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Gan T, Liu Y, Bambrick H, Zhou M, Hu W. Liver Cancer Mortality Disparities at a Fine Scale Among Subpopulations in China: Nationwide Analysis of Spatial and Temporal Trends. JMIR Public Health Surveill 2024; 10:e54967. [PMID: 39118559 DOI: 10.2196/54967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 08/10/2024] Open
Abstract
Background China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. Objective The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. Methods Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. Results In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period. Conclusions Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.
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Affiliation(s)
- Ting Gan
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hilary Bambrick
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Huang SY, Chen JD, Zeng QS, Lai YS. High-resolution mapping of age- and gender-specific risk of Clonorchis sinensis infection risk in Guangdong, China: a geostatistical modeling study. Parasit Vectors 2024; 17:67. [PMID: 38365792 PMCID: PMC10873974 DOI: 10.1186/s13071-024-06166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND The latest national survey on the distribution of human parasites in China demonstrated that Guangdong was among the endemic provinces with the highest Clonorchis sinensis infection rates. High-resolution, age- and gender-specific risk maps of the temporal and spatial distributions are essential for the targeted control work. METHODS Disease data on the prevalence of C. sinensis infection from 1990 onwards, either age- and gender-specific or aggregated across age and gender, were collected through systematic review and four large-scale surveys in Guangdong Province. Environmental and socioeconomic variables were obtained from open-access databases and employed as potential predictors. A Bayesian geostatistical model was developed to estimate the C. sinensis infection risk at high spatial resolution. RESULTS The final dataset included 606 surveys at 463 unique locations for C. sinensis infection. Our findings suggested that following an initial increase and stabilization, the overall population-adjusted prevalence had declined to 2.2% (95% Bayesian credible interval: 1.7-3.0%) in the period of 2015 onwards. From 2015 onwards, moderate and high infection risks were found in the northern regions (e.g. Heyuan and Shaoguan cities) and the southern Pearl River Delta (e.g. Foshan, Zhongshan, Zhuhai and Jiangmen cities), respectively. Age- and gender-specific risk maps revealed that males had a higher infection risk than females, and the infection risk was higher in adults compared to children. CONCLUSIONS Our high-resolution risk maps of C. sinensis infection in Guangdong Province identified the spatial, temporal, age and gender heterogeneities, which can provide useful information assisting tailored control strategies.
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Affiliation(s)
- Si-Yue Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jing-Diao Chen
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People's Republic of China
| | - Qing-Sheng Zeng
- Xinhui District Center for Disease Control and Prevention, Jiangmen, Guangdong Province, People's Republic of China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
- Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
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Lin Y, Zheng L, Fang K, Zheng Y, Wu J, Zheng M. Proportion of liver cancer cases and deaths attributable to potentially modifiable risk factors in China. Int J Epidemiol 2023; 52:1805-1814. [PMID: 37431632 DOI: 10.1093/ije/dyad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Understanding the differences in the burden of liver cancer due to different risk factors across provinces is critical to informing and improving liver cancer prevention and control. In this study, we estimated the population attributable fractions (PAFs) of liver cancer in all 31 provinces of China in 2016. METHODS Prevalence estimates of risk factors were derived from representative surveys. We used pooled relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses. We calculated PAFs using multiple formulas which included exposure prevalence and relative risk data stratified by sex, age and province, and then combined and created overall PAFs by sex, risk factors and risk factor groups. RESULTS Approximately 252 046 liver cancer cases {69.5% [95% confidence interval (CI) 52.6, 76.5]} and 212 704 deaths [67.7% (95% CI 50.9, 74.6)] were attributable to modifiable risk factors in China in 2016. The overall PAF for liver cancer was approximately 1.5 times higher in men than in women, with the top three risk factors in men being hepatitis B virus (HBV), smoking and alcohol drinking, whereas in women, they were HBV, excess body weight and hepatitis C virus (HCV). Among the risk factor groups, infectious agents had the highest PAF, followed by behavioural factors and metabolic factors. CONCLUSIONS The PAF for liver cancer caused by modifiable risk factors varies widely among provinces and socioeconomic and geographical regions in China. The use of tailored primary prevention strategies across provinces and socioeconomic and geographical regions has great potential to reduce the burden and disparities of liver cancer.
