[Construction of a schistosomiasis transmission risk assessment system in Wuhan City based on analytic hierarchy process].

OBJECTIVE: To construct a schistosomiasis transmission risk assessment system in Wuhan City and preliminary evaluate its application effect, so as to promote the rational allocation of schistosomiasis control resources and accelerate the progress towards schistosomiasis elimination. METHODS: The schistosomiasis risk assessment indicators were collected through referring schistosomiasis surveillance data of Wuhan City from 2014 to 2020, literature review and expert interviews. Indicators within each criterion and sub-criterion were screened using the Delphi method, and a hierarchical structure model was created based on analytic hierarchy process. Quantitative assignment of each indicator was conducted according to relative importance, and the weight and combination weight of each criterion were calculated in each analytic hierarchy framework to create a schistosomiasis transmission risk assessment system, which was used for the schistosomiasis transmission risk assessment in 12 national schistosomiasis surveillance sites in Wuhan City. RESULTS: A three-level schistosomiasis transmission risk assessment system was preliminarily constructed, which included a target layer, 5 criterion layers and 21 sub-criterion layers. Of all indicators in the criterion layer, transmission route had the highest weight (0.433), followed by source of Schistosoma japonicum infection (0.294); and among all indicators in the sub-criterion layer, S. japonicum infection in Oncomelania hupensis and sentinel mice had the highest combination weight (0.125), followed by prevalence of S. japonicum infection in humans (0.091) and bovines (0.053), snail control by chemical treatment (0.049), positive rate of inquiry examinations (0.048), allocation of schistosomiasis control professionals (0.045), and areas of submerged snail-infested settings (0.041). Of the 12 national schistosomiasis surveillance sites in Wuhan City, there were 5 sites with weights of > 0.8, 4 sites with weights of 0.6 to 0.8, and 3 sites with weights of < 0.6 in 2020. CONCLUSIONS: A schistosomiasis transmission risk assessment system has been constructed based on analytic hierarchy process in Wuhan City, which may provide a evidence-based basis for health resource allocation and decision-making for schistosomiasis control.

Comparative assessment of the SjSAP4-incorporated gold immunochromatographic assay for the diagnosis of human schistosomiasis japonica.

Background: Schistosomiasis, a disease caused by parasites of the genus Schistosoma, remains a global public health threat. This study aimed to validate the diagnostic performance of a recently developed gold immunochromatographic assay (GICA) for the detection of S. japonicum infection in a rural endemic area of the Philippines. Methods: Human clinical samples were collected from 412 subjects living in Laoang and Palapag municipalities, Northern Samar, the Philippines. The presence of Schistosoma-specific antibodies in serum samples was tested with the SjSAP4-incorporated GICA strips and the results were converted to fully quantitative data by introducing an R value. The performance of the established GICA was further compared with other diagnostic tools, including the Kato-Katz (KK) technique, point-of-care circulating cathodic antigen (POC-CCA), droplet digital (dd) PCR, and enzyme-linked immunosorbent assays (ELISAs). Results: The developed GICA strip was able to detect KK positive individuals with a sensitivity of 83.3% and absolute specificity. When calibrated with the highly sensitive faecal ddPCR assay, the immunochromatographic assay displayed an accuracy of 60.7%. Globally, the GICA assay showed a high concordance with the SjSAP4-ELISA assay. The schistosomiasis positivity rate determined by the GICA test was similar to those obtained with the SjSAP4-ELISA assay and the ddPCR assay performed on serum samples (SR_ddPCR), and was 2.3 times higher than obtained with the KK method. Conclusion: The study further confirms that the developed GICA is a valuable diagnostic tool for detecting light S. japonicum infections and implies that this point-of-care assay is a viable solution for surveying endemic areas of low-intensity schistosomiasis and identifying high-priority endemic areas for targeted interventions.

Development and assessment of a novel gold immunochromatographic assay for the diagnosis of schistosomiasis japonica.

