three pilot villages, Ci values were larger, with top comprehensive ranking. The results of the RSR method showed that the RSR values of Model 2 were 0.75, 0.708, and 0.736 in the three pilot villages, with top comprehensive ranking. The results from the fuzzy combination model of entropy-weighted TOPSIS and RSR showed that implementation of Model 2 resulted in the highest comprehensive ranking among the three models in the three pilot villages under Ci: RSR = 0.1: 0.9, Ci: RSR = 0.5: 0.5 and Ci: RSR = 0.9: 0.1. CONCLUSION: The integrated health education-led strategy with an emphasis on infectious source management was the optimal model to manage the risk of transmission of schistosomiasis during the post-transmission interruption phase.

Effect of Health Education on Schistosomiasis Control Knowledge, Attitude, and Practice after Schistosomiasis Blocking: Results of a Longitudinal Observational Study in the Field.

OBJECTIVES: Schistosomiasis is a zoonotic infectious disease that seriously harms people's physical and mental health. As early as 1985, the WHO suggested that health education and health promotion should be the focus of schistosomiasis prevention work. This study aimed to explore the effect of health education on controlling the risk of schistosomiasis transmission after schistosomiasis blocking and to provide a scientific basis for the further improvement of intervention strategies after schistosomiasis interruption in China and other endemic countries. METHODS: In Jiangling County, Hubei Province, China, one severe, one moderate, and one mildly endemic village were selected as the intervention group; two severe, two moderate, and two mildly endemic villages were selected as the control group. In towns with different epidemic types, a primary school was randomly selected for intervention. In September 2020, a baseline survey was carried out through a questionnaire survey to understand the knowledge, attitudes, and practices (KAP) of adults and students concerning schistosomiasis control. Next, two rounds of health education interventions for schistosomiasis control were carried out. The evaluation survey was conducted in September 2021 and the follow-up survey conducted in September 2022. RESULTS: Compared with the baseline survey, the qualified rate of the KAP on schistosomiasis prevention of the control group in the follow-up survey increased from 79.1% (584/738) to 81.0% (493/609) (p > 0.05); in the intervention group, the qualified rate of the KAP on schistosomiasis control increased from 74.9% (286/382) to 88.1% (260/295) (p < 0.001). In the baseline survey, the qualified rate of the KAP of the intervention group was lower than that of the control group, and in the follow-up survey, the qualified rate of the KAP of the intervention group was 7.2% higher than that of the control group (p < 0.05). Compared with the baseline survey, the accuracy rates of the KAP of the intervention group's adults were higher than those of the control group, with statistical significance (p < 0.001). Compared with the baseline survey, the qualified rate of the students' KAP in the follow-up survey increased from 83.8% (253/302) to 97.8% (304/311) (p < 0.001). In the follow-up survey, the accuracy rate of the knowledge, attitudes, and practices of the students was significantly different from the baseline accuracy (p < 0.001). CONCLUSION: a health education-led risk control model of schistosomiasis can significantly improve schistosomiasis control knowledge among adults and students, establishing correct attitudes and leading to the development of correct hygiene habits.

Spatiotemporal distribution of schistosomiasis transmission risk in Jiangling County, Hubei Province, P.R. China.

OBJECTIVE: This study aims to explore the spatiotemporal distribution of schistosomiasis in Jiangling County, and provide insights into the precise schistosomiasis control. METHODS: The descriptive epidemiological method and Joinpoint regression model were used to analyze the changes in infection rates of humans, livestock, snails, average density of living snails and occurrence rate of frames with snails in Jiangling County from 2005 to 2021. Spatial epidemiology methods were used to detect the spatiotemporal clustering of schistosomiasis transmission risk in Jiangling county. RESULTS: The infection rates in humans, livestock, snails, average density of living snails and occurrence rate of frames with snails in Jiangling County decreased from 2005 to 2021 with statistically significant. The average density of living snails in Jiangling County was spatially clustered in each year, and the Moran's I varied from 0.10 to 0.26. The hot spots were mainly concentrated in some villages of Xionghe Town, Baimasi Town and Shagang Town. The mean center of the distribution of average density of living snails in Jiangling County first moved from northwest to southeast, and then returned from southeast to northwest after 2014. SDE azimuth fluctuated in the range of 111.68°-124.42°. Kernal density analysis showed that the high and medium-high risk areas of Jiangling County from 2005 to 2021 were mainly concentrated in the central and eastern of Jiangling County, and the medium-low and low risk areas were mainly distributed in the periphery of Jiangling County. CONCLUSIONS: The epidemic situation of schistosomiasis decreased significantly in Jiangling County from 2005 to 2021, but the schistosomiasis transmission risk still had spatial clustering in some areas. After transmission interruption, targeted transmission risk intervention strategies can be adopted according to different types of schistosomiasis risk areas.