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Affiliation(s)
- Yushi Lin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Luyan Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kailu Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of General Practice, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Liu K, Tan J, Xiao L, Pan RT, Yao XY, Shi FY, Li SZ, Li LH. Spatio-temporal disparities of Clonorchis sinensis infection in animal hosts in China: a systematic review and meta-analysis. Infect Dis Poverty 2023; 12:97. [PMID: 37845775 PMCID: PMC10580589 DOI: 10.1186/s40249-023-01146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Clonorchis sinensis, one of the most important food-borne zoonotic trematodes, remains prevalent in China. Understanding its infection status in animals is crucial for controlling human clonorchiasis. Here we conducted a systematic review and meta-analysis to focus on the spatio-temporal disparities of C. sinensis infection in animals in China. METHODS Data on C. sinensis prevalence in snails, the second intermediate hosts, or animal reservoirs in China were extracted from electronic databases including PubMed, Embase, Web of Science, Chinese Wanfang database, CNKI, VIP, and China Biomedical Literature database. A random-effects meta-analysis model was utilized to estimate the pooled prevalence in each of the above animal hosts. Subgroup analysis and multivariable meta-regression were performed to explore potential sources of heterogeneity across studies and compare the temporal disparity of infection rates between high and low epidemic areas. Scatter plots were used to depict the biogeographical characteristics of regions reporting C. sinensis infection in animals. RESULTS The overall pooled prevalence of C. sinensis was 0.9% (95% CI: 0.6-1.2%) in snails, 14.2% (12.7-15.7%) in the second intermediate host, and 14.3% (11.4-17.6%) in animal reservoirs. Prevalence in low epidemic areas (with human prevalence < 1%) decreased from 0.6% (0.2-1.2%) before 1990 to 0.0% (0.0-3.6%) after 2010 in snails (P = 0.0499), from 20.3% (15.6-25.3%) to 8.8% (5.6-12.6%) in the second intermediate hosts (P = 0.0002), and from 18.3% (12.7-24.7%) to 4.7% (1.0-10.4%) in animal reservoirs. However, no similar decrease in prevalence was observed in high epidemic areas (with human prevalence ≥ 1.0%). C. sinensis infections were predominantly reported in areas with altitudes below 2346 m and annual cumulative precipitation above 345 mm and were mostly concentrated in eastern China. CONCLUSIONS There are spatio-temporal disparities in the animal infections of C. sinensis in different areas of China. Animal infections are primarily concentrated in regions with low altitude and high precipitation. The results suggest that implementing One Health-based comprehensive measures targeting both humans and animals, especially in high epidemic areas, is essential for successful eradication of C. sinensis in China.
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Affiliation(s)
- Kai Liu
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Jing Tan
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Lu Xiao
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Rui-Tai Pan
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Xiao-Yan Yao
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Fu-Yan Shi
- School of Public Health, Weifang Medical University, Weifang, 261053, China
| | - Shi-Zhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Center for Malaria, Schistosomiasis and Filariasis, Shanghai, 200025, China.
| | - Lan-Hua Li
- School of Public Health, Weifang Medical University, Weifang, 261053, China.
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Xiao HY, Chai JY, Fang YY, Lai YS. The spatial-temporal risk profiling of Clonorchis sinensis infection over 50 years implies the effectiveness of control programs in South Korea: a geostatistical modeling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100697. [PMID: 36817868 PMCID: PMC9932111 DOI: 10.1016/j.lanwpc.2023.100697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Background Over the past 50 years, two national control programs on Clonorchis sinensis infection have been conducted in South Korea. Spatial-temporal profiles of infection risk provide useful information on assessing the effectiveness of the programs and planning spatial-targeted control strategies. Methods Advanced Bayesian geostatistical joint models with spatial-temporal random effects were developed to analyze disease data collecting by a systematic review with potential influencing factors, and to handle issues of preferential sampling and data heterogeneities. Changes of the infection risk were analyzed. Findings We presented the first spatial-temporal risk maps of C. sinensis infection at 5 × 5 km2 resolution from 1970 to 2020 in South Korea. Moderate-to-high risk areas were shrunk, but temporal variances were shown in different areas. The population-adjusted estimated prevalence across the country was 5.99% (95% BCI: 5.09-7.01%) in 1970, when the first national deworming campaign began. It declined to 3.95% (95% BCI: 2.88-3.95%) in 1995, when the campaign suspended, and increased to 4.73% (95% BCI: 4.00-5.42%) in 2004, just before the Clonorchiasis Eradication Program (CEP). The population-adjusted prevalence was estimated at 2.77% (95% BCI: 1.67-4.34%) in 2020, 15 years after CEP started, corresponding to 1.42 (95% BCI: 0.85-2.23) million infected people. Interpretation The first nationwide campaign and the CEP showed effectiveness on control of C. sinensis infection. Moderate-to-high risk areas identified by risk maps should be prioritized for control and intervention. Funding The National Natural Science Foundation of China (project no. 82073665) and the Natural Science Foundation of Guangdong Province (project no. 2022A1515010042).
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Affiliation(s)
- Hai-Yan Xiao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Jong-Yil Chai
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, and Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, 110-799, South Korea
| | - Yue-Yi Fang
- Institute of Parasitic Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, PR China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, PR China,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, PR China,Corresponding author. Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, PR China.