Background: The neglected zoonosis, schistosomiasis japonica, remains a major public health problem in the Philippines. The current study aims to develop a novel gold immunochromatographic assay (GICA) and evaluate its performance in the detection of Schistosoma japonicum infection. Methods: A GICA strip incorporating a S. japonicum saposin protein, SjSAP4 was developed. For each GICA strip test, diluted serum sample (50 µl) was loaded and strips were scanned after 10 min to convert the results into images. ImageJ was used to calculate an R value, which was defined as the signal intensity of the test line divided by the signal intensity of the control line within the cassette. After determination of optimal serum dilution and diluent, the GICA assay was evaluated with sera collected from non-endemic controls (n = 20) and individuals living in schistosomiasis-endemic areas of the Philippines (n = 60), including 40 Kato Katz (KK)-positive participants and 20 subjects confirmed as KK-negative and faecal droplet digital PCR assay (F_ddPCR)-negative at a dilution of 1:20. An ELISA assay evaluating IgG levels against SjSAP4 was also performed on the same panel of sera. Results: Phosphate-buffered saline (PBS) and 0.9% NaCl were determined as optimal dilution buffer for the GICA assay. The strips tested with serial dilutions of a pooled serum sample from KK-positive individuals (n = 3) suggested that a relatively wide range of dilutions (from 1:10 to 1:320) can be applied for the test. Using the non-endemic donors as controls, the GICA strip showed a sensitivity of 95.0% and absolute specificity; while using the KK-negative and F_ddPCR-negative subjects as controls, the immunochromatographic assay had a sensitivity of 85.0% and a specificity of 80.0%. The SjSAP4-incorperated GICA displayed a high concordance with the SjSAP4-ELISA assay. Conclusions: The developed GICA assay exhibited a similar diagnostic performance with that of the SjSAP4-ELISA assay, yet the former can be performed by local personnel with minimal training with no requirement for specialised equipment. The GICA assay established here represents a rapid, easy-to-use, accurate and field-friendly diagnostic tool for the on-site surveillance/screening of S. japonicum infection.

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.

[Assessment of schistosomiasis transmission risk along the Yangtze River basin after the flood disaster in 2020].

OBJECTIVE: To evaluate the impact of the flood disaster on schistosomiasis transmission along the Yangtze River basin in 2020, so as to provide insights into schistosomiasis prevention and control in flood-affected areas. METHODS: The data pertaining to the endemic situation of schistosomiasis were collected from 5 provinces of Hunan, Hubei, Jiangxi, Anhui and Jiangsu from 2013 to 2019, including Schistosoma japonicum infections in humans and livestock and snail distribution, and the warning water levels and actual water status were collected in water regions locating in these 5 provinces. The cumulative numbers of S. japonicum egg-positive individuals and bovines during the period from 2013 to 2019, the area of snail habitats in 2019 and the water level on July 12, 2020 were estimated at a county level and employed as parameters for classification of schistosomiasis transmission risk. Then, the cumulative value of each risk index was calculated to assess the risk of schistosomiasis transmission risk. RESULTS: After the flood disaster along the Yangtze River basin in 2020, there were 10, 5 and 9 counties (districts) at high risk of schistosomiasis transmission in 5 provinces of Hunan, Hubei, Jiangxi, Anhui and Jiangsu based on number of egg-positive individuals, number of egg-positive bovines and snail distribution, respectively. Based on comprehensive risk indices, there were 10 (8 in Dongting Lake regions of Hunan Province and 2 in Poyang Lake regions of Jiangxi Province) and 15 counties (districts) (4 in Hubei Province, 7 in Hunan Province and 4 in Jiangxi Province) identified at grades 5 and 4 risk of schistosomiasis transmission. CONCLUSIONS: Dongting Lake regions and Poyang Lake regions are the most severely flood-affected schistosomiasis-endemic foci of China in 2020, and the flood disaster may facilitate the transmission of schistosomiasis in affected areas. Therefore, schistosomiasis control requires to be intensified after the flood disaster to prevent the rebound of the disease.

Contributions and achievements on schistosomiasis control and elimination in China by NIPD-CTDR.

