Comparison of the miracidium hatching test and modified Kato-Katz method for detecting Schistosoma japonicum in low prevalence areas of China.

The diagnosis of Schistosoma japonicum (Sj) infection in low prevalence areas of the People's Republic of China is challenging due to the sensitivity of the detection methods, leading to an underestimation of the disease burden. We compared the sensitivities of the miracidium hatching test (MHT) with the modified Kato-Katz method (KK) and the combination of the two methods (KK-MHT) to detect Sj infection in low prevalence areas of China. The stool samples of 3,853 residents from 8 villages with a light to moderate prevalence (0-23%) of Sj infection were examined by KK, MHT and KK-MHT. The findings were inconsistent. The KK-MHT conbination gave more positives than either the KK or MHT alone. Using the KK-MHT, we determined the missed rates with the KK (mR(K)) and MHT (mR(H)) to be 30.1% and 10.2%, respectively. At light prevalence sites (infection rate < 10%) the mR(K) was 60.6%, significantly higher than the mR(K) of 22.3% found at moderate prevalence sites (10-23%). However, the mR(H) at the light and moderate prevalence sites were 11.54% and 9.90%, respectively (p > 0.05). The combination KK-MHT had the best sensitivity in low Sj prevalence areas in China and the KK method alone was the least sensitive. Using KK alone as a screening method will result in an underestimation of Sj infection disease burden.

[The impact of water level changes on the Oncomelania snail habitats in Poyang Lake regions before and after the impoundment of Three Gorges reservoir].

OBJECTIVE: To explore the impact of the impoundment of Three Gorges reservoir on Oncomelania snail habitats of Poyang Lake. METHODS: Four counties with schistosomiasis endemic around the Poyang Lake, naming as Xingzi, Duchang, Jinxian and Xinjian, were selected as study areas. The average daily water level of four major hydrological stations near the above 4 counties from 1997 to 2008 were collected, as well as the elevation of 215 marshlands with snails in those 4 counties, the data of schistosomiasis endemic situation and snail survey of 4 counties in the year before the impoundment of Three Gorges reservoir (2002) and the 6th year after the impoundment of Three Gorges reservoir (2008). The fluctuations of water levels of Poyang Lake, flooding day of marshland with snails as well as the changes of the indicators in snail survey and prevention and control measures before and after the impoundment of Three Gorges reservoir were compared. RESULTS: Before the impoundment of Three Gorges reservoir, the fluctuations of average water level of the four hydrological stations around Poyang Lake was 6.91-12.93 m; which reduced to 5.72 - 10.75 m after the impoundment. The D-value of the fluctuations of average water level was (1.06 ± 0.47) m. The date of the annual maximum water level delayed by an average of 12 d; while the date of annual minimum water level arrived an average of 12 d earlier than the impoundment of Three Gorges reservoir. The average flooding days of marshland with snails were separately (100.04 ± 42.06) d before the impoundment and (64.13 ± 22.30) d after the impoundment. The difference was statistically significant (t = 3.70, P < 0.05). The density of snails in the 4 counties around Poyang Lake was 0.8437/0.1 m(2) after the impoundment; declining by 31.04% from the snail density (1.2234/0.1 m(2)) before the impoundment. The density of infectious snails was 0.0014/0.1 m(2) after the impoundment; dropping by 67.34% from it (0.0042/0.1 m(2)) before the impoundment; the infection rate of snails was separately 0.34% after the impoundment and 0.16% before the impoundment. The difference was statistically significant (χ(2) = 53.25, P < 0.05). The coverage rate of chemotherapy increased from 4.45% (35 558/798 200) in 2002 to 9.80% (79 457/810 400) in 2008; the difference was statistically significant (χ(2) = 17 336.63, P < 0.05). The coverage rate of snail killing increased from 1.35% (389.04/28 824.66) in 2002 to 7.49% (2260.90/30 166.22) in 2008; the difference was also statistically significant (χ(2) = 28 824.66, P < 0.05). CONCLUSION: The impact of the impoundment of Three Gorges reservoir shortened the flooding days of marshland with snails and helped the prevention and control of schistosomiasis in Poyang Lake regions as the environment went against the breeding of the snails.