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Xie Y, Kanankege KST, Jiang Z, Liu S, Yang Y, Wan X, Perez AM. Epidemiological characterization of Clonorchis sinensis infection in humans and freshwater fish in Guangxi, China. BMC Infect Dis 2022; 22:263. [PMID: 35303819 PMCID: PMC8932281 DOI: 10.1186/s12879-022-07244-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Clonorchiasis is a widespread yet neglected foodborne disease with over 85% of all cases found in China. Guangxi province, located in southeastern China, ranks among the highest endemic provinces. We explore the epidemiological status and determinants of Clonorchis sinensis (C. sinensis) infection in humans and freshwater fish in Guangxi, China. Methods Data on C. sinensis infection in humans from January 2008 to December 2017were extracted from the China Information System for Disease Control and Prevention. An active surveillance of C. sinensis infection in fish was conducted in 2016–2017. County level data including potential environmental, social-economical and behavioral determinants was also collected. Univariate and multivariate logistic regression models were used to explore the determinants of C. sinensis infection in humans and fish. Simple and multiple zero-inflated Poisson regression models were fit to assess the associated factors of clonorchiasis in humans at the county level. Results Totally, 4526 C. sinensis cases were reported between 2008 and 2017, with an annual prevalencerate of 0.96/100,000 persons. Of 101 counties in Guangxi, 97 reported at least 1 case. Among 2,098 fish samples, 203 (9.7%) from 70 counties contained C. sinensis. The rate was higher in small fish including Pseudorasbora parva (45.3%), Misgurnus anguillicaudatus (41.2%), Hemicculter leuciclus (34.5%), unclassified small fishes (30.9%), Cyprinidae (20.0%), Cirrhinus molitorella (16.4%), Carassius auratus (13.6%) and Cyprinus carpio (13.3%), while it was lower in fish species that are usually used in preparing raw fish dishes including Ctenopharyngodon idellus (3.6%), Spinibarbus denticulatus (3.7%), Monopterus albus (6.4%), Cyprinus carpio (4.4%), Oreochromis mossambicus (3.3%) and Spualiobarbus Curriculus (6.6%). The C. sinensis infection in fish was only associated with fish species. The estimated human clonorchiasis prevalence at the county level was positively associated with raw fish consumption habits and certain rivers. Conclusions Clonorchiasis is highly prevalent in both humans and freshwater fish in Guangxi. Environmental, social-economic and behavioral determinants contribute to the high prevalence as well as the significant differential distribution by county. Regular surveillance should be implemented for clonorchiasis to demonstrate the change in epidemiology and burden, which will benefit the design of interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07244-2.
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Affiliation(s)
- Yihong Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, P.O. Box 530021, Nanning, Guangxi, China.
| | - Kaushi S T Kanankege
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, P.O. Box 55414, Minneapolis, USA
| | - Zhihua Jiang
- Division of Parasitic Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, P.O. Box 530021, Nanning, Guangxi, China
| | - Shun Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22 Shuangyong Road, P.O. Box 530021, Nanning, Guangxi, China
| | - Yichao Yang
- Division of Parasitic Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, P.O. Box 530021, Nanning, Guangxi, China
| | - Xiaoling Wan
- Division of Parasitic Disease Prevention and Control, Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, P.O. Box 530021, Nanning, Guangxi, China
| | - Andres M Perez
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, P.O. Box 55414, Minneapolis, USA
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Current status of human liver fluke infections in the Greater Mekong Subregion. Acta Trop 2021; 224:106133. [PMID: 34509453 DOI: 10.1016/j.actatropica.2021.106133] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022]
Abstract
The Greater Mekong Subregion (GMS) is a trans-national region of the Mekong River basin in Southeast Asia comprising Cambodia, the People's Republic of China (specifically Yunnan Province and Guangxi Zhuang Autonomous Region), Lao People's Democratic Republic (Lao PDR), Myanmar, Thailand, and Vietnam home to more than 340 million people or almost 4.5% of the global population. Human liver fluke infections caused by Opisthorchis viverrini and Clonorchis sinensis have been major public health problems in this region for decades. Opisthorchiasis caused by O. viverrini is prevalent in Thailand, Lao PDR, Cambodia and central-southern Vietnam with more than 12 million people infected. Clonorchiasis caused by C. sinensis is endemic in northern Vietnam and Guangxi with estimated 3.5 -5 million infected. The infections can cause several liver and biliary diseases such as cholangitis, periductal fibrosis, gallstones, and cholangiocarcinoma (CCA), a fatal bile duct cancer. Key determinants of the geographical distribution differences of the two liver fluke species are snail species and geographic barriers. Main risk behaviour of the infections is the culture of eating raw fish "the raw attitude" of people in the GMS, especially the Tai/Dai/Thai/Laos ethnic groups, the major population in the GMS. Over the past 20 years, there is a big change in prevalence of the infections. Opisthorchiasis has long been endemic, particularly in northern and northeastern Thailand and Lao PDR with over 8-10 million cases estimated. However, after several rounds of national campaign against opisthorchiasis using integrated control approach in Thailand over the past three decades, the prevalence of O. viverrini infection has reduced from over 15% in 1996 to 2.2% in 2019. High prevalence of O. viverrini infection continues in Lao PDR and central Vietnam. Emerging high prevalence, up to a maximum of 47.5%, has been noted in Cambodia during the past 10 years possibly due to more studies being conducted rather than increasing prevalence. O. viverrini infection has now also been reported in Lower Myanmar in recent years. Clonorchiasis has been known in northern Vietnam and southern China for a long time. Several surveys have reported infections in Guangxi in the last 10 years, and until now liver fluke infected cases have not been reported in Yunnan. Overall, nowadays, there is a shift in high risk areas for GMS liver fluke infection from northeastern Thailand to Lao PDR, Cambodia, Vietnam, Myanmar, and Guangxi P.R. China. Urgent systematic disease mapping and integrated liver fluke control using One Health approaches should be implemented nationwide in GMS countries.