Being a zoonotic parasitic disease, schistosomiasis was widely spread in 12 provinces of Southern China in the 1950s, severly harming human health and hindering economic development. The National Institute of Parasitic Diseases at the Chinese Center for Diseases Control and Prevention, and Chinese Center for Tropical Diseases Research (NIPD-CTDR), as the only professional institution focussing on parasitic diseases at the national level, has played an important role in schistosomiasis control in the country. In this article, we look back at the changes of schistosomiasis endemicity and the contribution of NIPD-CTDR to the national schistosomiasis control programme. We review NIPD-CTDR's activities, including field investigations, design of control strategies and measures, development of diagnostics and drugs, surveillance-response of endemic situation, and monitoring & evaluation of the programme. The NIPD-CTDR has mastered the transmission status of schistosomiasis, mapped the snail distribution, and explored strategies and measures suitable for different types of endemic areas in China. With a good understanding of the life cycle of Schistosoma japonicum and transmission patterns of the disease, advanced research carried out in the NIPD-CTDR based on genomics and modern technology has made it possible to explore highly efficient and soft therapeutic drugs and molluscicides, making it possible to develop new diagnostic tools and produce vaccine candidates. In the field, epidemiological studies, updated strategies and targeted intervention measures developed by scientists from the NIPD-CTDR have contributed significantly to the national schistosomiasis control programme. This all adds up to a strong foundation for eliminating schistosomiasis in China in the near future, and recommendations have been put forward how to reach this goal.

Process Development of Sj-p80: A Low-Cost Transmission-Blocking Veterinary Vaccine for Asiatic Schistosomiasis.

Asiatic schistosomiasis caused by Schistosoma japonicum is a neglected tropical disease resulting in significant morbidity to both humans and animals - particularly bovines - in endemic areas. Infection with this parasite leads to less healthy herds, causing problems in communities which rely on bovines for farming, milk and meat production. Additionally, excretion of parasite eggs in feces perpetuates the life cycle and can lead to human infection. We endeavored to develop a minimally purified, inexpensive, and effective vaccine based on the 80 kDa large subunit of the calcium activated neutral protease (calpain) from S. japonicum (Sj-p80). Here we describe the production of veterinary vaccine-grade Sj-p80 at four levels of purity and demonstrate in a pilot study that minimally purified antigen provides protection against infection in mice when paired with a low-cost veterinary adjuvant, Montanide™ ISA61 VG. Preliminary data demonstrate that the vaccine is immunogenic with robust antibody titers following immunization, and vaccination resulted in a reduction of parasite eggs being deposited in the liver (23.4-51.4%) and intestines (1.9-55.1%) depending on antigen purity as well as reducing the ability of these eggs to hatch into miracidia by up to 31.6%. We therefore present Sj-p80 as a candidate vaccine antigen for Asiatic schistosomiasis which is now primed for continued development and testing in bovines in endemic areas. A successful bovine vaccine could play a major role in reducing pathogen transmission to humans by interrupting the parasitic life cycle and improving quality of life for people living in endemic countries.

[Application and effect of integrated control model of schistosomiasis interruption in mountainous and hilly endemic regions].

OBJECTIVE: To explore the integrated schistosomiasis control model in mountainous and hilly endemic regions, so as to provide insights into the development of the schistosomiasis elimination strategy. METHODS: Five hilly and mountainous areas endemic for schistosomiasis were selected as the integrated control demonstration areas in Sichuan Province from 2011 to 2015. According to the epidemic characteristics, economic levels and overall development planning of the demonstration areas, the goals, strategies and measures were developed, and the effectiveness of schistosomiasis control was evaluated following implementation of the integrated control. RESULTS: The support system of the integrated schistosomiasis control model was built in the integrated control demonstration areas in Sichuan Province from 2011 to 2015, and five ecological, industrialized and sustainable development models of integrated schistosomiasis control were developed, including integration of balancing rural and urban development, systematic ecological improvement, intensified ecological agriculture, scientific management and health education of schistosomiasis control and ecological ethnic circular economy. Since the implementation of the integrated schistosomiasis control model, the snail habitats were completely changed. Until 2015, 92.0% of all historical areas with snails were managed, the coverage of safe drinking water was 100.0%, and more than 95.0% of the livestock were fenced. The coverage of sanitary toilets increased by 93.0%, 96.8%, 78.8%, 87.1% and 82.0% from 2011 to 2015, respectively, and the farmers'mean yearly income increased by 32.7% in the demonstration areas. From 2011 to 2015, the seroprevalence of human Schistosoma japonicum infections reduced from 3.1% in 2011 to 1.6% in 2015 in the demonstration areas, and no egg-positives were identified. In addition, the number of fenced bovines reduced year by year, and no egg-positives were detected. The areas of snail habitats were 398.7, 108.2 hm2 and 52.9 hm2 in the demonstration areas from 2011 to 2013, with no infected snails found, and no snails were detected since 2014. The awareness of schistosomiasis control knowledge and percentage of correct behavior formation increased year by year among residents in the demonstration areas from 2011 to 2015. CONCLUSIONS: The five integrated schistosomiasis control models meet the needs of the current schistosomiasis control activities in mountainous and hilly endemic areas of Sichuan Province, and achieve the goals of controlling the sources of S. japonicum infections, economic development, social progress and improving the ecological environment, which provides new insights into schistosomiasis elimination in the country.