Control of the Invasive Agricultural Pest Pomacea canaliculata with a Novel Molluscicide: Efficacy and Safety to Nontarget Species.

The golden apple snail Pomacea canaliculata is an invasive pest that causes extensive damage to agricultural production. P. canaliculata is also an intermediate host of Angiostrongylus cantonensis, which causes human eosinophilic meningitis. In this study, the molluscicidal activity and safety profile of a novel molluscicide PBQ [1-(4-chlorophenyl)-3-(pyridin-3-yl)urea] were evaluated. PBQ exhibited strong molluscicidal potency against adult and juvenile snails (LC50 values of 0.39 and 0.07 mg/L, respectively). In field trials, PBQ killed 99.42% of the snails at 0.25 g a.i./m2. An acute toxicity test in rats demonstrated that PBQ is a generally nonhazardous chemical. PBQ is also generally safe for nontarget organisms including Brachydanio rerio, Daphnia magna, and Apis mellifera L. Transcriptomics analysis revealed that PBQ had a significant impact on the carbohydrate and lipid metabolism pathways, which provided insights into its molluscicidal mechanism. These results suggest that PBQ could be developed as an effective and safe molluscicide for P. canaliculata control.

Cost-effectiveness analysis of the integrated control strategy for schistosomiasis japonica in a lake region of China: a case study.

BACKGROUND: Schistosomiasis japonica remains an important public health concern due to its potential to cause severe outcomes and long-term sequelae. An integrated control strategy implemented in the Peoples' Republic of China has been shown to be effective to control or interrupt the transmission of schistosomiasis. The objective of this study is to estimate the disease burden of schistosomiasis and assess the cost-effectiveness of the integrated control strategy focused on different major interventions at three stages for schistosomiasis control in a lake setting, to provide reference for policy making or planning. METHODS: Annual cost data of schistosomiasis control during 2009-2019 were obtained from the control program implementers in Jiangling County, Hubei Province, China. Economic costs are provided in constant 2009 Chinese Yuan (CNY). Epidemiological data of schistosomiasis were collected from the Jiangling county station for schistosomiasis control. Disease burden of schistosomiasis was assessed by calculating years of life lost (YLLs) owing to premature death, years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs were calculated as the sum of YLLs and YLDs. We then conducted a rudimentary cost-effectiveness analysis by determining the ratio by dividing the difference between the average cost of integrated control strategy at transmission control (2013-2016) or transmission interruption (2017-2019) and the average cost at stage of infection control (2009-2012) with the difference between the DALYs of schistosomiasis at different control stages. Descriptive statistics on the costs and DALYs were used in the analysis. RESULTS: The total economic costs for schistosomiasis control in Jiangling County from 2009 to 2019 were approximately CNY 606.88 million. The average annual economic costs for schistosomiasis prevention and control at stages of infection control (2009-2012), transmission control (2013-2016), and transmission interruption (2017-2019) were approximately CNY 41.98 million, CNY 90.19 million and CNY 26.06 million respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to 1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the infection control stage as the control, the incremental cost-effectiveness ratio of integrated control strategy was CNY 8505.5 per case averted, CNY 60 131.6 per DALY decreased at transmission control stage and CNY -2217.6 per case averted, CNY -18 116.0 per DALY decreased at transmission interruption stage. CONCLUSIONS: The disease burden of schistosomiasis decreased significantly with the implementation of the integrated prevention and control strategy. Surveillance and management on elder population should be strengthened to decrease diseases burden. There remains a need for well-conducted studies that examine the long-term cost-effectiveness of the integrated control strategy for schistosomiasis. GRAPHIC ABSTARCT.

Toxicity of a molluscicide candidate PPU07 against Oncomelania hupensis (Gredler, 1881) and local fish in field evaluation.