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Brindley PJ, Bachini M, Ilyas SI, Khan SA, Loukas A, Sirica AE, Teh BT, Wongkham S, Gores GJ. Cholangiocarcinoma. Nat Rev Dis Primers 2021; 7:65. [PMID: 34504109 PMCID: PMC9246479 DOI: 10.1038/s41572-021-00300-2] [Citation(s) in RCA: 276] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 02/08/2023]
Abstract
Cholangiocarcinoma (CCA) is a highly lethal adenocarcinoma of the hepatobiliary system, which can be classified as intrahepatic, perihilar and distal. Each anatomic subtype has distinct genetic aberrations, clinical presentations and therapeutic approaches. In endemic regions, liver fluke infection is associated with CCA, owing to the oncogenic effect of the associated chronic biliary tract inflammation. In other regions, CCA can be associated with chronic biliary tract inflammation owing to choledocholithiasis, cholelithiasis, or primary sclerosing cholangitis, but most CCAs have no identifiable cause. Administration of the anthelmintic drug praziquantel decreases the risk of CCA from liver flukes, but reinfection is common and future vaccination strategies may be more effective. Some patients with CCA are eligible for potentially curative surgical options, such as resection or liver transplantation. Genetic studies have provided new insights into the pathogenesis of CCA, and two aberrations that drive the pathogenesis of non-fluke-associated intrahepatic CCA, fibroblast growth factor receptor 2 fusions and isocitrate dehydrogenase gain-of-function mutations, can be therapeutically targeted. CCA is a highly desmoplastic cancer and targeting the tumour immune microenvironment might be a promising therapeutic approach. CCA remains a highly lethal disease and further scientific and clinical insights are needed to improve patient outcomes.
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Affiliation(s)
- Paul J. Brindley
- Department of Microbiology, Immunology & Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | | | - Sumera I. Ilyas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Shahid A. Khan
- Liver Unit, Division of Digestive Diseases, Imperial College London, London, UK
| | - Alex Loukas
- Centre for Molecular Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Alphonse E. Sirica
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
| | - Sopit Wongkham
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Gregory J. Gores
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,
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Cao M, Ding C, Xia C, Li H, Sun D, He S, Chen W. Attributable deaths of liver cancer in China. Chin J Cancer Res 2021; 33:480-489. [PMID: 34584373 PMCID: PMC8435823 DOI: 10.21147/j.issn.1000-9604.2021.04.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Objective There is little information about contributions of the well-known risk factors to the liver cancer burden. We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors. Methods Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in 2014. Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International. Population attributable fraction (PAF) by age, sex, and province was calculated using multiple formulas. Results In total, 72.4% of liver cancer deaths could be attributable to the studied risk factors. Hepatitis B virus (HBV) was responsible for the largest fraction of liver cancer burden in both genders (PAF=55.6% in males, PAF=46.5% in females). PAFs for liver cancer burden attributable to smoking (15.7% vs. 4.8%), and alcohol drinking (10.3% vs. 1.6%) were significantly higher in males than in females. The burden of HBV-attributable deaths was the highest in Qinghai province.
Conclusions HBV still contributes to the majority of liver cancer burden than any other risk factors. Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.
