Epidemiological Features and Control Progress of Schistosomiasis in Waterway-Network Region in The People's Republic of China

The Efficiency of Commercial Immunodiagnostic Assays for the Field Detection of Schistosoma japonicum Human Infections: A Meta-Analysis

Although great strides have been achieved, schistosomiasis japonica remains a major public health concern in China. Immunodiagnostics have been widely accepted as the first choice in large-scale screening of Schistosoma japonicum human infections, and indirect hemagglutination test (IHA), enzyme-linked immunosorbent assay (ELISA), and dipstick dye immunoassay (DDIA) are currently the three most common immunological tests for the diagnosis of S. japonicum human infections in China. This meta-analysis aimed to comprehensively assess the performance of IHA, ELISA, and DDIA for the field diagnosis of S. japonicum human infections. A total of 37 eligible publications were enrolled in the final analysis, including 29 Chinese publications and 8 English publications. No significant heterogeneities were detected among the studies reporting ELISA (I2 = 88%, p < 0.05), IHA (I2 = 95%, p < 0.05), or DDIA (I2 = 84%, p < 0.05). DDIA showed the highest pooled sensitivity (90.8%, 95% CI: 84.6% to 94.7%) and IHA presented the highest pooled specificity for detection of S. japonicum human infections (71.6%, 95% CI: 65.9% to 76.7%). Summary receiver operating characteristic (SROC) curve analysis showed that IHA exhibited the highest area under the SROC curve (AUC) (0.88, 95% CI: 0.85 to 0.9), and ELISA presented the lowest AUC (0.85, 95% CI: 0.82 to 0.88). Deeks’ funnel plots indicated no publication bias. IHA presented the highest sensitivity in medium-endemicity regions and the highest specificity for diagnosis of S. japonicum human infections in low-endemicity regions, and ELISA showed the highest diagnostic sensitivity in high-endemicity regions and the highest specificity in medium-endemicity regions, while DDIA exhibited the highest diagnostic sensitivity in high-endemicity regions and the highest specificity in low-endemicity regions. IHA and DDIA presented a higher efficiency for the diagnosis of S. japonicum human infections in marshland and lake regions than in hilly and mountainous regions, while ELISA showed a comparable diagnostic sensitivity between in marshland and lake regions and hilly and mountainous regions (88.3% vs. 88.6%), and a higher specificity in marshland and lake regions than in hilly and mountainous regions (60% vs. 48%). Our meta-analysis demonstrates a comparable diagnostic accuracy of IHA, ELISA, and DDIA for S. japonicum human infections, and the diagnostic sensitivity and specificity of IHA, ELISA, and DDIA vary in types and infection prevalence of endemic regions. DDIA combined with IHA is recommended as a tool for screening chemotherapy targets and seroepidemiological surveys during the stage moving towards schistosomiasis elimination in China. Further studies to examine the effectiveness of combinations of two or three immunological tests for diagnosis of S. japonicum human infections are warranted.

Assessment of China's contributions to the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses: a questionnaire survey

Background

The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS⁺) was established in 1998, which has developed close partnerships with Asian countries endemic for schistosomiasis and other helminthiasis in Asia. RNAS⁺ has provided an ideal regional platform for policy-makers, practitioners and researchers on the prevention, control and research of parasitic diseases in Asian countries. China, one of the initiating countries, has provided significant technical and financial support to the regional network. However, its roles and contributions have not been explored so far. The purpose of this study was to assess China's contributions on the supporting of RNAS⁺ development.

Methods

An assessment research framework was developed to evaluate China’s contributions to RNAS⁺ in four aspects, including capacity building, funding support, coordination, and cooperation. An anonymous web-based questionnaire was designed to acquire respondents’ basic information, and information on China’s contributions, challenges and recommendations for RNAS⁺development. Each participant scored from 0 to 10 to assess China’s contribution: “0” represents no contribution, and “10” represents 100% contribution. Participants who included their e-mail address in the 2017–2019 RNAS⁺ annual workshops were invited to participate in the assessment.

Results

Of 71 participants enrolled, 41 responded to the survey. 37 (37/41, 90.24%) of them were from RNAS⁺ member countries, while the other 4 (4/41, 9.76%) were international observers. Most of the respondents (38/41, 92.68%) were familiar with RNAS⁺. Respondents reported that China’s contributions mainly focused on improving capacity building, providing funding support, coordination responsibility, and joint application of cooperation programs on RNAS⁺ development. The average scores of China’s contributions in the above four fields were 8.92, 8.64, 8.75, and 8.67, respectively, with an overall assessment score of 8.81 (10 for a maximum score). The challenge of RNAS⁺ included the lack of sustainable funding, skills, etc. and most participants expressed their continual need of China’s support.

Conclusions

This survey showed that China has played an important role in the development of RNAS⁺ since its establishment. This network-type organization for disease control and research can yet be regarded as a great potential pattern for China to enhance regional cooperation. These findings can be used to promote future cooperation between China and other RNAS⁺ member countries.

