Large water management projects and schistosomiasis control, Dongting Lake region, China

Three Gorges Dam: the changing trend of snail density in the Yangtze River basin between 1990 and 2019

BACKGROUND

The area of Oncomelania hupensis snail remains around 3.6 billion m², with newly emerging and reemergent habitats continuing to appear in recent years. This study aimed to explore the long-term dynamics of snail density before and after the operation of Three Gorges Dam (TGD).

METHODS

Data of snail survey between 1990 and 2019 were collected from electronic databases and national schistosomiasis surveillance. Meta-analysis was conducted to estimate the snail density. Joinpoint model was used to identify the changing trend and inflection point. Inverse distance weighted interpolation (IDW) was used to determine the spatial distribution of recent snail density.

RESULTS

A total of 3777 snail survey sites with a precise location of village or beach were identified. For the downstream area, snail density peaked in 1998 (1.635/0.11 m², 95% CI: 1.220, 2.189) and fluctuated at a relatively high level before 2003, then declined steadily from 2003 to 2012. Snail density maintained lower than 0.150/0.11 m² between 2012 and 2019. Joinpoint model identified the inflection of 2003, and a significant decreasing trend from 2003 to 2012 with an annual percentage change (APC) being - 20.56% (95% CI: - 24.15, - 16.80). For the upstream area, snail density peaked in 2005 (0.760/0.11 m², 95% CI: 0.479, 1.207) and was generally greater than 0.300/0.11 m² before 2005. Snail density was generally lower than 0.150/0.11 m² after 2011. Snail density showed a significant decreasing trend from 1990 to 2019 with an APC being - 6.05% (95% CI: - 7.97, - 7.09), and no inflection was identified. IDW showed the areas with a high snail density existed in Poyang Lake, Dongting Lake, Jianghan Plain, and the Anhui branch of the Yangtze River between 2015 and 2019.

CONCLUSIONS

Snail density exhibited a fluctuating downward trend in the Yangtze River basin. In the downstream area, the operation of TGD accelerated the decline of snail density during the first decade period, then snail density fluctuated at a relatively low level. There still exists local areas with a high snail density. Long-term control and monitoring of snails need to be insisted on and strengthened.

Oncomelania hupensis Distribution and Schistosomiasis Transmission Risk in Different Environments under Field Conditions

The goal of schistosomiasis prevention and control in China is shifting from transmission interruption to elimination. However, the area inhabited by the intermediate host, the snail Oncomelania hupensis, has not changed much in recent years. Different environmental types have different impacts on snail breeding, and understanding these differences is conducive to improving the efficiency of snail monitoring and control and to saving resources. Based on previous epidemiological data, we selected 199 villages in 2020 and 269 villages in 2021 from transmission control, transmission interruption, and elimination areas of snail breeding. Snail surveys were conducted in selected villages using systematic sampling and/or environmental sampling methods in six types of snail-breeding environments (canals, ponds, paddy fields, dry lands, bottomlands, and undefined environments). All live snails collected from the field were evaluated for Schistosoma japonicum infection using the microscopic dissection method, and a subsample of snails was subjected to loop-mediated isothermal amplification (LAMP) to assess the presence of S. japonicum infection. Snail distribution data and infection rate and nucleic acid positive rate of schistosomes in snails were calculated and analyzed. The 2-year survey covered 29,493 ha of the environment, in which 12,313 ha of snail habitats were detected. In total, 51.16 ha of new snail habitats and 107.76 ha of re-emergent snail habitats were identified during the survey. The occurrence rate of snails in canals (10.04%, 95% CI: 9.88-10.20%) and undefined environments (20.66%, 95% CI: 19.64-21.67%) was relatively high in 2020, and the density of snails in bottomlands (0.39, 95% CI: 0.28-0.50) and undefined environments (0.43, 95% CI: 0.14-1.60) was relatively high in 2021. Of the 227,355 live snails collected in this study, none were S. japonicum-positive as determined by microscopy. Of the 20,131 pooled samples, however, 5 were S. japonicum-positive based on LAMP analysis, and they were distributed in three environmental types: 3 in bottomland, 1 in dry land, and 1 in a canal. The bottomland environment has a high risk of schistosomiasis transmission because it contains a large area of newly emerging and re-emerging snail habitats, and it also had the most breeding snails infected with S. japonicum. Thus, this habitat type should be the key target for snail monitoring and early warning and for the prevention and control of schistosomiasis.