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Affiliation(s)
- Maomao Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Chao Ding
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Changfa Xia
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - He Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Dianqin Sun
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Siyi He
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing 100021, China
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10
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Xu M, Jiang Y, Yin J, Cao S, Shen Y, Cao J. Risk Factors for Clonorchis sinensis Infection in Residents of Binyang, Guangxi: A Cross-Sectional and Logistic Analysis Study. Front Public Health 2021; 9:588325. [PMID: 34026699 PMCID: PMC8131673 DOI: 10.3389/fpubh.2021.588325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Clonorchiasis is a serious food-borne parasitic disease caused by Clonorchis sinensis infection. C. sinensis, a major fish-borne trematode, is a known causative agent of cholangiocarcinoma. The risk factors for C. sinensis infection include individual eating behaviors and environmental factors. In this study, we evaluated the C. sinensis infection rate and the associated risk factors among residents in Binyang County, Guangxi, China. Methods: In 2016 and 2017, five villages from Binyang, Guangxi were selected by multistage cluster random sampling for a cross-sectional study. A modified Kato-Katz thick smear method was used to examine C. sinensis eggs in fecal samples in triplicate (three smears for each sample). Both uni-variate and multi-variate logistic regression analyses were carried out to identify the risk factors for C. sinensis infection. Results: A total of 1,977 fecal samples were collected from villagers in the investigated areas. The overall infection rates of C. sinensis in Binyang County was 20.49% (405/1,977). The mean age of participants was 39.42 ± 23.48 (range: 3–89 years old), and the highest infection rate (33.72%) was seen in the age group of 40-49 years old, followed by those aged 50–59 (31.83%). Multi-variate logistic regression analysis showed that higher infection rates were significantly associated with males (aOR = 6.51, 95% CI = 4.67–9.08), Zhuang (aOR = 2.41, 95% CI = 1.62–3.59), ages (aOR = 33.51, 95% CI = 10.13–110.86), frequency of raw fresh fish consumption (aOR = 14.56, 95% CI = 9.80–21.63), and close contact with cats and dogs (aOR = 1.53, 95% CI = 1.02–2.30). Occupations and education levels showed no significant association with C. sinensis infection (P > 0.05). Conclusions: High levels of C. sinensis infection were observed among residents in Binyang County, Guangxi. Intervention strategies should be strengthened among the investigated population at high risk, such as males, Zhuang and older individuals, especially those who frequently eat raw fresh fish. In addition, the individuals contacting with cats and/or dogs were observed to have significantly higher infection rate of C. sinensis than those having no contact with cats and dogs. The association between contacting with cats and/or dogs and C. sinensis infection needs to be explored and confirmed in the future study by more epidemiological investigations of human C. sinensis infection from different areas.
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Affiliation(s)
- Meng Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China
| | - Yanyan Jiang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China
| | - Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China
| | - Shengkui Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China
| | - Yujuan Shen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China.,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Chinese Center for Tropical Diseases Research, Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,World Health Organization Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China.,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Wen C, Huang X, Feng L, Chen L, Hu W, Lai Y, Hao Y. High-resolution age-specific mapping of the two-week illness prevalence rate based on the National Health Services Survey and geostatistical analysis: a case study in Guangdong province, China. Int J Health Geogr 2021; 20:20. [PMID: 33941201 PMCID: PMC8094611 DOI: 10.1186/s12942-021-00273-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The two-week illness prevalence rate is an important and comparable indicator of health service needs. High-spatial-resolution, age-specific risk mapping of this indicator can provide valuable information for health resource allocation. The age-prevalence relationships may be different among areas of the study region, but previous geostatistical models usually ignored the spatial-age interaction. METHODS We took Guangdong province, the province with the largest population and economy in China, as a study case. We collected two-week illness data and other potential influencing predictors from the fifth National Health Services Survey in 2013 and other open-access databases. Bayesian geostatistical binary regression models were developed with spatial-age structured random effect, based on which, high-resolution, age-specific two-week illness prevalence rates, as well as number of people reporting two-week illness, were estimated. The equality of health resource distribution was further evaluated based on the two-week illness mapping results and the health supply data. RESULTS The map across all age groups revealed that the highest risk was concentrated in the central (i.e., Pearl River Delta) and northern regions of the province. These areas had a two-week illness prevalence > 25.0%, compared with 10.0-20.0% in other areas. Age-specific maps revealed significant differences in prevalence between age groups, and the age-prevalence relationships also differed across locations. In most areas, the prevalence rates decrease from age 0 to age 20, and then increase gradually. Overall, the estimated age- and population-adjusted prevalence was 16.5% [95% Bayesian credible interval (BCI): 14.5-18.6%], and the estimated total number of people reporting illness within the two-week period was 17.5 million (95% BCI: 15.5-19.8 million) in Guangdong Province. The Lorenz curve and the Gini coefficient (resulted in 0.3526) showed a moderate level of inequality in health resource distribution. CONCLUSIONS We developed a Bayesian geostatistical modeling framework with spatial-age structured effect to produce age-specific, high-resolution maps of the two-week illness prevalence rate and the numbers of people reporting two-week illness in Guangdong province. The methodology developed in this study can be generalized to other global regions with available relevant survey data. The mapping results will support plans for health resource allocation.
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Affiliation(s)
- Chuchun Wen
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaoliang Huang
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Lifen Feng
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Long Chen
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Wei Hu
- Department of Statistics, Government Affairs Service Center of Health Commission of Guangdong Province, Guangzhou, 510060, China
| | - Yingsi Lai
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
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12
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Feng C, Li R, Shamim AA, Ullah MB, Li M, Dev R, Wang Y, Zhao T, Liao J, Du Z, Ling Y, Lai Y, Hao Y. High-resolution mapping of reproductive tract infections among women of childbearing age in Bangladesh: a spatial-temporal analysis of the demographic and health survey. BMC Public Health 2021; 21:342. [PMID: 33579253 PMCID: PMC7881647 DOI: 10.1186/s12889-021-10360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproductive tract infections (RTIs) have become major but silent public health problems devastating women's lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings. METHODS We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh. RESULTS We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5-11.7%), 13.9% (95% BCI: 13.3-14.5%) and 13.4% (95% BCI: 12.8-14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years. CONCLUSION The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.