[Approaches used for assessment of the burden of advanced schistosomiasis japonica: a comparative study].

OBJECTIVE: To compare the approaches used for the assessment of disability adjust life years (DALYs) for advanced schistosomiasis japonica, so as to provide scientific evidence for accurate assessment of the burden of advanced schistosomiasis japonica. METHODS: The patients with advanced schistosomiasis japonica receiving treatment and assistance programs in Hunan Province in 2017 were enrolled, and the years lived with disability (YLD) for the patients with advanced schistosomiasis japonica was calculated using the common global burden of disease (GBD) estimation method, the modified GBD method with addition of common syndromes of advanced schistosomiasis japonica, and the quality of life assessment method. RESULTS: The YLDs of patients with advanced schistosomiasis japonica, the mean YLDs per capita, and the percentages of YLD were 673.94, 728.77 person-years and 1 761.99 person-years; 0.181, 0.196 person-years and 0.474 person-years; and 10.61, 11.48 person-years per 100 thousand persons and 27.75 person-years per 100 thousand persons with the common GBD method, modified GBD method and the quality of life method, respectively. The YLDs of the patients with advanced schistosomiasis japonica in Hunan Province estimated with the modified GBD method and the quality of life method were 8.14% and 2.61 times higher than that with the common GBD method. Of the major symptoms included in the calculation, the 5 symptoms with the greatest contribution to the burden of advanced schistosomiasis japonica included ascites, moderate anemia, severe anemia, diarrhea and hematochezia. CONCLUSIONS: The quality of life method may more comprehensively assess the YLDs in patients with advanced schistosomiasis japonica than the common and modified GBD methods.

Utilization of real time PCR for the assessment of egg burden in the organs of Schistosoma japonicum experimentally infected mice.

Schistosoma japonicum, causing zoonotic intestinal schistosomiasis, is found in China, the Philippines and parts of Indonesia. Severe disease manifestations are basically due to the deposition of eggs in some vital organs such as the liver, spleen and brain. Traditionally, histopathological microscopic examination of the egg burden was used to evaluate the intensity of infection in the affected organs. However, this technique is laborious, time-consuming and requires trained personnel. In this study, real time PCR targeting the mitochondrial NADH dehydrogenase I gene was used to compare with microscopic examination of tissue sections in evaluating the egg burdens in different affected organs. Livers, spleens and brains of the S. japonicum infected mice after 8 and 18 weeks post-infection (p.i) were harvested and examined. Results showed that there were statistically significant correlations between the egg burden evaluated by tissue section examination, and the Ct values of the real time PCR of livers with heavy egg burden at 8 (r = -0.81) and 18 (r = -0.80) weeks p.i. Furthermore, a correlation (r = -0.56) between the egg burden assessed by the microscopic examination and Ct value of the real time PCR of spleens with moderate egg burden after 18 weeks p.i and not 8 weeks p.i was also observed. Brains with low egg burden showed no schistosome eggs in the microscopic examination, however one sample tested positive by real time PCR. These results suggested that real time PCR is useful in evaluating schistosome egg burden in the organs of the experimentally infected mice model that will give further insights into the pathology of schistosomiasis.

A cross-sectional survey comparing a free treatment program for advanced schistosomiasis japonica to a general assistance program.

