Clonorchis sinensis calcium-binding protein Cs16 causes acute hepatic injury possibly by reprogramming the metabolic pathway of bone marrow-derived monocytes.

Introduction: Clonorchis sinensis infection results in various complications in the liver and biliary systems and is a neglected tropical disease in Eastern Asia. In this study, we report that C. sinensis calcium-binding protein Cs16 activates host immune cells and induces immunopathology in liver. Methods: Immunohistochemistry was used to detect the localization of Cs16 in C. sinensis adult worms. ELISA was used to detect the serum levels of anti-Cs16 IgG antibody in infected humans and mice. Bile duct injection model was used to figure out the role of Cs16 in vivo. RT-qPCR and ELISA were used to detect the cytokine production from Cs16-treated BMMs in vitro. Seahorse assay was used to detect the metabolic pathway of Cs16-treated BMMs in vitro. Result: Cs16 localizes in the tegument and gut of C. sinensis. Humans and mice with C. sinensis infection exhibited increased levels of anti-Cs16-specific antibody. Using the bile duct injection technique, we found that Cs16 induced obvious inflammation and hepatic necrosis in vivo. Cs16 treatment caused the upregulation of inflammatory cytokines in innate immune cells. Moreover, Cs16-treated monocytes relied more on the glycolytic metabolic pathway. Discussion: Our findings suggest that Cs16 is a potential pathogenic factor derived from C. sinensis adult worm. By reprogramming the metabolic pathway of innate immune cells, Cs16 triggers pro-inflammatory responses in the liver, and therefore, Cs16 is a potential target for the prevention and treatment of clonorchiasis.

Soil-transmitted helminthiasis in mainland China from 2016 to 2020: a population-based study.

Background: Soil-transmitted helminthiasis is epidemic in China and many other countries of the world, and has caused substantial burdens to human health. We conducted successive national monitoring in China from 2016 to 2020 to analyze the prevalence, changing trends, and factors influencing soil-transmitted helminthiasis, which provided a reference for future control strategies. Methods: Soil-transmitted helminth monitoring was carried out in 31 provinces (autonomous regions or municipalities, herein after referred to as "provinces") throughout China. Each province determined the number and location of monitoring sites (counties), and a unified sampling method was employed. At least 1,000 subjects were investigated in each monitoring county. Stool samples were collected and the modified Kato-Katz thick smear method was employed for stool examination. Infection data and the details of factors influencing soil-transmitted helminthiasis from 2016 to 2020 were collected from national monitoring sites. Additional influencing factors such as environment, climate and human activities were obtained from authoritative websites. Prevalence of soil-transmitted helminths was presented by species, province, sex, and age group. ArcGIS software was used to conduct spatial autocorrelation and hotspot analysis on the infection data. A Poisson distribution model and SaTScan software were used to analyze the infection data with retrospective spatiotemporal scan statistics. A database was built by matching village-level infection rate data with influencing factors. Subsequently, machine learning methods, including a Linear Regression (LR), a Random Forest (RF), a Gradient Boosted Machine (GBM), and an Extreme gradient boosting (XGBOOST) model was applied to construct a model to analyze the main influencing factors of soil-transmitted helminthiasis. Findings: The infection rates of soil-transmitted helminths at national monitoring sites from 2016 to 2020 were 2.46% (6,456/262,380), 1.78% (5,293/297,078), 1.29% (4,200/326,207), 1.40% (5,959/424,766), and 0.84% (3,485/415,672), respectively. The infection rate of soil-transmitted helminths in 2020 decreased by 65.85% compared to that in 2016. From 2016 to 2020, the infection rate of soil-transmitted helminthiasis was relatively high in southern and southwestern China, including Hainan, Yunnan, Sichuan, Guizhou, and Chongqing. In general, the infection rate was higher in females than in males, with the highest rate in the population aged 60 years and above, and the lowest in children aged 0-6 years. Global autocorrelation and hotspot analyses revealed spatial aggregation in both the national and local distribution of soil-transmitted helminthiasis in China from 2016 to 2020. The hotspots were concentrated in southwestern China. The spatiotemporal scanning analysis revealed aggregation years from 2016 to 2017 located in southwestern China, including Yunnan, Sichuan, Chongqing, Guizhou and Guangxi. The RF model was the best fit model for the infection rate of soil-transmitted helminths in China. The top six influencing factors of this disease in the model were landform, barefoot farming, isothermality, temperature seasonality, year, and the coverage of sanitary toilets. Interpretation: The overall infection rate of soil-transmitted helminths in China showed a decreasing trend from 2016-2020 due to the implementation of control measures and the economic boom in China. However, there are still areas with high infection rates and the distribution of such areas exhibit spatiotemporal aggregation. As a strategic next step, control measures should be adjusted to local conditions based on the main influencing factors and the prevalence of different sites to aid in the control and elimination of soil-transmitted helminthiasis. Funding: This research was funded by the National Key Research and Development Program of China (Grant Nos. 2021YFC2300800 and 2021YFC2300804) and the National Natural Science Foundation of China (Grant No. 32161143036).