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Affiliation(s)
- Chenyang Feng
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ruixue Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Abu Ahmed Shamim
- James P Grant School of public Health, BRAC University, Dhaka, Bangladesh
| | - Md Barkat Ullah
- Department of Nutrition, University of California Davis, California, USA
| | - Mengjie Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Rubee Dev
- Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal
| | - Yijing Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tingting Zhao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuheng Ling
- CNRS UMR 6240, Universite de Corse Pascal Paoli, 20250, Corti, France
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
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13
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The selectivity for the second intermediate host (fish) of Clonorchis sinensis in the Jialing River basin, China—from the perspective of fish ecological viewpoint. Biologia (Bratisl) 2021. [DOI: 10.2478/s11756-020-00502-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Brattig NW, Bergquist R, Qian MB, Zhou XN, Utzinger J. Helminthiases in the People's Republic of China: Status and prospects. Acta Trop 2020; 212:105670. [PMID: 32841589 DOI: 10.1016/j.actatropica.2020.105670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Helminth infections, many of them listed as neglected tropical diseases by the World Health Organization, remain a public health issue in many parts of the world. The People's Republic of China (P.R. China) stands out due to impressive progress in the control and local elimination of helminth infections. An important contextual factor is P.R. China's sustained social and economic development that allowed implementation of health-related poverty alleviation, improving water, sanitation and hygiene, enhancing information, education and communication, coupled with major engineering and infrastructure development and intersectoral collaboration. Nonetheless, food-borne trematodiases, soil-transmitted helminthiases, echinococcosis, cysticercosis/taeniasis and schistosomiasis still exert a considerable burden in P.R. China, even though the numbers of infected people have decreased substantially since the new millennium. This special issue of Acta Tropica provides a comprehensive update of the current knowledge of the main helminth infections in P.R. China, summarises progress in research and discusses future prospects for gaining and sustaining control towards the final goal of breaking transmission and hence, eliminating helminthiases. It consists of 34 articles with a wide coverage that can be grouped into six domains: (i) epidemiological assessment and disease burden estimates; (ii) diagnostics and antigen characterisation; (iii) drug and vaccine development; (iv) host-parasite interactions and snail genetics; (v) surveillance and public health response; and (vi) capacity building and international cooperation. The control and elimination of helminthiases not only furthers the health and wellbeing of the Chinese people, but also provides innovative approaches, tools and strategies, which can be adopted and applied in other countries and regions of the world where helminthiases still prevail.
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15
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Kinkar L, Korhonen PK, Wang D, Zhu XQ, Chelomina GN, Wang T, Hall RS, Koehler AV, Harliwong I, Yang B, Fink JL, Young ND, Gasser RB. Marked mitochondrial genetic variation in individuals and populations of the carcinogenic liver fluke Clonorchis sinensis. PLoS Negl Trop Dis 2020; 14:e0008480. [PMID: 32813714 PMCID: PMC7437864 DOI: 10.1371/journal.pntd.0008480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 01/24/2023] Open
Abstract
Clonorchiasis is a neglected tropical disease caused by the Chinese liver fluke, Clonorchis sinensis, and is often associated with a malignant form of bile duct cancer (cholangiocarcinoma). Although some aspects of the epidemiology of clonorchiasis are understood, little is known about the genetics of C. sinensis populations. Here, we conducted a comprehensive genetic exploration of C. sinensis from endemic geographic regions using complete mitochondrial protein gene sets. Genomic DNA samples from C. sinensis individuals (n = 183) collected from cats and dogs in China (provinces of Guangdong, Guangxi, Hunan, Heilongjiang and Jilin) as well as from rats infected with metacercariae from cyprinid fish from the Russian Far East (Primorsky Krai region) were deep sequenced using the BGISEQ-500 platform. Informatic analyses of mitochondrial protein gene data sets revealed marked genetic variation within C. sinensis; significant variation was identified within and among individual worms from distinct geographical locations. No clear affiliation with a particular location or host species was evident, suggesting a high rate of dispersal of the parasite across endemic regions. The present work provides a foundation for future biological, epidemiological and ecological studies using mitochondrial protein gene data sets, which could aid in elucidating associations between particular C. sinensis genotypes/haplotypes and the pathogenesis or severity of clonorchiasis and its complications (including cholangiocarcinoma) in humans. Clonorchiasis is an important neglected tropical disease caused by the Chinese liver fluke, Clonorchis sinensis, which can induce malignant bile duct cancer (cholangiocarcinoma). Little precise information is available on the biology, epidemiology and population genetics of C. sinensis. For this reason, we explored here the genetic composition of C. sinensis populations in distinct endemic areas in China and Russia. Using a deep sequencing-informatic approach, we revealed marked mitochondrial genetic variation within and between individuals and populations of C. sinensis, with no particular affiliation with geographic or host origin. These molecular findings and the methodology established should underpin future genetic studies of C. sinensis causing human clonorchiasis and associated complications (cancer) as well as transmission patterns in endemic regions.