A strategy to control transmission of Schistosoma japonicum in China.

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

[Risk evaluation of Schistosomiasis japonica in potential endemic areas in China].

OBJECTIVE: To analyze the impact of large hydraulic projects on schistosomiasis transmission and evaluate the transmission risk in potential endemic areas. METHODS: During 2008-2010, surveillance on risk factors related to schistosomiasis transmission and risk assessment were carried out in potential endemic sites in counties of Xuyu, Hongze, Jinhu, and Gaoyou in Jiangsu Province, Weishan County in Shangdong, Qianjiang City and Yiling District of Yichang City in Hubei, Juchao District of Chaohu City in Anhui Province, Wanzhou and Kaixian in Chongqing in Three Gorges Dam region or passed by South-to-North Water Diversion Project and Zhangjiagang City in Jiangsu Province located in lower reach of Yangtze River. At least one fixed and three temporary monitoring sites were set in each county (city or district). Local inhabitants aged 6-65 years old were screened by indirect haemagglutination assay (IHA) or ELISA, and the sero-positives were tested by Kato-Katz or miracidium hatching techniques to investigate possible infection in 2008. The endemic status of schistosomiasis in mobile population was surveyed every year during 2008-2010. Infection status in livestocks was surveyed in Juchao, Qianjiang, Gaoyou and Wanzhou Counties in 2008-2010. Oncomelania hupensis distribution was investigated in risky and suspicious areas. Snail spreading investigation was conducted through salvaging floater and snails-inducing by straw curtains in rivers connected with Yangtze River. RESULTS: 8 256 local inhabitants were investigated by serological tests with a positive rate of 0.7% (60/8 256). Among the 60 serologically positive subjects, 55 individuals were examined by stool examination but none of them was egg positive. The antibody prevalence rate of migrating population in 2008-2010 was 2.0%, 1.4%, and 1.7%, respectively, with no significant difference (chi2 = 3.57, P > 0.05). Among the serologically positive subjects, egg-positive cases were found in migrating population in Juchao District each year and one case was found in Jinhu County in 2010. Oncomelania snails were only found in in Jinhu and Gaoyou without infected ones. A lot of aquatic shell-fish and snails were collected in the water floater and straw curtain without Oncomelania snails. CONCLUSION: Schistosomiasis is not endemic in the original nonendemic areas in Three Gorges Dam region and areas passed by South-to-North Water Diversion Project until now, but potential risk of transmission exists. Long term surveillance scheme on schistosomiasis should be established with varied monitoring factors in different category areas.

[The impact of water level changes on distribution of snails around lake areas reacted by thematic mapper images].

OBJECTIVE: To study the impact of water level changes on the distribution of snails around lakes, and to study the possibility of forecasting the distribution of snails according to changes of water level reacted by remote sensing images. METHODS: All information including water level information of Xingzi Hydrometric Station from 1997 to 2007, twelve TM images of Poyang Lake between 1998 and 2006 were collected. The water areas of Poyang Lake was extracted by MNDWI threshold approach, and the relationships between water areas from TM images and water level from Hydrometric Station was analyzed; Majiawan and Menqiantan marshland of Zhuxi village, Xingzi county was chosen as study pilot to set frames and investigate snails 2991 frames in 2007, and the information of snails of this pilot from 1998 to 2006 was collected to analyze the relationships between snails and water level. RESULTS: The water areas of Poyang Lake extracted from Remote Sensing images from 1998 to 2006 was 1658.73 - 5873.48 km(2), and the corresponding daily water level of Xingzi Hydrometric Station was 9.96 - 21.72 m, according to correlation analysis, they were positive correlation relationship, the correlation coefficient was 0.96 (P < 0.01), and build a model: S = 5189.96 x ln(h) - 10 284.97; the percent of frames with living snail of zhuxi pilot from 1998 - 2007 was 28.33% - 77.46%, the corresponding monthly average water level of last August was 13.19 - 21.96 m, the corresponding highest water level of last year was 15.97 - 21.96 m, according to correlation analysis. The percent of frames with living snail of zhuxi pilot was negatively correlated with the corresponding monthly average water level of last August and the corresponding highest water level of last year, and the correlation coefficient was -0.69 (P < 0.05), and -0.77 (P < 0.01) respectively. CONCLUSION: Water areas of Poyang Lake extracted from remote sensing images could well express the actual changes of water level, and the highest water level ahead of the year investigating snails influence the distribution of snails, thus we can estimate the distribution of snails around lakes by remote sensing images.

