Eco-social determinants of Schistosoma japonicum infection supported by multi-level modelling in Eryuan county, People's Republic of China

Involvement of SIRT1 in amelioration of schistosomiasis-induced hepatic fibrosis by genistein

Previous study revealed that genistein alleviate the extent of hepatic fibrosis in schistosomiasis-infected mice, however, the potential mechanism is still incomplete. Present study was, therefore, carried out to investigate the underlying mechanism of ameliorating schistosomiasis-induced hepatic fibrosis by genistein. α-smooth muscle actin (α-SMA) expression, as a critical fibrotic marker, was markedly upregulated in Schistosoma japonicum (S. japonicum) egg-induced liver fibrosis, and gradually inhibited by genistein administration in infected mice. Contrary to the changes of α-SMA expression, hepatic SIRT1 expression and activity was greatly inhibited in mice upon S. japonicum infection, and the repression was reversed in liver tissues after receiving 25 mg/kg genistein. 50 mg/kg genistein treatment gave rise to the higher SIRT1 expression and activity than that of the control group. In hepatic stellate cells (HSCs), genistein (5, 10, 20 μM) treatment resulted in the increases of SIRT1 expression and activity in concentration-dependent manner. Moreover, to mimic the fibrogenesis in vivo, macrophage was treated with soluble egg antigen (SEA) to obtain macrophage-conditioned medium (MφCM), which was used to stimulate HSCs. Intriguingly, SIRT1 overexpression decreased fibrosis associated gene expression in HSCs exposed to MφCM or not. Additionally, MφCM gave rise to high levels of α-SMA and p-Smad3 and the increments were reversed upon genistein treatment in HSCs. Furthermore, EX527, SIRT1 specific inhibitor, abrogated the inhibitory effects of genistein on HSCs activation. Together, the results support the notion that the strong elevation of SIRT1 expression and activity may represent a potential mechanism of protection against schistosomiasis-induced hepatic fibrosis by genistein.

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.

Emergence of zoonoses such as COVID-19 reveals the need for health sciences to embrace an explicit eco-social conceptual framework of health and disease

An accurate understanding of why zoonoses such as SARS-CoV-2 are emerging at an increased rate, is vital to prevent future pandemics from the approximately 700,000 viruses with zoonotic potential. Certain authors have argued that the consumption of wildlife, or human contact with bats was responsible for the emergence of SARS-CoV-2. Others argue that a range of anthropogenic environmental degradations have played a vital role in the emergence of SARS-CoV-2 and other zoonoses. In this opinion piece, I argue that these divergent viewpoints stem, in part, from different foundational conceptual frameworks - biomedical individualist and eco-social frameworks, respectively. Based on the fact that the eco-social framework provides a more complete account of the different types of causal factors underpinning the emergence of zoonoses, I propose that the COVID-19 pandemic provides an additional reason for the health sciences to ground its theory of health and disease in an eco-social conceptual framework.

Epidemiological big data and analytical tools applied in the control programmes on parasitic diseases in China: NIPD's sustained contributions in 70 years

The analysis of epidemiological data has played an important role for the academic research carried out by the National Institute of Parasitic Diseases, China CDC, since its foundation in 1950s. Those researches, e.g., the temporal-spatial patterns of disease transmission and the identification of risk factors, have contributed significantly to the national parasitic disease control and elimination programmes in China. With the development and application of epidemiological data analysis in the last decade, all research results improve our understanding of parasitic diseases epidemiology and related health issues through the application platform of epidemiological big data and analytical tools. In particular, implementation research on analytical predictions on disease outbreak or epidemic risks have provided references to the scientific guidance on effective preventions and interventions in the parasitic disease elimination in China, such as fliariasis, malaria and schistosomiasis. This review has reflected the function of data accumulation and application of temporospatial tools in parasitic diseases control, and the ways of the NIPD's sustained contributions to the disease control programmes in China.

Collaborative RNAS+ research: Priorities and outcomes

Over the past 20 years, RNAS⁺ has been generating research results from highly collaborative projects meant to promote and advance understanding in various aspects of schistosomiasis. Epidemiological studies in endemic countries like the Philippines, the People's Republic of China (PR China), the Lao People's Democratic Republic (Lao PDR) and Cambodia clarified the role of reservoir hosts in transmission and the use of spatio-temporal methods such as remote sensing and geographical information systems (GIS) in surveillance of schistosomiasis. Morbidity studies proposed factors that might influence development of fibrosis, anaemia and malnutrition in schistosomiasis. Immune responses in schistosomiasis continue to be an interesting focus in research to explain possible development of resistance with age. Results of evaluation of candidate vaccine molecules are also presented. New diagnostics are continually being developed in response to the call for more sensitive and field applicable techniques that will be used for surveillance in areas nearing elimination of the disease. Several studies presented here show the insufficiency of mass drug administration (MDA) with praziquantel in eliminating the disease. Emphasis is given to an integrated control approach that can be accomplished through intensive and extensive intersectoral collaboration.