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Affiliation(s)
- Liina Kinkar
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Pasi K. Korhonen
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Daxi Wang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
- BGI International, Shenzhen, China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, China
| | - Galina N. Chelomina
- Department of Parasitology, Federal Scientific Center of the East Asia Terrestrial Biodiversity FEB RAS, Vladivostok, Russia
| | - Tao Wang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Ross S. Hall
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Anson V. Koehler
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | | | | | | | - Neil D. Young
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail: (NDY); (RBG)
| | - Robin B. Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
- * E-mail: (NDY); (RBG)
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16
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Huang XH, Qian MB, Zhu GH, Fang YY, Hao YT, Lai YS. Assessment of control strategies against Clonorchis sinensis infection based on a multi-group dynamic transmission model. PLoS Negl Trop Dis 2020; 14:e0008152. [PMID: 32218570 PMCID: PMC7156112 DOI: 10.1371/journal.pntd.0008152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/14/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022] Open
Abstract
Clonorchiasis is one of the most important food-borne trematodiases affecting millions of people. Strategies were recommended by different organizations and control programmes were implemented but mostly in short-time periods. It's important to assess the long-term benefits and sustainability of possible control strategies on morbidity control of the disease. We developed a multi-group transmission model to describe the dynamics of C. sinensis transmission among different groups of people with different raw-fish-consumption behaviors, based on which, a full model with interventions was proposed and three common control measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental modification) and their possible combinations were considered. Under a typical setting of C. sinensis transmission, we simulated interventions according to different strategies and with a series of values of intervention parameters. We found that combinations of measures were much beneficial than those singly applied; higher coverages of measures had better effects; and strategies targeted on whole population performed better than that on at-risk population with raw-fish-consumption behaviors. The strategy recommended by the government of Guangdong Province, China shows good and sustainable effects, under which, the infection control (with human prevalence <5%) could be achieved within 7.84 years (95% CI: 5.78-12.16 years) in our study setting (with original observed prevalence 33.67%). Several sustainable strategies were provided, which could lead to infection control within 10 years. This study makes the effort to quantitatively assess the long-term effects of possible control strategies against C. sinensis infection under a typical transmission setting, with application of a multi-group dynamic transmission model. The proposed model is easily facilitated with other transmission settings and the simulation outputs provide useful information to support the decision-making of control strategies on clonorchiasis.
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Affiliation(s)
- Xiao-Hong Huang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People’s Republic of China
- WHO Collaborating Centre for Tropical Diseases, Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, People’s Republic of China
| | - Guang-Hu Zhu
- Department of Mathematics and Computing Science, Guilin University of Electronic Technology, Guilin, Guangxi, People’s Republic of China
| | - Yue-Yi Fang
- Institute of Parasitic Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, People’s Republic of China
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
- * E-mail:
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17
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Zhu TJ, Chen YD, Qian MB, Zhu HH, Huang JL, Zhou CH, Zhou XN. Surveillance of clonorchiasis in China in 2016. Acta Trop 2020; 203:105320. [PMID: 31877282 DOI: 10.1016/j.actatropica.2019.105320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Ting-Jun Zhu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China
| | - Ying-Dan Chen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China
| | - Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China
| | - Hui-Hui Zhu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China
| | - Ji-Lei Huang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China
| | - Chang-Hai Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, No.207 Ruijin Road, Huangpu District, Shanghai 200025, China.
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18
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Affiliation(s)
- Men-Bao Qian
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- Chinese Center for Tropical Diseases Research, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, China
- Chinese Center for Tropical Diseases Research, Shanghai, China
- WHO Collaborating Center for Tropical Diseases, Shanghai, China
- * E-mail:
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19
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Chen W, Xia C, Zheng R, Zhou M, Lin C, Zeng H, Zhang S, Wang L, Yang Z, Sun K, Li H, Brown MD, Islami F, Bray F, Jemal A, He J. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment. Lancet Glob Health 2019; 7:e257-e269. [PMID: 30683243 DOI: 10.1016/s2214-109x(18)30488-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/24/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China. METHODS In this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 county-level surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors. FINDINGS About 1 036 004 cancer deaths (45·2% of all cancer deaths [95% CI 44·0-46·4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51·2% [95% CI 50·0-52·4]) than in women (34·9% [33·6-36·2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35·2% in Shanghai to 52·9% in Heilongjiang, while the PAF varied from 40·9% in Shanghai to 56·4% in Guangdong among men and from 26·9% in Shanghai to 48·0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province). INTERPRETATION The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden. FUNDING National Science and Technology Basic Research Special Foundation of China.