[The effect and influencing factors of schistosomiasis control by forbidding livestock denaturing on marshland with Oncomelania snails].

OBJECTIVE: To evaluate the effect of schistosomiasis control by forbidding livestock denaturing on marshland with Oncomelania snails and to analyse its influencing factors. METHODS: The village of Aiguo, Xinhe, Huangjia, Fanrong, Fengfu and Caomen and its respective nearby marshland, i.e., Aiguoniu, Liulingwei, Huangjianiu, Da, Goulian, and Litouzui, in Jinxian county, Jiangxi province were selected as the pilot areas for implementing the measures of forbidding livestock denaturing on the marshlands with Oncomelania snails during the period of the year 2005 to 2007. A total of 300 residents in each village were randomly chosen for stool examination with the Kato-Katz technique every year. The snail survey was carried out in spring and autumn every year on the marshlands close to the villages with systemic sampling method. The marshlands with a height 16.5 m above the sea level in Futian was selected for snail survey and planting with sesame. The residents aged 20 - 50 years old in Fengfu and Aiguo villages were studied by using questionnaire on the compliance of forbidding livestock pasturing on marshlands with Oncomelania snails. RESULTS: Before implementation of the measures, human infection rate with Schistosoma japonicum was 11.35% (90/793) in Aiguo, 4.00% (12/300) in Xinhe, 4.00% (6/150) in Huangjia, 8.00% (12/150) in Fanrong, 3.17% (4/126) in Fengfu and 6.64% (14/211) in Caomen. After implementation in 2008, human schistsome infection rate in the aforementioned 6 villages was declined to 0.18% (1/551), 0.00% (0/348), 0.00% (0/316), 2.27% (7/308), 1.17% (5/428) and 1.16% (5/430), respectively. Only in Fengfu village the decline of the human prevalence was not significant (χ(2) = 2.4, P = 0.12), while in the other 5 villages, human prevalence rate had been declined significantly (χ(2) = 126.77, P < 0.01; χ(2) = 16.31, P < 0.01; χ(2) = 18.79, P < 0.01; χ(2) = 10.39, P < 0.01; χ(2) = 14.17, P < 0.01, respectively). Infected snails were not found in 5 out of the 6 marshlands close to the villages. Three infected snails were founded in Da marshland because of poor environmental isolation. Before planting, the living snail density was 0.063/0.11 m(2) (34/540), and after planting, the living snail density was 0.0074/0.11 m(2) (4/538), a 88.25% reduction (Z = 12.47, P < 0.01) was recorded through economy crop planting at Futiandaan marshland in 2008. A total of 986 pieces of questionnaire were provided, and 968 valid ones were collected. The results of questionnaire indicate that compliance of forbidding livestock denaturing on marshland with Oncomelania snails in Aiguo and Fengfu villages was 84.38% (216/256) and 75.42% (537/712), respectively. Using logistic regression model, knowledge level on harmfulness of livestock denaturing on marshland with Oncomelania snails, willingness of culture with machine to substitute traditional cattle culture, and willingness of investment to marshland culture development are 3 varieties that affect residents' implementation of forbidding livestock denaturing on marshland with Oncomelania snails. CONCLUSION: The infected snail density and human schistosome infection rate were reduced on the marshlands of well environmental isolation after 2 - 3 years implementation of forbidding livestock denaturing on marshlands with Oncomelania snails. The key influencing factors of forbidding livestock denaturing on marshland with Oncomelania snails are knowledge level on harmfulness of livestock denaturing on the snail infested marshlands, the willingness of machine culture to substitute cattle culture, and the willingness of investment to marshland culture development.