Schistosomiasis japonica caused by Schistosoma japonicum infection is recognized as a considerable economic and public health concern in Asia. Oncomelania hupensis is the sole intermediate host of S. japonicum. The only molluscicide recommended by World Health Organization (WHO) since 1960s is relative toxic to other aquatic species. In this article, we evaluated the novel molluscicide PPU07 in field trials on their efficiency against O. hupensis and toxicity for local fish. 25% PPU07 sulfate WP exhibited similar molluscicidal effect at 2.0 g/m2 and 2.0 g/m3 in the spraying and immersion trials with the WHO recommended molluscicide niclosamide (1 g/m2 and 1 g/m3). The mortality rates reached 95% and 96%, respectively. Moreover, little toxicity was observed for local fish and other aquatic organisms at the effective molluscicidal concentrations. In all, 25% PPU07 sulfate WP is a promising molluscicide for snail control, particularly in semi-commercial or commercial aquaculture ponds.

Field evaluation of a novel molluscicide (niclosamidate) against Oncomelania hupensis, intermediate host of Schistosoma japonicum.

The molluscicidal activity of a novel molluscicide (niclosamidate) was evaluated in field trials against Oncomelania hupensis, the intermediate host of Schistosoma japonicum. The environmental safety of niclosamidate for local fishes was also studied under field conditions. The results showed that, at the dosages of 8.0 g/m2 and 4.0 g/m3, niclosamidate exhibits highly potent molluscicidal activity in the spraying and immersion trials, resulting in mortality rates of up to 81.8 and 72.7%, respectively. Its performance seems to be target-specific, with good molluscicidal ability observed for Oncomelania hupensis snails, but very low toxicity for local fishes and other aquatic organisms. The results suggest that niclosamidate can be used as an alternative molluscicide for snail control, which would be particularly applicable in semi-commercial or commercial aquaculture ponds.

Pattern analysis of schistosomiasis prevalence by exploring predictive modeling in Jiangling County, Hubei Province, P.R. China.

BACKGROUND: The prevalence of schistosomiasis remains a key public health issue in China. Jiangling County in Hubei Province is a typical lake and marshland endemic area. The pattern analysis of schistosomiasis prevalence in Jiangling County is of significant importance for promoting schistosomiasis surveillance and control in the similar endemic areas. METHODS: The dataset was constructed based on the annual schistosomiasis surveillance as well the socio-economic data in Jiangling County covering the years from 2009 to 2013. A village clustering method modified from the K-mean algorithm was used to identify different types of endemic villages. For these identified village clusters, a matrix-based predictive model was developed by means of exploring the one-step backward temporal correlation inference algorithm aiming to estimate the predicative correlations of schistosomiasis prevalence among different years. Field sampling of faeces from domestic animals, as an indicator of potential schistosomiasis prevalence, was carried out and the results were used to validate the results of proposed models and methods. RESULTS: The prevalence of schistosomiasis in Jiangling County declined year by year. The total of 198 endemic villages in Jiangling County can be divided into four clusters with reference to the 5 years' occurrences of schistosomiasis in human, cattle and snail populations. For each identified village cluster, a predictive matrix was generated to characterize the relationships of schistosomiasis prevalence with the historic infection level as well as their associated impact factors. Furthermore, the results of sampling faeces from the front field agreed with the results of the identified clusters of endemic villages. CONCLUSION: The results of village clusters and the predictive matrix can be regard as the basis to conduct targeted measures for schistosomiasis surveillance and control. Furthermore, the proposed models and methods can be modified to investigate the schistosomiasis prevalence in other regions as well as be used for investigating other parasitic diseases.

[Cost-effectiveness evaluation on comprehensive control measures carrying out in schistosomiasis endemic areas with regard to different layers of administrative villages stratified by infection situation of human and domestic animals. II Correlation analysis of costs and inputs with changes of schistosomiasis endemic situation in inner embankment of marshland and lake regions from 2006 to 2013].