The Potential Distribution Prediction of Oncomelania hupensis Based on Newly Emerging and Reemergent Habitats - China, 2015-2019

What is already known about this topic?

Oncomelania hupensis (O. hupensis) is the only intermediate host of Schistosoma japonica. The distribution of O. hupensis is affected by a series of climate, geographical, sand ocioeconomic factors, which reflect the risk areas of schistosomiasis.

What is added by this report?

There were certain geographical aggregations in the potential high distribution areas of O. hupensis, which were mainly distributed in Poyang Lake area, Dongting Lake area, and the middle and the lower reaches of the Yangtze River.

What are the implications for public health practice?

Monitoring and forecasting the distribution of O. hupensis is conducive to improving the early warning capabilities of the potential risk of schistosomiasis transmission and progressively promoting the elimination of schistosomiasis nationwide.

Comparative analysis of transcriptional profiles of Schistosoma japonicum adult worms derived from primary-infected and re-infected water buffaloes

BACKGROUND

Schistosoma japonicum (S. japonicum) is an important zoonotic parasite that is prevalent in China and parts of Southeast Asia. Water buffaloes are an important reservoir and the main transmission sources of S. japonicum. However, self-curing and resistance to re-infection have been observed in water buffaloes.

RESULTS

In this study, we compared the morphometry and differences in transcriptional expression of adult S. japonicum worms recovered from primary-infected and re-infected water buffaloes using Illumina RNA-sequencing (RNA-Seq) technology. Results of morphometry analysis revealed that adult S. japonicum worms recovered from re-infected water buffaloes were runtish with smaller organs. The ventral length of male worms was shorter in re-infected buffaloes (328 ± 13 vs 273 ± 8 µm, P < 0.05), and in female worms the oral sucker length (44 ± 3 vs 33 ± 5 µm, P < 0.05), ovary length (578 ± 23 vs 297 ± 27 µm, P < 0.05) and width (150 ± 8 vs 104 ± 9 µm, P < 0.05) were shorter, with fewer eggs in the uteri (41 ± 2 vs 12 ± 1, P < 0.05). Of 13,605 identified genes, 112 were differentially expressed, including 51 upregulated and 61 downregulated genes, in worms from re-infected compared with primary-infected water buffaloes. Gene ontology (GO) enrichment analysis revealed that GO terms such as "oxidation-reduction process", "calcium-dependent phospholipid binding", "lipid binding" and "calcium ion binding" were significantly enriched in downregulated genes, whereas GO terms related to metabolism and biosynthesis were significantly enriched in upregulated genes. The results revealed that the downregulation of some important genes might contribute to a reduction in worm numbers and maldevelopment of surviving worms in re-infected water buffaloes. Furthermore, upregulation of genes related to metabolic processes and biosynthesis might be a compensatory mechanism of worms in disadvantageous environments.

CONCLUSIONS

To our knowledge, our results present the first large-scale transcriptional expression study identifying the differences between adult S. japonicum worms from primary-infected and re-infected water buffaloes, and particularly emphasize differential expression that may affect the survival and growth of worms in re-infected water buffalo. This will provide new insight into screening for anti-schistosome targets and vaccine candidates.

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.

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

BACKGROUND

The prevalence of schistosomiasis remains a key public health issue in China. Jiangling County in Hubei Province is a typical lake and marshland endemic area. The pattern analysis of schistosomiasis prevalence in Jiangling County is of significant importance for promoting schistosomiasis surveillance and control in the similar endemic areas.

METHODS

The dataset was constructed based on the annual schistosomiasis surveillance as well the socio-economic data in Jiangling County covering the years from 2009 to 2013. A village clustering method modified from the K-mean algorithm was used to identify different types of endemic villages. For these identified village clusters, a matrix-based predictive model was developed by means of exploring the one-step backward temporal correlation inference algorithm aiming to estimate the predicative correlations of schistosomiasis prevalence among different years. Field sampling of faeces from domestic animals, as an indicator of potential schistosomiasis prevalence, was carried out and the results were used to validate the results of proposed models and methods.

RESULTS

The prevalence of schistosomiasis in Jiangling County declined year by year. The total of 198 endemic villages in Jiangling County can be divided into four clusters with reference to the 5 years' occurrences of schistosomiasis in human, cattle and snail populations. For each identified village cluster, a predictive matrix was generated to characterize the relationships of schistosomiasis prevalence with the historic infection level as well as their associated impact factors. Furthermore, the results of sampling faeces from the front field agreed with the results of the identified clusters of endemic villages.

CONCLUSION

The results of village clusters and the predictive matrix can be regard as the basis to conduct targeted measures for schistosomiasis surveillance and control. Furthermore, the proposed models and methods can be modified to investigate the schistosomiasis prevalence in other regions as well as be used for investigating other parasitic diseases.