The prevalence and intensity of schistosomiasis has dropped dramatically in China due to an effective integrated control program. However, advanced schistosomiasis is becoming a key challenge on the road to elimination. The aims of this study were to compare the disease condition between advanced cases under the general assistance program (GAP) and free treatment program (FTP) and to determine whether the FTP should be popularized to provide an objective reference for policymakers in China's advanced schistosomiasis control program. One hundred and ninety-four patients with schistosomiasis japonica who were enrolled in the GAP or FTP participated in this study. Little significant difference was observed in the potential confounders, including general characteristics, comorbidities, and lifestyle, indicating a similar effect on the pathology of liver damage caused by schistosome infection. There was no apparent difference in the incidence of common clinical symptoms. Furthermore, no significant difference was observed in the ultrasound findings, implying that the GAP and FTP groups shared a similar degree of liver lesion. With the exception of the abnormal rates of aspartate aminotransferase (AST), alkaline phosphatase (ALP), and hyaluronic acid (HA), the other serological indicators were comparable between the groups. Overall, the FTP is not a better option for controlling advanced schistosomiasis in China. It is important to reveal the precise mechanism underlying the pathogenesis of advanced schistosomiasis so that specific approaches to treating and preventing the development of advanced schistosomiasis can be developed and schistosomiasis can be eliminated in China.

An integrated environmental improvement of marshlands: impact on control and elimination of schistosomiasis in marshland regions along the Yangtze River, China.

BACKGROUND: Schistosomiasis is a global snail-transmitted infectious disease of poverty. Transmission control had been achieved in China in 2015 after the control efforts for over 60 years. Currently, the remaining core regions endemic for Schistosoma japonicum are mainly located in the marshland and lake regions along the Yangtze River basin. METHODS: During the period from 2001 through 2015, an integrated environmental improvement of the marshlands was carried out through the implementation of industrial, agricultural and resources development projects in Yizheng County along the Yangtze River. S. japonicum infection in humans, livestock and snails was estimated by serology, stool examination, hatching technique and microscopy during the 15-year study period to evaluate the effect of the integrated environmental improvement on control and elimination of schistosomiasis. RESULTS: A 0.05% overall rate of S. japonicum infection was observed in snails during the 15-year study period, and no infected snails were detected since 2012. The overall prevalence of S. japonicum infection was 0.09% in humans during the study period, and no human infection was found since 2012. In addition, only 13 bovines were identified with S. japonicum infection in 2003 during the 15-year study period, and since 2004, no infection was found in livestock. CONCLUSION: The results of the present study demonstrate that the implementation of industrial, agricultural and water resources development projects, not only alters snail habitats in marshland regions, and promotes local economic development, which appears a win-to-win strategy to block the transmission of S. japonicum and accelerate socio-economic development along the Yangtze River.

Assessment of the effect of treatment and assistance program on advanced patients with schistosomiasis japonica in China from 2009 to 2014.

Schistosomiasis is one of the most important zoonoses, threatening approximately 800 million people in 78 countries with a loss of 70 million disability-adjusted life years. Over the past six decades, China has made remarkable achievements in morbidity control, but disability and mortality control remains much to desire; thus, advanced schistosomiasis is a growing problem when on the road to schistosomiasis elimination. Since 2005, China has initiated a national treatment and assistance program to advanced patients, aiming to improve patients' symptoms and quality of life. Here, we conducted a two-phase study to evaluate the program's implementation and effect on advanced patients from 2009 to 2014 in Jiangxi Province, China. A total of 6425 advanced schistosomiasis cases were included in this study. For those having been treated and assisted (90.7 %), the cure or improvement rate was over 99.9 %, with 668 (11.5 %) cases having reached clinical cure and 5152 (88.4 %) cases' condition having improved, which can be partially reflected in the significant decline of the proportion of hepatomegaly (splenomegaly), the degree of liver fibrosis, ascites-related indicators (abdominal girth and frequency of shifting dullness), and portal hypertension-related indices (inner diameter of portal vein and frequency of subcutaneous varicose vein of abdominal wall). Besides, it was estimated to have saved 2004 years of life lost at total. Therefore, the government should continue support and increase input of treatment and assistance program so that this project can reach more patients, leading to consolidation of achievements of schistosomiasis control and contribution to schistosomiasis elimination.

Assessment of the diagnostic efficacy of enolase as an indication of active infection of Schistosoma japonicum.