Prediction of cardiovascular adverse events in newly diagnosed multiple myeloma: Development and validation of a risk score prognostic model.

Background: Multiple myeloma (MM) is the second most common hematological malignancy, and the treatments markedly elevate the survival rate of the patients in recent years. However, the prevalence of cardiovascular adverse events (CVAEs) in MM had been increasing recently. CVAEs in MM patients are an important problem that we should focus on. Clinical tools for prognostication and risk-stratification are needed. Patients and methods: This is a retrospective study that included patients who were newly diagnosed with multiple myeloma (NDMM) in Shanghai Changzheng Hospital and Affiliated Jinhua Hospital, Zhejiang University School of Medicine from June 2018 to July 2020. A total of 253 patients from two medical centers were divided into training cohort and validation cohort randomly. Univariable analysis of the baseline factors was performed using CVAEs endpoints. Multivariable analysis identified three factors for a prognostic model that was validated in internal validation cohorts. Results: Factors independently associated with CVAEs in NDMM were as follows: age>61 years old, high level of baseline office blood pressure, and left ventricular hypertrophy (LVH). Age contributed 2 points, and the other two factors contributed 1 point to a prognostic model. The model distinguished the patients into three groups: 3-4 points, high risk; 2 points, intermediate risk; 0-1 point, low risk. These groups had significant difference in CVAEs during follow-up days in both training cohort (p<0.0001) and validation cohort (p=0.0018). In addition, the model had good calibration. The C-indexes for the prediction of overall survival of CVAEs in the training and validation cohorts were 0.73 (95% CI, 0.67-0.79) and 0.66 (95% CI, 0.51-0.81), respectively. The areas under the receiver operating characteristic curve (AUROCs) of the 1-year CVAEs probability in the training and validation cohorts were 0.738 and 0.673, respectively. The AUROCs of the 2-year CVAE probability in the training and validation cohorts were 0.722 and 0.742, respectively. The decision-curve analysis indicated that the prediction model provided greater net benefit than the default strategies of providing assessment or not providing assessment for all patients. Conclusion: A prognostic risk prediction model for predicting CVAEs risk of NDMM patients was developed and internally validated. Patients at increased risk of CVAEs can be identified at treatment initiation and be more focused on cardiovascular protection in the treatment plan.

Sensitivity and reusability of a simple microbial fuel cell-based sensor for detecting bisphenol A in wastewater.

Polycarbonate plastic processing wastewater contains high concentrations of bisphenol A (BPA), requiring a real-time technology to monitor wastewater containing BPA. Since the activity of electrogenic microorganisms on the anode surface of the microbial fuel cell (MFC) sensor is inhibited by exposure to contaminants, the toxicity of contaminants in wastewater can be determined by observing the variation in voltage output from the MFC sensor. The simple MFC sensor that is developed in this work exhibited a significant decrease in voltage output in BPA-containing wastewater concentration of 5-100 mg/L. Sensitivity analysis revealed that the voltage change (ΔV) was strongly correlated with the BPA concentration, with R2 as high as 0.97. This study was the first to investigate the number of repeated uses of the MFC sensor, using sodium acetate as the regeneration solution for the MFC sensor, leading to a successful recovery of detection performance. However, as the number of uses increased (up to the third or fourth use), the ΔV of the MFC sensor for BPA gradually decreased and the sensitivity decreased significantly from 0.238 mV/mg/L to 0.027 mV/mg/L. In the low BPA concentration range (≦20 mg/L), the MFC sensor can be reused up to 5 times, demonstrating that the proposed MFC sensor can be reused. Microorganisms contribute to the power generation of the MFC sensor, which can be exploited in the detection of pollutants, enabling the determination of wastewater toxicity and providing early warnings of thereof. Conventional MFC sensors are complex and lack the ability to explore repeated use, so they are not easily applied to actual wastewater detection. The proposed MFC sensor has many advantages such as simplicity, rapid detection, and reusability, solving the problem of the high cost of using disposable MFC sensors and making them feasible for practical use.