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.

China's new strategy to block Schistosoma japonicum transmission: experiences and impact beyond schistosomiasis.

Despite sustained efforts for its control made over the past 50+ years, the re-emergence of schistosomiasis in China was noted around the turn of the new millennium. Consequently, a new integrated strategy was proposed to stop the contamination of schistosome eggs to the environment, which emphasizes health education, access to clean water and adequate sanitation, mechanization of agriculture and fencing of water buffaloes, along with chemotherapy. Validation of this integrated control strategy in four pilot counties in the provinces of Anhui, Hubei, Hunan and Jiangxi revealed significant reductions in the rate of Schistosoma japonicum infection in humans and intermediate host snails. Importantly, this strategy showed an impact on diseases beyond schistosomiasis, signified by concomitant reductions in the prevalence of soil-transmitted helminth infections. In view of China's new integrated strategy for transmission control of schistosomiasis showing an ancillary benefit on other helminthic diseases, we encourage others to investigate the scope and limits of integrated control of neglected tropical diseases.

[Infectious status of infection sources in the epidemic regions of Schistosomiasis japonica in China].

OBJECTIVE: To understand the infectious status of infection sources in some epidemic regions of Schistosomiasis japonica, and provide a scientific basis for further controlling infection sources in a comprehensive way. METHODS: Longshang village which lies in the area of hills and mountains and Yuye village which lies in the area of lakes and marshlands were chosen for field investigation. The study was targeted at snails and 1512 residents, while 197 samples of livestock were randomized (80 cattle, 46 pigs, 45 dogs, 18 cats, 8 sheep) and 32 wild animals (field rats) were screened in Anhui province between October to November in 2007. The infection rate and intensity of infection were calculated after pathogenic examination on the populations, livestock and wild animals (field rats). RESULTS: (1) The infection rate of snails in Longshang and Yuye village were 2.26%, 1.06% in 2007, and 0.55%, 0.72% in 2006 respectively. (2) Of the infection rate and geometric mean of egg per gram (EPG) of population, 3.8% and 0.14 (EPG) were in Longshang village and 3.4% and 0.13 (EPG) were in Yuye village. The positive rate of blood examination of the different sex in Longshang village was 17.5% (44/252) of the males, higher than that of the females 11.0% (25/227) (chi(2) = 4.026, P = 0.045), whereas, in Yuye village was 21.4% (66/309) of males and 19.4% (25/129) for the females, without significant differences (chi(2) = 0.217, P > 0.05). The positive rate of fecal examination of the different sex in Longshang village was 5.2% (14/268) of the men and 2.1% (5/236) of the women showing no statistical significance (chi(2) = 3.336, P > 0.05); whereas, in Yuye village was 5.7% (14/245) of the men and 1.2% (3/250) of the women (chi(2) = 7.603, P = 0.006). (3) The infection rate and the arithmetic mean of EPG of the cattle, 10.8% (8/74) and 135.00 (EPG) were in Longshang village, meanwhile, the infection rate of the bull was 9.1% (6/66) and 25.0% (2/8) for cow without statistical significance (chi(2) = 0.586, P = 0.444), whereas, the total number of cattle was 6 that had been examined and there was no positive case in Yuye village. Of 8 sheep examined in Yuye village, 6 was positive, with arithmetic mean of 254.82 (EPG), while there was no sheep in Longshang village. (4) Of the positive rate of the incubation for dog's feces and intensity of infection, 55.6% (24/36) and 20.00 (EPG) were in Yuye village whereas 23.81% (5/21) and 1.21 (EPG) were in Longshang village. (5) Of the infection rate of the field rats, 13.64% (3/22) in Longshang village whereas a total number of mouse was 10 that had been examined and there was no positive case in Yuye village. CONCLUSION: The farm cattle should be still the chief sources of infection in the regions of lakes and marshlands for schistosomiasis. Whereas, with the implementing in-depth of the strategy on controlling source of infection in a integrated way, high priorities should be given to the epidemiological factors of the animals such as sheep, dogs, field mouse and so on which are spreading schistosomiasis.