Schistosomiasis is a common zoonoses affecting humans. The atypical clinical symptoms, low morbidity, and low degree of infection impede diagnosis and assessment of epidemics. Detecting circulating antigens from adult worms in patients' body fluids should be diagnostically superior to examining eggs in feces. Herein, the excretory-secretory proteins of adult worms were analyzed by using 2-D protein electrophoresis and mass spectrometry. The Schistosoma japonicum enolase (Sj enolase) was identified as the most abundant excretory-secretory antigen. Purified recombinant Sj enolase was prepared, and specific monoclonal and polyclonal antibodies were raised against it. A sandwich enzyme-linked immunoassay (sandwich ELISA) was established that used the monoclonal antibody as a capture antibody and the polyclonal antibody as a detection antibody. The linear detection range was 0.7-1000 ng/ml (minimum 700 pg/ml). Sj enolase could be detected in the sera of infected rabbits and disappeared rapidly postpraziquantel treatment. The sensitivity and specificity of this sandwich ELISA to detect field serum samples of schistosomiasis were 84.61 and 95.83 %, respectively. The cross-reaction rates for clonorchiasis and paragonimiasis were 3.33 and 5 %, respectively. This ELISA assay was used to test 45 matching sera of schistosomiasis patients before treatment and at 3, 6, 9, and 12 months posttreatment. Among the sera, 88.89 % were positive before treatment. At 3, 6, 9, and 12 months postpraziquantel treatment, 93.33, 97.78, 100, and 100 % tested negative, respectively. Therefore, Sj enolase can be used to indicate active Schistosoma infection, and detecting serum Sj enolase is important for diagnosis and evaluating treatment effect.

[Pathology and pathogenesis of liver fibrosis induced by Schistosoma japonicum].

Schistosomiasis is a widely distributed parasitic zoonoses that threatens human' s health and social economic development. China is one of the most endemic countries in the world. Schistosoma egg are mainly lodged in the liver and intestinal tissues. There, the eggs induce a granulomatous host immune response largely characterized by lymphocytes, eosinophils, and alternatively activated macrophages. The process of granuloma formation induces chronic inflammation that leads to liver fibrosis accompanied by obvious manifestations such as hepatosplenomegaly and ascites. In this article, we review the advanced progress in research about schistosomiasis hepatic fibrosis, including the pathology of liver fibrosis, the formation and modulation of granuloma and fibrosis, the key inflammatory factors and related signaling pathways, the regulatory role of ncRNA in the process of fibrosis, and anti-fibrosis treatment and new drugs development.

Schistosomiasis in a migrating population in the lake region of China and its potential impact on control operation.

Coverage of migrating people in schistosomiasis control program is a growing concern in China. Schistosomiasis caused by Schistosoma japonicum is still one of the major infectious diseases of public health importance in China though tremendous efforts have been made to control the transmission over the past decades. Along with the rapid social-economic development, migrant population has been remarkably increasing across the country. The infected migrants may introduce a new souse of infection to endemic areas or the areas where the transmission had been controlled or interrupted but the intermediate host Oncomelania snail is still present. Preliminary studies for surveillance on schistosomiasis prevalence in migrants were reported, but there is little basic information provided. We carried out an investigation on the prevalence in immigrants, emigrants and permanent residents in three villages of Hunan province located in the main endemic area of lake region, and analyzed the potential impact of migration on control practice. In the study villages, the migrant population accounts for 53.6% of the total. Schistosoma infection was detected by modified Kato-Katz method and miracidium hatching test. Questionnaire survey was conducted comprising knowledge of disease and its transmission, water contact, personal protective measures, and whether examined and treated after water contact. The survey indicated that the migrants and permanent residents had similar life style, and the majority of them experienced water contact in agricultural work or routine life activities. However, the infection rate in immigrants was significantly higher than that in permanent residents. It was also found that the migrants had significantly less knowledge about the disease than the permanent residents, and took no personal protective measures. This is due to that the control program could not cover the migrants when they were absent at the time the program being implemented. The present study suggested that the surveillance and intervention for migrants, immigrants in particular, should be included and strengthened in schistosomiasis control program and a feasible scheme be developed.

Integrated control programmes for schistosomiasis and other helminth infections in P.R. China.