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Affiliation(s)
- Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Changfa Xia
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunqing Lin
- International Agency for Research on Cancer, Lyon, France
| | - Hongmei Zeng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siwei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhixun Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kexin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Matthew D Brown
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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20
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Zhang X, Sun B, Tang Q, Chen R, Han S. Molecular Identification and Phylogenetic Analysis of Nuclear rDNA Sequences of Clonorchis sinensis Isolates From Human Fecal Samples in Heilongjiang Province, China. Front Microbiol 2019; 10:26. [PMID: 30745896 PMCID: PMC6360181 DOI: 10.3389/fmicb.2019.00026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/09/2019] [Indexed: 01/14/2023] Open
Abstract
Studying the genetic diversity of parasite is important for understanding their biogeography and molecular epidemiology, as well as for establishing disease prevention and control strategies. Clonorchis sinensis is an important foodborne parasite worldwide. However, despite its epidemiological significance, the genetic diversity of C. sinensis has not been well studied from human in northeastern China. In this study, a total of 342 fecal specimens were collected from residents living in five villages in Heilongjiang Province and analyzed for the presence of C. sinensis by PCR amplification and sequencing of the internal transcribed spacer 1 (ITS1) and ITS2 regions of nuclear ribosomal DNA. 21.64% (74/342) of fecal samples were found to be positive for C. sinensis by PCR. The sequences of the ITS1 region in 34 of the 74 samples (45.95%) matched that of MK179278, Genetic polymorphisms were observed at six nucleotide sites. The ITS2 gene sequence of 37 of the 74 samples (50%) matched that of MK179281. In conclusion, a low degree of genetic diversity between C. sinensis isolates from China and different geographical regions was found at ITS loci. Despite this conservation, sequencing of the rDNA region has provided important data that will be useful for future studies addressing the molecular evolution, biology, medical implications and ecology of C. sinensis.
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Affiliation(s)
- Xiaoli Zhang
- Department of Parasitology, Harbin Medical University, Harbin, China
| | - Beibei Sun
- Department of Parasitology, Harbin Medical University, Harbin, China
| | - Qiaoran Tang
- Department of Parasitology, Harbin Medical University, Harbin, China
| | - Rui Chen
- Department of Orthopaedics, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Su Han
- Department of Parasitology, Harbin Medical University, Harbin, China
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21
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Wang L, Zou Y, Zhu X, Bottazzi ME, Hotez PJ, Zhan B. China's shifting neglected parasitic infections in an era of economic reform, urbanization, disease control, and the Belt and Road Initiative. PLoS Negl Trop Dis 2019; 13:e0006946. [PMID: 30677027 PMCID: PMC6345419 DOI: 10.1371/journal.pntd.0006946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Lei Wang
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Beijing Key Laboratory for Prevention and Treatment of Tropical Diseases, Beijing, PR China
| | - Yang Zou
- Beijing Institute of Tropical Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
- Beijing Key Laboratory for Prevention and Treatment of Tropical Diseases, Beijing, PR China
| | - Xinping Zhu
- Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Capital Medical University, Beijing, PR China
| | - Maria Elena Bottazzi
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Peter J. Hotez
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Bin Zhan
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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22
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Yuan R, Huang J, Zhang X, Ruan S. Modeling the Transmission Dynamics of Clonorchiasis in Foshan, China. Sci Rep 2018; 8:15176. [PMID: 30310106 PMCID: PMC6181966 DOI: 10.1038/s41598-018-33431-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/27/2018] [Indexed: 01/19/2023] Open
Abstract
Clonorchiasis, known as the Chinese liver fluke disease, is caused by Clonorchis sinensis infection with food-borne liver fluke, which is transmitted via snails to freshwater fish and then to human beings or other piscivorous mammals. Clonorchis sinensis infection is mainly related to liver and biliary disorders, especially cholangiocarcinoma, and has an increased human-health impact due to the greater consumption of raw freshwater fish. In this article, we propose a deterministic model to describe the spread of clonorchiasis among human-snail-fish populations and use the model to simulate the data on the numbers of inspected and infected individuals of Foshan City, located in Guangdong Province in the southeast of P.R China, from 1980-2010. Mathematical and numerical analyses of the model are carried out to understand the transmission dynamics of clonorchiasis and explore effective control measures for the local outbreaks of the disease. We find that (i) the transmission of clonorchiasis from cercariae to fish plays a more important role than that from eggs to snails and from fish to humans; (ii) As the cycle of infection-treatment-reinfection continues, it is unlikely that treatment with drugs alone can control and eventually eradicate clonorchiasis. These strongly suggest that a more comprehensive approach needs to include environmental modification in order to break the cercariae-fish transmission cycle, to enhance awareness about the disease, and to improve prevention measures.
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Affiliation(s)
- Ruixia Yuan
- School of Mathematics and Statistics, Central China Normal University, Wuhan, 430079 P. R. China
| | - Jicai Huang
- School of Mathematics and Statistics, Central China Normal University, Wuhan, 430079 P. R. China
| | - Xinan Zhang
- School of Mathematics and Statistics, Central China Normal University, Wuhan, 430079 P. R. China
| | - Shigui Ruan
- Department of Mathematics, University of Miami, Coral Gables, FL 33146 USA
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