From country control programmes to translational research

From the time it was conceptualized in 1998 to the present, RNAS⁺ has largely concentrated on research that will generate results to facilitate control, prevention and elimination of its target diseases. Diagnostics has remained an active field of research in order to develop tools that are appropriate for each stage from the first efforts until attempts to block transmission. For example, with regard to schistosomiasis, chemotherapy has excellent impact on morbidity, while better diagnostics and vaccine research have been promoted to complement the other components of the control programme. The need for surveillance in areas where the prevalence has been brought down to very low levels necessitated development of spatio-temporal tools and ecological models based on geographical information systems (GIS) to produce risk and distribution maps for monitoring and evaluation of programme success. New knowledge and experiences in management of the diseases contribute to the formulation of new schemes in management and treatment. Ways of drawing attention to the disease, such as determining disability weights for use in computation of burden of disease, updating epidemiological profile and unravelling new aspects of the disease provide bases for modifying the operation of control programmes as we move forward. Programme evaluation based on reports of actual implementation of activities brought to the fore problems related to the distribution of chemotherapy as well as social, cultural and behavioural aspects of endemic communities. Importantly, this highlighted the necessity of adapting control activities to specific situations of the endemic areas. New models evolving from reviews of this kind and success stories, such us the elimination of lymphatic filariasis (LF) in PR China and Cambodia are presented.

The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis

BACKGROUND

Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry.

METHODS AND FINDINGS

We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review's end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review's inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high.

CONCLUSIONS

This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions.

The influence of natural factors on the spatio-temporal distribution of Oncomelania hupensis

BACKGROUND

We analyzed the influence of natural factors, such as temperature, rainfall, vegetation and hydrology, on the spatio-temporal distribution of Oncomelania hupensis and explored the leading factors influencing these parameters. The results will provide reference methods and theoretical a basis for the schistosomiasis control.

METHODS

GIS (Geographic Information System) spatial display and analysis were used to describe the spatio-temporal distribution of Oncomelania hupensis in the study area (Dongting Lake in Hunan Province) from 2004 to 2011. Correlation analysis was used to detect the natural factors associated with the spatio-temporal distribution of O. hupensis. Spatial regression analysis was used to quantitatively analyze the effects of related natural factors on the spatio-temporal distribution of snails and explore the dominant factors influencing this parameter.

RESULTS

(1) Overall, the spatio-temporal distribution of O. hupensis was governed by the comprehensive effects of natural factors. In the study area, the average density of living snails showed a downward trend, with the exception of a slight rebound in 2009. The density of living snails showed significant spatial clustering, and the degree of aggregation was initially weak but enhanced later. Regions with high snail density and towns with an HH distribution pattern were mostly distributed in the plain areas in the northwestern and inlet and outlet of the lake. (2) There were space-time differences in the influence of natural factors on the spatio-temporal distribution of O. hupensis. Temporally, the comprehensive influence of natural factors on snail distribution increased first and then decreased. Natural factors played an important role in snail distribution in 2005, 2006, 2010 and 2011. Spatially, it decreased from the northeast to the southwest. Snail distributions in more than 20 towns located along the Yuanshui River and on the west side of the Lishui River were less affected by natural factors, whereas relatively larger in areas around the outlet of the lake (Chenglingji) were more affected. (3) The effects of natural factors on the spatio-temporal distribution of O. hupensis were spatio-temporally heterogeneous. Rainfall, land surface temperature, NDVI, and distance from water sources all played an important role in the spatio-temporal distribution of O. hupensis. In addition, due to the effects of the local geographical environment, the direction of the influences the average annual rainfall, land surface temperature, and NDVI had on the spatio-temporal distribution of O. hupensis were all spatio-temporally heterogeneous, and both the distance from water sources and the history of snail distribution always had positive effects on the distribution O. hupensis, but the direction of the influence was spatio-temporally heterogeneous. (4) Of all the natural factors, the leading factors influencing the spatio-temporal distribution of O. hupensis were rainfall and vegetation (NDVI), and the primary factor alternated between these two. The leading role of rainfall decreased year by year, while that of vegetation (NDVI) increased from 2004 to 2011.

CONCLUSIONS

The spatio-temporal distribution of O. hupensis was significantly influenced by natural factors, and the influences were heterogeneous across space and time. Additionally, the variation in the spatial-temporal distribution of O. hupensis was mainly affected by rainfall and vegetation.

Natural and human induced factors influencing the abundance of Schistosoma host snails in Zambia

Schistosomiasis remains a global public health problem affecting about 240 million people. In Zambia, 2 million are infected while 3 million live with the risk of getting infected. Research and interventions relating to schistosomiasis are mainly linked to disease epidemiology. Malacological and ecological aspects of the disease are superficially understood. Developing effective control measures requires an understanding of interacting environmental and socioeconomic factors of host snails vis-a-vis schistosomiasis. Therefore, the present work involved collecting social and environmental data in a large field study in two zones in Zambia that are different in terms of temperature and rainfall amounts. Social data collected through questionnaires included demographic, educational and knowledge of schistosomiasis disease dynamics. Environmental data included physicochemical factors, aquatic plants and snails. Gender (P < 0.001) significantly influences livelihood strategies, while age (P = 0.069) and level of education (P = 0.086) have a moderate influence in zone I. In zone III, none of these factors (age, P = 0.378; gender, P = 0.311; education, P = 0.553) play a significant role. Environmental parameters explained 43 and 41 % variation in species composition for zones I and III, respectively. Most respondents' (52 %, 87 %) perception is that there are more cases of bilharzia in hot season than in other seasons (rainy season 23 %, 7 %; cold season 8 %, 0 % and year round 17 %, 6 %) for zone I and zone III, respectively.