National surveillance of hookworm disease in China: A population study.

BACKGROUND: Hookworm disease is endemic in China and is widespread globally. The disease burden to humans is great. METHODS: The study described the national surveillance of hookworm implemented in 31 provinces/autonomous regions/municipalities (P/A/Ms) of China in 2019. Each P/A/M determined the number and location of surveillance spots (counties). A unified sampling method was employed, and at least 1000 subjects were investigated in each surveillance spot. The modified Kato-Katz thick smear method was employed for stool examination. Fifty samples positive with hookworm eggs were cultured in each surveillance spot to discriminate species between A. duodenale and N. americanus. Twenty-five soil samples were collected from each surveillance spot and examined for hookworm larva. The 2019 surveillance results were analyzed and compared with that of 2016-2018. RESULTS: A total of 424766 subjects were investigated in 31 P/A/Ms of China in 2019, and the overall hookworm infection rate was 0.85% (3580/424766). The weighted infection and standard infection rates were 0.66% (4288357/648063870) and 0.67% (4343844/648063870), respectively. Sichuan province had the highest standard infection rate (4.75%) in 2019, followed by Chongqing (2.54%) and Hainan (2.44%). The standard infection rates of other P/A/Ms were all below 1%, with no hookworm detected in 15 P/A/Ms. The standard hookworm infection rate in the males and the females were 0.61% (2021216/330728900) and 0.71% (2267141/317334970), respectively, with a significant difference between different genders ([Formula: see text] = 17.23, P<0.0001). The highest standard hookworm infection rate (1.97%) was among age ≥ 60 years, followed by 45~59 years (0.77%), 15~44 years (0.37%), and 7~14 years (0.20%). The lowest standard infection rate was among the 0~6 years age group (0.12%). A significant difference was observed among different age groups ([Formula: see text] = 2 305.17, P<0.0001). The constitute ratio for N. americanus, A. duodenale, and coinfection was 78.70% (1341/1704), 2.03% (346/1704), and 1.00% (17/1704), respectively. The detection rate of hookworm larva from soil was 3.45% (71/2056). CONCLUSION: The national surveillance showed that the hookworm infection rate has been decreasing annually from 2016 to 2019, and it is now below 1%. China has made significant progress in controlling hookworm. The national surveillance system is an important way to understand the endemic status and provide important information in this process and thus needs to be continually optimized.

Soil-transmitted helminthiasis in China: A national survey in 2014-2015.

BACKGROUND: Based on two national surveys, the prevalence of soil-transmitted helminthiasis (STH) in China had decreased from 53.58% in 1988-1992 to 19.56% in 2001-2004. To update the epidemiology and characteristics of STH in China, a third national survey was implemented in 2014-2015. METHODOLOGY/PRINCIPAL FINDINGS: This survey covered rural areas in 31 provinces in mainland of China. Multiple-stage stratified cluster sampling was employed, which included three levels (provinces, ecozones and economical levels). Stool samples were collected and the Kato-Katz method was applied for helminth eggs detection. Samples with hookworm eggs were selected and hatched to differentiate the species based on larval morphology. Between June 2014 and May 2015, a total of 484,210 participants from 604 counties were enrolled. The weighted prevalence of STH overall was 4.49% (95% confidential interval (CI): 2.45%-6.53%), including 2.62% (95% CI: 0.86%-4.38%) hookworm infections, 1.36% (95% CI: 0.49%-2.23%) ascariasis, and 1.02% (95% CI: 0.15%-1.89%) trichuriasis. The estimated population infected was 29.12 million (95% CI: 15.88 million-42.32 million) for all STH; 16.97 million (95% CI: 5.57 million-28.39 million) for hookworm infections; 8.83 million (95% CI: 3.18 million-14.45 million) for ascariasis; and 6.60 million (95% CI: 0.97 million-12.25 million) for trichuriasis. Overall, the prevalence of ascariasis and trichuriasis was relatively high in children, while hookworm infections were more common in the older population, especially those over 60. STH was highly prevalent in western China, and moderately in central areas, but low in eastern and northern regions. Out of 3,579 hookworm cases with species differentiation, 479 cases (13.38%) were infected with only Ancylostoma spp., 2,808 cases (78.46%) with only Necator americanus, and another 292 cases (8.16%) with both species. CONCLUSIONS/SIGNIFICANCE: This survey demonstrated the continuous decrease of STH in rural China. However, endemicity still prevails in the western areas of the country. Hookworm, especially N. americanus, is becoming the predominant species. Older farmers in western China should be prioritized for control due to the high prevalence of hookworm.