OBJECTIVE: To investigate the correlations between inputs and costs and endemic situation of schistosomiasis in inner embankment, so as tb provide the references for the strategy optimization of schistosomiasis control. METHODS: Jiangling County was selected as the study field. The correlatibn and regression analyses were applied to analyze the endemic situation of schistosomiasis in Jiangling County from 2006 to 2013. The methods of two-stages least squares and path analysis were applied to analyze the impacts between costs and inputs and endemic situation of schistosomiasis. RESULTS: The adjusted infection rate of population, number of bovines and Oncomelania hupensis snail areas reduced by 77.42%, 76.34% and 19.43%, respectively in Jiangling County from 2006 to 2013. The correlations between the infection rate of snails and the population positive rates of blood and fecal exams, and the infection rate of bovines were significant (all P < 0.05); and there was a significant linear regression between the infection rates of snails and bovines (P < 0.05). There were statistically significant regressions between inputs at different levels and the population positive rates of blood and fecal exams, and the infection rates of bovines and snails, as well as between the costs and the population positive rate of fecal exams and the infection rates of bovines and snails (all P < 0.05), whereas there was no statistically significant regression between the costs and the population positive rate by blood exams (P > 0.05). The inputs at county level had an impact on the population positive rate of blood exams; the costs of comprehensive treatment had an impact on the population positive rate of fecal exams; the costs of human labor and measures for exams and treatments had an impact on the infeiction rate of bovines; the inputs at national level and the costs of measures for exams and treatments had an impact on the infection rate of snails (all P < 0.05). CONCLUSION: The inputs and costs of schistosomiasis control were related to the epidemic situation of schistosomiasis in Jiangling County from 2006 to 2013; therefore, it is necessary to develop a comprehensive surveillance system as substitute for the current indexes on schistosomiasis control.

[Construction and operation of network laboratory for schistosomiasis diagnosis in Jianglin County].

OBJECTIVE: To build a high quality diagnosis system for schistosomiasis surveillance in the situation of low infection in Jianglin County. METHODS: The network laboratory for schistosomiasis diagnosis was built according to the national criteria in Jianglin County in 2012. RESULTS: The network laboratory for schistosomiasis diagnosis was established successfully and the operation was quiet well. CONCLUSION: The establishment and operation of the laboratory play an important role in the realization of schistosomiasis elimination.

[Efficacy of routinely used patterns for schistosomiasis diagnosis in lake and marshland regions].

OBJECTIVE: To evaluate the efficacy of routinely used pattern for schistosomiasis diagnosis in lake and marshland regions. METHODS: A historically heavy endemic village of schistosomiasis named Jinggan Village from Jiangling County was selected for field survey. The residents aged 6-65 years were screened by indirect hemagglutination assay (IHA) and dipstick dye immunoassay (DDIA) in parallel. The serological positives were examined by Kato-Katz technique and miracidium hatching technique to determine the infection of schistosome. The consistency of the two serological methods was evaluated. In addition, the schistosome infection rates were estimated accordingto the 3 detection patterns namely IHA, DDIA, IHA+DDIA combined with the etiologic examination. RESULTS: A total of 530 individuals were examined by the serological tests. The positive rate of DDIA was 46.98% (249/530), significantly higher than that of IHA (28.49%, 151/530) (χ2 = 59.55, P < 0.01). Totally 279 individuals were serological positives determined by IHA or DDIA, while 252 of them were detected by stool examination, and 22 cases were determined as parasitological positives, while 7 and 3 cases were diagnosed as antibody negatives by IHA and DDIA, respectively. The estimated infection rates determined by IHA, DDIA, IHA plus DDIA combined with stool examination were 3.14%, 3.97%, 4.60%, respectively. CONCLUSIONS: Under the condition of endemic situation becoming more and more waning, the current routinely used pattern for schistosomiasis detection may lead to missed diagnosis. So, more sensitive and effective diagnostic tools or appropriate detection patterns need to be explored.

[Analysis of schistosomiasis endemic situation in Jiangling County from 2004 to 2013].

OBJECTIVE: To analyze the schistosomiasis endemic situation and understand its transmission trend in Jiangling County from 2004 to 2013, so as to improving the schistosomiasis control. METHODS: The relevant data of schistosomiasis were collected and analyzed statistically in Jiangling county from 2004-2013. RESULTS: The human prevalence of schistosomiasis was decreased from 10.22% in 2004 to 0.63% in 2013 with the descend rate of 93.84%, and the notable descend rate was 76.92% from 2009-2013. The cattle infection rate was decreased yearly from 7.59% in 2004 to 0 in 2013. The appearance rate of frames with living Oncomelania hupensis snails and the infection rate of snails reduce by 17.53% and 100% respectively. CONCLUSIONS: After 10-year control, the endemic situation of schistosomiasis in Jiangling County decreases and is at a low level. However, the risk factors of transmission still exist. Therefore, the comprehensive control measures still should be enhanced continuously.