Approaches being used in the national schistosomiasis elimination programme in China: a review

Schistosomiasis japonica, caused by the human blood fluke Schistosoma japonicum, remains a major public health problem in China, although great success has been achieved. The control efforts during the past half-decade, notably the wide implementation of the new integrated strategy with emphasis on control of the source of S. japonicum infection across the country since 2004, has greatly reduced S. japonicum in humans, livestock, and intermediate host Oncomelania hupensis snails, and transmission control of schistosomiasis was achieved in China in 2015. A two-stage roadmap was therefore proposed for schistosomiasis elimination in 2015, with aims to achieve transmission interruption by 2020 and achieve disease elimination by 2025 in the country. During the last two decades, a variety of approaches, which target the epidemiological factors of schistosomiasis japonica have been developed, in order to block the transmission cycle of the parasite. These approaches have been employed in the national or local schistosomiasis control activities, and facilitated, at least in part, the progress of the schistosomiasis elimination programs. Here, we present an approach to control the source of S. japonicum infection, three new tools for snail control, three approaches for detecting and monitoring S. japonicum infection, and a novel model for health education. These approaches are considered to play a great role in the stage moving towards transmission interruption and elimination of schistosomiasis in China.

Policy Support and Resources Mobilization for the National Schistosomiasis Control Programme in The People's Republic of China

Schistosomiasis remains a public health problem in many developing countries around the world. After the founding of The People's Republic of China, from 1949 till date, all levels of government, from central to local, have been attaching great importance to schistosomiasis control in The People's Republic of China. With considerable policy support and resources mobilization, the national schistosomiasis control programmes have been implemented during the past 65years. Here, we summarize the successful experience of schistosomiasis control during the process. Recommendations for the future management of the Chinese national schistosomiasis elimination programme are put forward after considering the remaining challenges, shortcomings and lessons learnt from 65years of schistosomiasis control drives in The People's Republic of China. They will help to sustain past achievements, foster the attainment of the ultimate goal of schistosomiasis elimination for the country and provide reference for schistosomiasis control programme in other countries.

Epidemiological Features and Effectiveness of Schistosomiasis Control Programme in Lake and Marshland Region in The People's Republic of China

Schistosomiasis is one of neglected tropical diseases in the world. The People's Republic of China has made great achievements in schistosomiasis control through integrated interventions. Although the morbidity and mortality have been reduced to the lowest level in all three endemic regions, namely lake and marshland regions, hilly and mountainous regions and plains with waterway networks regions, the endemic status in lake and marshland region is still that of implementing the interventions in the higher endemicity areas towards elimination of schistosomiasis transmission. This review explores and analyses the endemic characteristics, control measures and its effectiveness in the course of schistosomiasis control programme, in order to provide more theoretical information and experiences for development of appropriate strategies leading to schistosomiasis elimination in the next stage in the country.

Biology and Control of Snail Intermediate Host of Schistosoma japonicum in The People's Republic of China

Schistosomiasis caused by Schistosoma japonicum is a severe parasitic disease in The People's Republic of China and imposed considerable burden on human and domestic animal health and socioeconomic development. The significant achievement in schistosomiasis control has been made in last 60years. Oncomelania hupensis as the only intermediate host of S. japonicum plays a key role in disease transmission. The habitat complexity of the snails challenges to effective control. In this review we share the experiences in control and research of O. hupensis.

The Establishment and Function of Schistosomiasis Surveillance System Towards Elimination in The People's Republic of China

Schistosoma japonicum is the main schistosome species in The People's Republic of China, causing intestinal schistosomiasis, a debilitating disease of public health importance. The People's Republic of China used to be heavily endemic with schistosomiasis, but great progress has been made through the vigorous efforts of the national control programmes in the last six decades. Presently, efforts are geared towards eliminating schistosomiasis from The People's Republic of China by the end of 2025 through effective schistosomiasis surveillance, an important component in the drive towards schistosomiasis elimination. Therefore, this article explicitly outlines the development and progress made in schistosomiasis surveillance since 1990 with a special focus on the new surveillance system in use. Although the surveillance system has steadily improved over the years, it is faced with many challenges. Hence, more efforts are needed to establish an effective and sensitive evaluation system for the national schistosomiasis elimination programme in The People's Republic of China.

Towards the Elimination of Schistosomiasis japonica through Control of the Disease in Domestic Animals in The People's Republic of China: A Tale of over 60Years

Schistosomiasis japonica, an endemic, zoonotic tropical parasitic disease caused by Schistosoma japonicum, remains an important public health concern in The People's Republic of China. Unlike other species of Schistosoma, over 40 species of wild and domestic animals can act as reservoir hosts of S. japonicum, which increases the difficulty for the control of this tropical disease. It is widely recognized that domestic animals, particularly water buffaloes and cattle, play an important role in the transmission of S. japonicum. Hence, since the 1950s when The People's Republic of China commenced fight against the disease, the control of animal schistosomiasis has been carried out almost synchronously with that of human schistosomiasis, such that great strides have been made over the past six decades. In this chapter, we review the history and current status of schistosomiasis control in domestic animals in The People's Republic of China. We thoroughly analyse the prevalence of domestic animal schistosomiasis at different stages of schistosomiasis control and the role of different species of domestic animals in transmission of the disease, summarize the control strategies and assess their effectiveness. Furthermore, the challenges ahead are discussed and recommendations for future direction are provided.