Engagement of the National Institute of Parasitic Diseases in control of soil-transmitted helminthiasis in China.

Soil-transmitted helminthiases (STHs) have been widely transmitted in China and the control of STHs was initiated by NIPD-CTDR since its foundation. Three national surveys on STHs have been carried out in China, and the infection rate has dropped from 53.58% in the first national survey (1988-92) to 4.49% in the third national survey (2014-16) due to strong interventions including mass drug administration, health education and environment improvement. National surveillance of STHs started in 2006 and has been implemented successively until now, which allows to understand the endemic status and trends of STHs prevalence in China. Surveillance has been expanded to 30 provinces of China since 2016. Integrated pilot programmes have been implemented between 2006 and 2009, in which an integrated strategy, with health education and control of infection sources as key components, was adopted. Since 2019, new control pilots have been started, which will be continued for five successive years to further explore appropriate control strategies in the current "new era". With the decline of infection rate of STHs, China is approaching the elimination stage for STHs. In order to achieve this final target, poverty alleviation programmes should be integrated with precise control measures, according to real situations.

From awareness to action: NIPD's engagement in the control of food-borne clonorchiasis.

Clonorchiasis is caused by ingestion of raw freshwater fish containing infective larvae of Clonorchis sinensis. China harbours the largest number of people with C. sinensis infection. During the past three decades, the National Institute of Parasitic Diseases, affiliated to the Chinese Center for Disease Control and Prevention (NIPD) conducted many studies to facilitate the control on clonorchiasis. Three national surveys have shown the updated epidemiology of clonorchiasis in China. Recently, a national surveillance system has also been established, which will enable the production of high-resolution map. The evaluation of the disease burden has enhanced the awareness on clonorchiasis. Diverse diagnosis techniques including rapid screening by questionnaire, serological tests, faecal examination and a molecular method have been developed or evaluated. The NIPD also participated in the early evaluation of praziquantel against clonorchiasis, which enhanced its application in China. Also, the NIPD has verified the efficacy of tribendimidine against clonorchiasis. A new sustainable strategy is also being explored. However, more research is expected to further facilitate control of clonorchiasis in China, as well as international cooperation in fighting human liver fluke infections in Asia.

Effectiveness of health education in improving knowledge, practice and belief related to clonorchiasis in children.

Clonorchiasis is caused by the ingestion of raw freshwater fish containing Clonorchis sinensis larvae. Health education is crucial in sustainable control of clonorchiasis but extremely challenging when dealing with adults. To investigate if education in children would be a beneficial long-term approach, a cluster-controlled trial was implemented in two primary schools between 2017 and 2019 in Binyang county, Guangxi, China. A baseline survey was conducted in both schools, and then comprehensive education activities were implemented in the interventional one. Six and 12 months later, all pupils were subjected to a survey to assess the potential change of knowledge, practice and belief related to clonorchiasis. Finally, 247 pupils in interventional school and 151 ones in control were eligible for analysis. In the interventional school, the percentage of pupils with knowledge on transmission route, early symptoms, complications and carcinogenicity increased from 15.0% to 78.5% (p < 0.001), from 6.5% to 36.8% (p < 0.001), from 4.0% to 93.9% (p < 0.001) and from 4.5% to 49.4% (p < 0.001) after 12 months. In this school, 16 pupils (6.5%) had eaten raw freshwater fish during the year immediately before the baseline survey, a number that decreased to 3 (1.2%) (p = 0.002) 12 months later. The percentage of students had the belief on the ability not to eat raw freshwater fish in the future was 70.9% at the baseline and 97.2% 12 months later (p < 0.001). Although knowledge related to clonorchiasis also increased in the control school, the absolute percentage of changes was lower; in particular, practice and belief had not changed.