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

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

[Impact of climate warming on schistosomiasis transmission and application of relative research techniques].

Oncomelania hupensis is the intermediate host of Schistosoma japonicum, and its distribution is consistent with that of schistosomiasis. Temperature is an essential environmental factor for the survival of snails. Therefore, it is important to study the impact of climate warming on snail-breeding and schistosomiasis transmission. This paper reviews the importance of climate warming to snail breeding and the spreading of the disease, and the application of relative research techniques.

Efficacy of China-made praziquantel for treatment of Schistosomiasis haematobium in Africa: A randomized controlled trial.

BACKGROUND: In the roadmap on the neglected tropical diseases (NTD) the World Health Organization (WHO) aims at attaining at least 75% coverage of preventive chemotherapy in pre-school and school-age children by 2020. A randomized controlled trial was used to compare the effectiveness of praziquantel in treating Schistosoma haematobium in Africa using two different sources for the drug, Merck Limited Partnership (KgaA), Germany and Nanjing Pharmaceutical Factory (NPF), China. METHODS: More than 6,000 participants testing positive for S. haematobium infection were enrolled from three villages (shehias) situated in the northern, middle and southern part of Pemba Island, Zanzibar. Applying criteria of inclusion and exclusion, resulted in a study population of 152 people (84 males, 68 females). A randomized controlled trial was conducted assigning participants to either praziquantel from NPF or Merck KGaA. After one month, the cure rate of S. haematobium and adverse events were compared to evaluate effectiveness. The ratio of male to female, the ratio of light/high infection intensity, and the average value of age were calculated between the two drug manufacturers. Chi-squared test and T-test were used for consistency analysis. RESULTS: Out of the total of 73 cases receiving praziquantel from NPF, the cure rate achieved was 97.3% (73/75), while the 74 cases receiving the drug from Merck KgaA reached a similar cure rate (96.1% or 74/77). There was no significant difference between the two outcomes (χ2 = 0.003, P = 0.956). Among the 75 patients treat, only one (a 16-years old female student), who had received the drug made in China had slight adverse reactions manifested as dizziness, headache and abdominal pain. CONCLUSION: The efficacy of China-made praziquantel does not differ significantly from praziquantel made by Merck KGaA in Germany. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03133832.

The epidemiological status of schistosomiasis in P. R. China after the World Bank Loan Project, 2002-2017.

World Bank Loan Project (WBLP) for schistosomiasis control conducted from 1992 to 2001, resulted in significant reduction of schistosomiasis morbidity and mortality in People's Republic of China (P.R. China), with implementation of morbidity control. Thereafter, an integrated control strategy, which targeted blocking disease transmission from reservoir hosts to the environment, was initiated in order to conquer schistosomiasis rebound after WBLP completion. Data obtained from the national schistosomiasis control reporting systems was collected and analyzed. The number of confirmed cases and infected cattle decreased significantly from 2002 to 2017, while no infected snails were found by dissection for four consecutive years. However, lake and marshland regions and some parts areas of Yunnan Province require attention for rigorous schistosomiasis control efforts. There is need to strengthen precise interventions and sensitive surveillance to achieve schistosomiasis elimination in P.R. China.