Reaching the Surveillance-Response Stage of Schistosomiasis Control in The People's Republic of China: A Modelling Approach

With the goal set to eliminate schistosomiasis nationwide by 2020, The People's Republic of China has initiated the surveillance-response stage to identify remaining sources of infection and potential pockets from where the disease could reemerge. Shifting the focus from classical monitoring and evaluation to rapid detection and immediate response, this approach requires modelling to bridge the surveillance and response components. We review here studies relevant to schistosomiasis modelling in a Chinese surveillance-response system with the expectation to achieve a practically useful understanding of the current situation and potential future study directions. We also present useful experience that could tentatively be applied in other endemic regions in the world. Modelling is discussed at length as it plays an essential role, both with regard to the intermediate snail host and in the definitive, mammal hosts. Research gaps with respect to snail infection, animal hosts and sectoral research cooperation are identified and examined against the prevailing background of ecosystem and socioeconomic changes with a focus on coexisting challenges and opportunities in a situation with increasing financial constraints.

An investigation into the potential effects of infrapopulation structure and other sources of sampling error, on population genetic studies of the transmission of Schistosoma japonicum (Trematoda: Digenea)

Background

Schistosoma japonicum remains a major challenge to human and animal health. Earlier microsatellite-based studies reported possible definitive-host-specific private alleles within S. japonicum, opening the possibility that different definitive hosts might harbour different parasite strains. Previous investigations have also detected near-identical multilocus genotypes in populations of adult worms - possibly the result of mutations occurring during the asexual (intramolluscan) phase of clonal expansion. Research has also revealed extensive deviations from Hardy-Weinberg Proportions (HWP) and conflicting results among studies. The present study was performed to examine some of the potential effects of infrapopulation structure on microsatellite-based studies of the transmission ecology of S. japonicum. Potential sources of bias considered included organotropic distribution of worms, non-random mating and corrections for clonal expansion.

Results

Stool samples from naturally infected hosts were used to infect snails in the laboratory and thereby expose mice. 274 individual worms were typed at seven microsatellite loci. Removal of individuals bearing duplicate MLGs (as a correction for presumed clonal expansion) had an impact on both HWP and organotropic genetic differentiation. The study found no evidence that heterozygote deficiencies were caused by a Wahlund effect. Female-male pairings appeared to be random and there was no evidence for mate choice by heterozygosity. There was some indication that excess heterozygosity, induced by clonal expansion, can offset heterozygote deficiencies caused by small population size or populations fragmented by parasite control efforts.

Conclusions

The view is supported that miracidia are preferable to adult worms in investigations into host-specific parasite lineages. Where adults must be used, extreme care should be taken with regard to sampling if infrapopulations of small animals are compared with those of larger animals; this is because of organotropic patterns in genetic variation and the tendency to sample from different organs in differently sized hosts. As corrections for clones may accentuate signals of population subdivision, corrections should only be made if tests for clonal expansion prove positive. Finally, evidence for heterozygote deficiency caused by small sample size, calls for carefully designed random and comprehensive sampling strategies for S. japonicum in China, where control efforts have greatly fragmented parasite populations.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-016-1454-0) contains supplementary material, which is available to authorized users.

Progress in research, control and elimination of helminth infections in Asia

Global health has substantially improved over the past 20 years. In low- and middle-income countries, in particular, great strives have been made in the control of communicable diseases, including helminth infections. Nevertheless, the most marginalised communities still suffer from infectious diseases that are intimately connected with poverty and lack of access to essential commodities and services, such as clean water, improved sanitation and sufficient food. A two-pronged approach is thus necessary: (i) intensifying control in remaining high-endemicity areas and pockets of high transmission; and (ii) moving from morbidity control to interruption of disease transmission in low-endemicity areas with the goal of local elimination. The latter will require new tools and strategies, going hand-in-hand with strong partnerships and new strategic alliances. In this special issue of Acta Tropica, 35 articles are featured that, together, provide an up-to-date overview of the latest progress made in research, control and elimination of helminth infections in East and Southeast Asia. The first 12 articles expound tools and approaches for improved detection, surveillance and monitoring of helminth infections. Control and elimination approaches for the most important helminth infections are revisited in the next 20 articles. The three remaining articles are cross-cutting pieces examining the interface of agriculture, environment and helminth infections and providing a rationale for integrated, multi-sectorial control approaches that are necessary for sustaining helminthiasis control and progressively moving towards elimination. An interesting aspect revealed through an in-depth analysis of the provenance of the 35 contributions is that the People's Republic of China emerges as a key player in global health, which is documented through its prominent role in research and control of helminth infection and networking throughout Asia. Policy implications are discussed and will hopefully shape the future agenda for the control and elimination of helminth infections the world over.