National surveillance on soil-transmitted helminthiasis in the People's Republic of China.

Soil-transmitted helminths (STHs) are widely distributed and remain a public health problem in the People's Republic of China. Altogether, 301 counties across 30 regions were investigated during the national surveillance on STHs carried out in 2016 based on the modified Kato-Katz thick smear method to examine faecal samples. A total of 305 081 people were investigated with 7 366 (2.4%) found to be infected. The infection rates were the following: hookworm 1.4%, Ascaris lumbricoides 0.8% and Trichuris trichiura 0.5%. Having established that the STHs infection rate is relatively low, it is time to move towards elimination. The national surveillance system is essential for providing basic data and formulation of useful control strategies towards achieving this goal.

Surveillance of clonorchiasis in China in 2016.

Clonorchiasis is an important food-borne parasitic disease in China, and infection with C. sinensis can cause hepatobiliary diseases. Comprehensive and systematic prevention and control of clonorchiasis requires the establishment of an effective surveillance. A total of 301 surveillance points were set up in 30 provinces across China in 2016, and 1000 people were selected by cluster sampling at each surveillance point annually for C. sinensis infection screening using Kato-Katz thick smear method. C. sinensis infection was detected in 6226 people following screening of 305081 people at the 301 surveillance points in 2016. Infection rate was 2.04%; with C. sinensis infection detected in 70 counties spread across 15 provinces, 89.37% of the infected people were distributed in Jilin, Heilongjiang, Guangdong and Guangxi provinces. Highest infection rate was observed in Da'an city, Jilin Province (49%). The national infection rate in male and female was 2.70% and 1.40% respectively. Infection rate between male and female was significantly different (P <0.01). Disease prevalence increases with age in both male and female, reaches peak in age group 40-49. Result obtained indicate that major C. sinensis endemic areas are distributed in the north and south of China, and areas with high prevalence are distributed along the river system at county level. Result, also, shows that middle-aged men are at high-risk of infection. These results suggest that surveillance activities should be sustained nationwide and highlight the need for an integrated approach to control C. sinensis transmission in regions with high disease prevalence in China.

Assessment of health education products aimed at controlling and preventing helminthiases in China.

BACKGROUND: Helminthiases have placed a huge burden of disease on the population in China. However, widespread control activities have led to significant achievements. As health education has been widely disseminated and plays an important role in the control and elimination of these diseases, we collected health education products aimed at controlling and preventing helminthiases in China. We analyzed their characteristics and assessed their quality. METHODS: Firstly, health education products aimed at controlling and preventing helminthiases were collected from a diverse range of organizations. Secondly, the expert brainstorming and Delphi methods were applied to establish an evaluation system, which was then used to assess the collected products systematically. Those deemed excellent were awarded. Characteristics - including type, source, targeted disease(s), targeted population, and languages - of the collected products and the awarded products were presented here. RESULTS: In total, 96 health education products on helminthiases were collected from 53 organizations. Most products belonged to either the graphic design (47) or daily-use (24) category. Seventy were collected from Centers for Disease Control and Prevention and 20 from institutes or control stations of parasitic diseases, primarily at the provincial and county levels. Regarding disease targets of the products, 67 focused on a single helminthiasis, 25 on multiple helminthiases, and the remaining four on non-specific diseases. Of the 67 single helminthiasis-focused products, most targeted schistosomiasis (37), followed by echinococcosis (16). The majority of products (79) targeted the general population, while 11 targeted students specifically. Regarding languages, 86 products were only in Chinese, while the other ten were in both Chinese and the minority languages of China. Out of these ten products, one targeted schistosomiasis and the other nine targeted echinococcosis. Thirty-four products were awarded. The characteristics of the awarded products were similar to those of the collected products. CONCLUSIONS: A diverse range of health education products have been designed and applied for the prevention and control of helminthiases in China. Many products have good features such as specifying the targeted diseases and populations. However, there are significant gaps in terms of both the quantity and quality of products pertaining to some of the diseases. Experiences from the awarded products could be drawn upon to design more products aimed at a range of different helminthiases.

Risk factors for Enterobius vermicularis infection in children in Gaozhou, Guangdong, China.