Field Testing Integrated Interventions for Schistosomiasis Elimination in the People's Republic of China: Outcomes of a Multifactorial Cluster-Randomized Controlled Trial.

Despite significant progress, China faces the challenge of re-emerging schistosomiasis transmission in currently controlled areas due, in part, to the presence of a range of animal reservoirs, notably water buffalo and cattle, which can harbor Schistosoma japonicum infections. Environmental, ecological and social-demographic changes in China, shown to affect the distribution of oncomelanid snails, can also impact future schistosomiasis transmission. In light of their importance in the S. japonicum, lifecycle, vaccination has been proposed as a means to reduce the excretion of egg from cattle and buffalo, thereby interrupting transmission from these reservoir hosts to snails. A DNA-based vaccine (SjCTPI) our team developed showed encouraging efficacy against S. japonicum in Chinese water buffaloes. Here we report the results of a double-blind cluster randomized trial aimed at determining the impact of a combination of the SjCTPI bovine vaccine (given as a prime-boost regimen), human mass chemotherapy and snail control on the transmission of S. japonicum in 12 selected administrative villages around the Dongting Lake in Hunan province. The trial confirmed human praziquantel treatment is an effective intervention at the population level. Further, mollusciciding had an indirect ~50% efficacy in reducing human infection rates. Serology showed that the SjCTPI vaccine produced an effective antibody response in vaccinated bovines, resulting in a negative correlation with bovine egg counts observed at all post-vaccination time points. Despite these encouraging outcomes, the effect of the vaccine in preventing human infection was inconclusive. This was likely due to activities undertaken by the China National Schistosomiasis Control Program, notably the treatment, sacrifice or removal of bovines from trial villages, over which we had no control; as a result, the trial design was compromised, reducing power and contaminating outcome measures. This highlights the difficulties in undertaking field trials of this nature and magnitude, particularly over a long period, and emphasizes the importance of mathematical modeling in predicting the potential impact of control intervention measures. A transmission blocking vaccine targeting bovines for the prevention of S. japonicum with the required protective efficacy would be invaluable in tandem with other preventive intervention measures if the goal of eliminating schistosomiasis from China is to become a reality.

Epidemiology of schistosomiasis in the People's Republic of China, 2004.

Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People's Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6-65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

[Impact of people's social behavior on schistosomiasis transmission in the Three Gorges Reservoir area].

OBJECTIVE: To investigate the changes in natural ecology and social environment after the construction of the dam in the Three Gorges Reservoir area, and to understand the social behavior status and education backgrounds of the local residents, and to analyze the potential impact of these factors on schistosomiasis spreading. METHODS: Data of nature and social economy after the construction of the dam in the Three Gorge area were collected, and a cross-sectional study with questionnaire survey on information including social demographic characteristics, people's production and life style, knowledge about schistosomiasis was conducted among natives, emigrations. RESULTS: After the construction of the dam, as the stream became slower, the water-level fluctuating zone on the bank of the reservoir was formed. The main source of drinking water and daily life activity are mainly depends on the river supplying (accounting about 68.7% and 75.8%, respectively); due to the needs of farming, washing cloths and vegetables, 45.6% of resident had a close contact with river water. People with away-from-home employment among emigrations were increased from 5.7% to 18.7%. The proportion of using hygienic lavatory was 88.6%. The main source of water for drinking and daily life among emigrations was tap water (85.4% and 87.0%). The residents had no awareness about the health hazard for schistosomiasis, with less health information CONCLUSION: The natural environment of reservoir areas and the life style are risk factors for the spread of schistosomiasis. The improved sanitation condition and the economy construction after the construction of the dam is propitious to keeping away from the introduction of schistosomiasis. However, people with away-from-home employment among emigrations are still at risk of schistosomiasis.

[A study of environmental changes on new snail habitat though multi-temporal relative radiometric normalized TM images].