The prevalence of human schistosomiasis and soil-transmitted helminthiasis (STH) has decreased significantly in the People's Republic of China (P.R. China), particularly after 2005 when the national control programmes were reinforced by forming of integrated control strategies. Furthermore, social-economic development also contributed to the decrease of schistosome and soil-transmitted helminth infections. The prevalence of the zoonotic helminthiasis, including clonorchiasis and echinococcosis, on the other hand, is either underestimated or has in fact increased due to changes in social and environmental factors. In comparison with the control strategies in force and their effects on those four kinds of helminthiasis, the challenges and control priorities for the potential transfer from control to elimination of each disease is reviewed, to provide evidence for policy-makers to act upon.

[Assessment of schistosomiasis endemic situation in national surveillance sites in Hubei Province from 2005 to 2010].

OBJECTIVE: To assess the schistosomiasis endemic situation in the national surveillance sites in Hubei Province, so as to provide the evidence for the prevention and control of schistosomiasis. METHODS: According to the national surveillance protocol, a longitudinal surveillance of endemic situation of schistosomiasis was carried out in 16 national surveillance sites from 2005 to 2010. RESULTS: In general, the positive rates of IHA, Kato-Katz technique and infection rates of Schistosoma japonicum decreased from 15.67%, 10.93% and 1.71% in 2005 to 10.48%, 8.54% and 0.90% in 2010, and declined by 33.12%, 22.70% and 47.95%, respectively. The infection rates of S. japonicum of the male were higher than that of the female, and the peak infection rates were in the groups aged above 30 years. The endemic situation of fishermen and farmers were relatively serious. The infection rates of S. japonicum in cattle decreased from 11.69% in 2005 to 1.41% in 2010, and declined by 88.01% (χ2 = 298.79, P < 0.001). The areas with infected Oncomelania hupensis snails, the densities of living snails, the rates of infected snails and the densities of infected snails decreased by 90.88%, 61.66%, 80.00% and 92.00%, respectively. CONCLUSION: The schistosomiasis endemic situation in the national surveillance sites in Hubei Province mitigates in 6 years, but the prevention is still a very daunting task.

Serodiagnosis of Schistosoma japonicum infection: genome-wide identification of a protein marker, and assessment of its diagnostic validity in a field study in China.

BACKGROUND: Schistosomiasis remains a highly prevalent and serious parasitic disease. A major factor preventing its effective management is the scarcity of effective diagnostic tools. We did a genome-wide identification of diagnostic protein markers for schistosome infection and assessed their diagnostic validity in a field study. METHODS: We predicted putative secreted proteins of Schistosoma japonicum (SjSPs) and expressed them as glutathione S-transferase (GST)-fusion proteins. The fusion proteins were arrayed on glutathione (GSH)-immobilised microplates and screened with serum samples from patients with schistosomiasis diagnosed by the Kato-Katz method. We further assessed an identified protein marker for sensitivity and specificity, first in infected serum samples collected from Jiangxi and Hunan Provinces, China, and then through a field study, done in two villages located in a high schistosomiasis-endemic area of the southeast of China. FINDINGS: Of 204 recombinant proteins, 35 yielded seropositive reactions, eight showed strong immunoreactivity, and only one (SjSP-13) reacted to the entire panel of 14 archived samples. The reactivity of SjSP-13 to 476 serum samples showed 90·4% (95% CI 86·5-93·5) sensitivity and 98·9% (95% CI 95·9-99·9) specificity. Of 1371 residents enrolled in a field study from Dec 6, 2010, to June 23, 2011, only 74 individuals were identified as being egg-positive, whereas 465 were diagnosed as positive by the SjSP-13-based ELISA kit (rSP13-ELISA). Of the 394 individuals found egg-negative but rSP13-ELISA-positive, 363 (92·4%) were confirmed to be positive for schistosome infection by PCR detection of S japonicum SjR2 retrotransposon. INTERPRETATION: The application of this sensitive, specific, and affordable rSP13-ELISA method should help reduce schistosomiasis transmission through targeted treatment of individuals, particularly with low intensity infections, and therefore support schistosomiasis control and elimination strategies. FUNDING: National 973 project in China.

Impact and cost-effectiveness of a comprehensive Schistosomiasis japonica control program in the Poyang Lake region of China.

Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003-2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%-544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%-1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.