BACKGROUND: Enterobius vermicularis infection is a prevalent intestinal parasitic disease in children. In this study, we explored the epidemiological status and risk factors for E. vermicularis infection in children in southern China. METHODS: A cross-sectional survey was carried out in Gaozhou city, Guangdong province, China, in December 2011. Children aged 2-12 years from five schools participated in the study. The adhesive cellophane-tape perianal swab method was applied to detect E. vermicularis infection, while a questionnaire was sent to each child's guardian(s) to collect demographic and socioeconomic data, as well as hygiene behaviors, pertaining to each child. Univariate and multivariate logistic regression analyses were performed to capture the potential risk factors. RESULTS: Out of the 802 children surveyed, 440 were infected with E. vermicularis, with an average prevalence of 54.86 %, and a range from 45.96 to 68.13 %. The age variable was found to be statistically significant, whereas the sex variable was not. It was found that a mother's education level (low) and not washing hands before dinner were major risk factors in all children (802). After stratification by age, a father's education level (primary or below) and biting pencils (or toys) were significant risk factors in the younger children (508), while not washing hands before dinner and playing on the ground were important risk factors in the older children (294). CONCLUSION: This study demonstrates the prevalence of E. vermicularis infection in children in Gaozhou and reveals underlying risk factors. Most importantly, it reveals that risk factors differ among the different age groups, which indicates that different control measures targeted at particular age groups should be implemented.

[Analysis of capability of examining helminthes: National technique competition of parasitic disease diagnosis in 2013].

OBJECTIVES: To understand the ability of worm detection of staff of centers for disease control and prevention (CDC) in China, so as to promote the ability construction. METHODS: In each province, four competitors were selected from the institutions of parasitic diseases control to attend the National Technique Competition for Parasitic Disease Diagnosis and the results of competition were collected and analyzed. RESULTS: The average scores of microscopic identification and slide preparation of all the 124 competitors were 27.3 and 7.6 respectively and the scores were increased significantly (t = 3.169, 5.009, both P < 0.05) compared to those in 2012. The average detection rate of helminthes was 62.7%, and it was increased significantly (χ2 = 28.630, P < 0.05) compared to that in 2012. The scores of competitors of different genders, ages, and profession titles were significantly different (t = 1.400, 2.080, F = 2.366-3.864, all P < 0.05). The scores of competitors of provinces with the control task of parasites were higher than those without any control task (t = 6.650, 4.630, both P < 0.01). CONCLUSIONS: The competition has enhanced the ability of staff of CDCs, especially for the young staff. However, the ability of detection for soil transmitted helminth eggs should be intensified. Monitoring sites should be established in low endemic areas of parasites and provinces without the prevention and control task and the training for the professional staff should be strengthened.

An Outbreak of Human Fascioliasis gigantica in Southwest China.

Fascioliasis is a common parasitic disease in livestock in China. However, human fascioliasis is rarely reported in the country. Here we describe an outbreak of human fascioliasis in Yunnan province. We reviewed the complete clinical records of 29 patients and performed an epidemiological investigation on the general human population and animals in the outbreak locality. Our findings support an outbreak due to Fasciola gigantica with a peak in late November, 2011. The most common symptoms were remittent fever, epigastric tenderness, and hepatalgia. Eosinophilia and tunnel-like lesions in ultrasound imaging in the liver were also commonly seen. Significant improvement of patients' condition was achieved by administration of triclabendazole®. Fasciola spp. were discovered in local cattle (28.6%) and goats (26.0%). Molecular evidence showed a coexistence of F. gigantica and F. hepatica. However, all eggs seen in humans were confirmed to be F. gigantica. Herb (Houttuynia cordata) was most likely the source of infections. Our findings indicate that human fascioliasis is a neglected disease in China. The distribution of triclabendazole®, the only efficacious drug against human fascioliasis, should be promoted.

Epidemiological profile of Clonorchis sinensis infection in one community, Guangdong, People's Republic of China.