OBJECTIVE: To study the environmental changes of new snail habitual by using multi-temporal relative radiometric normalized TM images taken in Wuzhoutou of Nanchang, Jiangxi province. METHODS: TM images of Poyang Lake were collected on 3rd April 1998, 16th April 2000 and 5th May 2004. Taking images in 2004 as a reference, the TM images in 1998 and 2000 were radiometric normalized. The images were analyzed to trace the vegetation background and snail historical information. RESULTS: The vegetation coverage rate of Wuzhaoutou on April 3rd in 1998 was 4.76%, but the vegetation coverage rates of Wuzhoutou on April 16th in 2000 and May 5th in 2004 were above 80%; the NDVI values of Wuzhoutou on April 3rd in 1998 were around -0.4 to 0.2, but the NDVI values of Wuzhoutou on April 16th in 2000 and May 5th in 2004 were mainly around 0.2 to 0.6, which had statistical difference with that in 1998 (q = 162.285321, P < 0.01 and q = 161.669725, P < 0.01). The greenness of three images have statistical differences(q = 178.679245, P < 0.01; q = 130.320755, P < 0.01 and q = - 48.358491, P < 0.01). CONCLUSION: Combining with the snail survey, the TM images could be an effective measure for setting up models to forecast the areas where snails might live to control the Schistosomiasis epidemic.

[Application of globe geographical positioning with wireless communication monitoring and supervision system in field survey on the endemic of schistosomiasis].

OBJECTIVE: To evaluate the practical value and the advantages of globe geographical positioning with wireless communication monitoring and supervision system in the field survey. METHODS: Spots which were randomly sampled by the National Ministry of Health for the investigation were chosen in the endemic areas for schistosomiasis in Jiangsu, Jiangxi, Anhui, Hunan, Hubei, Sichuan and Yunnan provinces. Portable GPS CEC9680 was used for collecting relevant waypoints and track, recording on-the-spot geographical positions. The positioning data package was sent back synchronously in the form of short message of SMS to the monitoring service center, and the moving routes of the terminal receiver monitored were displayed on the GIS map to achieve real-time supervision and staff scheduling. RESULTS: With globe geographical positioning with wireless communication monitoring and supervision system, accurate positioning of 12 spots in the provinces of Jiangsu and 3 trial spots for schistosomiasis control with comprehensive treatment designated by the State Council has been established with real-time communicating recording, and monitoring systems. CONCLUSION: The globe geographical positioning with wireless communication monitoring and supervision system has provided a technical platform for the survey of schistosomiasis and other infectious diseases.

[Effects of land surface temperature on supervising the existing area of snails].

OBJECTIVE: To discuss the land surface temperature's effect on supervising the areas with snails, comparing the land surface temperature (LST) of the areas with snails with the LST of those without snails. METHODS: Choosing the lake areas of farmland in Jiangxi Province and the beach in the bank of Ganjiang, dividing into four areas according to snails. Picking up the normalized difference vegetation index (NDVI) and LST from the remote sensing data to find the difference between the areas with snails and the areas without snails, so as to illuminate the effects of the LST on distinguishing the areas with snails. RESULTS: The NDVI of Dongfeng Wei (an area from farmland to lake) was 0 - 0.20, the NDVI of the areas with snails was 0.20 - 0.40. The NDVI of four areas is different (chi(2) = 104.69, P < 0.01). The LST of Dongfeng wei was 24 - 30 degrees C, Wuzhoutou without snails is 23 - 28 degrees C, Wuzhoutou with snails is 22 - 26 degrees C, Changjiangzhou was 20 - 24 degrees C. The LST of four areas is different (chi(2) = 115.23, P < 0.01). The analysis farther indicates the NDVI of areas without snails was lower than that of areas with snails, but the LST was higher. CONCLUSION: The NDVI and (or) the LST should be significantly different between the areas with snails and the areas without, it might be concluded that the LST should be a indication to some extent on judging whether some areas may be fit for snails.