BACKGROUND: Clonorchiasis caused by ingesting improperly prepared fish ranks among the most important but still neglected food-borne parasitic diseases, especially in the People's Republic of China (P.R. China). To promote the implementation of interventions efficiently, the demonstration of an epidemiological profile of Clonorchis sinensis infection is essential in hyper-epidemic areas. METHODS: In one community with higher levels of economic development in Guangdong province, P.R. China, villagers were motivated to provide stool samples for examining helminth eggs. Then, those infected with C. sinensis completed the structured questionnaire including demographical characteristics, knowledge and behavior. RESULTS: A total of 293 villagers infected with C. sinensis participated in questionnaire investigation. Among them, 94.54% were adult and 93.17% were indigenous. The geometric mean of C. sinensis eggs per gram of feces in the children, adult females and adult males was 58, 291 and 443, respectively. The divergence between knowledge and behavior in the adults, especially the adult males, was shown. Out of 228 persons eating raw fish, 160 did it more frequently at restaurants, the proportion of which varied in different populations, showing 25.00%, 54.88% and 80.28% in the children, adult females and adult males, respectively. CONCLUSIONS: Different interventions need to be adopted in different populations. Chemotherapy should be prioritized in the adults, especially the adult males. In addition, health education targeting the children, is essential and may play a crucial role in controlling clonorchiasis in the long term. In order to successfully control clonorchiasis, intervention in the restaurant should not be overlooked in some endemic areas.

[Enterobius vermicularis infection status among children in 9 provinces/autonomous regions/municipalities of China].

OBJECTIVE: To investigate the infection status of Enterobius vermicularis among children in 9 Provinces/Autonomous regions/Municipalities (P/A/M) of China, and analyze its risk factors. METHOD: From April to December 2011, one provincial capital (prefecture-level city) and one county (city, district) were chosen as investigation spots from Guangdong, Guangxi, Hainan, Chongqing, Sichuan, Zhejiang, Fujian, Anhui and Guizhou, respectively. Children aged 2 to 12 were examined by using adhesive cellophane anal swab with round-bottom tube. Information of children's family condition, health behavior and school environment were collected by questionnairing. RESULTS: 14 964 children were examined, and 14 582 qualified questionnaires were collected. The total prevalence was 17.8% (2 659/14 964). Of the 9 P/A/M, the prevalence was highest in Hainan Province (51.1%, 869/1 701) and lowest in Anhui Province (0.8%, 13/1 589). The prevalence in urban areas (7.3%, 552/7 581) was lower than that of rural areas (28.5%, 2 107/7 383) (chi2 = 1156.73, P < 0.01). The highest prevalence in urban and rural areas was found in Haikou City(38.0%, 322/847) and Wanning City (64.1%, 547/854) of Hainan Province. The prevalence rate in males and females was 17.4% (1 410/8 128) and 18.3% (1249/6 834), respectively (chi2 = 2.192, P > 0.05). The highest prevalence in males (61.2%, 300/490) and females (67.9%, 247/364) was found in children of Wanning City. Multivariate logistic regression analysis showed that residence, education level of parents, occupation of parents, nail biting, types of classroom ground and type of boarding were the risk factors on E. vermicularis infection. CONCLUSION: The prevalence of enterobiasis in children is still high in many areas of China, and the prevention and control measures should be taken according to the risk factors.

Disability weight of Clonorchis sinensis infection: captured from community study and model simulation.

BACKGROUND: Clonorchiasis is among the most neglected tropical diseases. It is caused by ingesting raw or undercooked fish or shrimp containing the larval of Clonorchis sinensis and mainly endemic in Southeast Asia including China, Korea and Vietnam. The global estimations for population at risk and infected are 601 million and 35 million, respectively. However, it is still not listed among the Global Burden of Disease (GBD) and no disability weight is available for it. Disability weight reflects the average degree of loss of life value due to certain chronic disease condition and ranges between 0 (complete health) and 1 (death). It is crucial parameter for calculating the morbidity part of any disease burden in terms of disability-adjusted life years (DALYs). METHODOLOGY/PRINCIPAL FINDINGS: According to the probability and disability weight of single sequelae caused by C. sinensis infection, the overall disability weight could be captured through Monte Carlo simulation. The probability of single sequelae was gained from one community investigation, while the corresponding disability weight was searched from the literatures in evidence-based approach. The overall disability weights of the male and female were 0.101 and 0.050, respectively. The overall disability weights of the age group of 5-14, 15-29, 30-44, 45-59 and 60+ were 0.022, 0.052, 0.072, 0.094 and 0.118, respectively. There was some evidence showing that the disability weight and geometric mean of eggs per gram of feces (GMEPG) fitted a logarithmic equation. CONCLUSION/SIGNIFICANCE: The overall disability weights of C. sinensis infection are differential in different sex and age groups. The disability weight captured here may be referred for estimating the disease burden of C. sinensis infection.