The Current Distribution of Oncomelania hupensis Snails in the People's Republic of China Based on a Nationwide Survey

Schistosomiasis is a helminth infection caused by the genus Schistosoma, which is still a threat in tropical and sub-tropical areas. In the China, schistosomiasis caused by Schistosoma japonicum is mainly endemic to the Yangtze River valley. The amphibious snail Oncomelania hupensis (O. hupensis) is the unique intermediate host of S. japonicum; hence, snail control is a crucial approach in the process of schistosomiasis transmission control and elimination. In 2016, a nationwide snail survey was conducted involving all snail habitats recorded since 1950 in all endemic counties of 12 provinces. A total of 53,254 existing snail habitats (ESHs) were identified, presenting three clusters in Sichuan Basin, Dongting Lake, and Poyang Lake. The overall habitat area was 5.24 billion m², of which 3.58 billion m² were inhabited by O. hupensis. The area inhabited by snails (AIS) in Dongting and Poyang Lakes accounted for 76.53% of the population in the country. Three typical landscape types (marshland and lakes, mountains and hills, and plain water networks) existed in endemic areas, and marshland and lakes had a predominant share (3.38 billion m²) of the AIS. Among the 12 endemic provinces, Hunan had a share of nearly 50% of AIS, whereas Guangdong had no ESH. Ditches, dryland, paddy fields, marshland, and ponds are common habitat types of the ESH. Although the AIS of the marshland type accounted for 87.22% of the population in the whole country, ditches were the most common type (35,025 or 65.77%) of habitat. Six categories of vegetation for ESHs were identified. A total of 39,139 habitats were covered with weeds, accounting for 55.26% of the coverage of the area. Multiple vegetation types of snail habitats appeared in the 11 provinces, but one or two of these were mainly dominant. Systematic sampling showed that the presence of living snails was 17.88% among the 13.5 million sampling frames. The occurrence varied significantly by landscape, environment, and vegetation type. The median density of living snails in habitats was 0.50 per frame (0.33 m × 0.33 m), and the highest density was 40.01 per frame. Furthermore, two main clusters with high snail densities and spatial correlations indicated by hotspot analysis were identified: one in Hunan and Hubei, the other in Sichuan. This national survey is the first full-scale census on the distribution of O. hupensis, which is significant, as transmission interruption and elimination are truly becoming the immediate goal of schistosomiasis control in China. The study discerns the detailed geographic distribution of O. hupensis with the hotspots of snail density in China. It is beneficial to understand the status of the snail population in order to finally formulate further national control planning.

Schistosomiasis model with treatment, habitat modification and biological control

Schistosomiasis is a parasitic disease caused by Schistosoma worm infection. Some species of snails can serve as the intermediate hosts for the parasite. Numerous interventions have been performed to repress the snail population. One of them is the use of molluscicide. Nevertheless, it is debated that molluscicide intervention has negative impacts on the ecosystem. To investigate the impact of more environmentally friendly interventions, we develop a schistosomiasis model with treatment, habitat modification and biological control. The biological control agent examined in our model is a snail predator. Moreover, to investigate the impact of snail habitat modification, we assume that the snail population grows logistically. We show that all solutions of our model are non-negative and bounded. We also study the existence and stability conditions of equilibrium points. The basic reproduction numbers are determined using the next-generation operator. Linearization combined with the Routh-Hurwitz criterion is used to prove the local stability condition of disease-free equilibrium points. Bifurcation theory is applied to investigate the local stability condition of the endemic equilibrium points. To examine the global behavior of our model, we use asymptotically autonomous system theory and construct a Lyapunov function. We perform several numerical simulations to validate and support our deductive results. Our results show that early treatment can reduce the basic reproduction number and schistosomiasis cases. In addition, modifying snail habitat and releasing the snail predator at the snail habitat can reduce schistosomiasis prevalence. We suggest using snail predators which can hunt and kill snails effectively as a biological control agent.

Circulating microRNAs as Biomarkers of Hepatic Fibrosis in Schistosomiasis Japonica Patients in the Philippines

Host-derived microRNAs (miRNAs) play important regulatory roles in schistosomiasis-induced hepatic fibrosis. This study analyzed selected serum miRNAs among Filipino schistosomiasis japonica patients with ultrasound (US)-detectable hepatic fibrosis. A prospective cohort study design with convenience sampling was employed from 2017 to 2019. The study sites were eight endemic barangays in Leyte, Philippines. Eligible chronic schistosomiasis patients with varying severities of hepatic fibrosis were enrolled in the cohort and serially examined at 6, 12, and 24 months from baseline. Baseline serum miR-146a-5p, let-7a-5p, miR-150-5p, miR-122-5p, miR-93-5p, and miR200b-3p were measured using RT-qPCR. A total of 136 chronic schistosomiasis patients were included in this prospective cohort study. Approximately, 42.6% had no fibrosis, 22.8% had mild fibrosis, and 34.6% had severe fibrosis at baseline The serum levels of the antifibrotic miR-146a (p < 0.0001), miR-150 (p = 0.0058), and let-7a (p < 0.0001) were significantly lower in patients with hepatic fibrosis while the profibrotic miR-93 (p = 0.0024) was elevated. miR-146a-5p (AUC = 0.90, 95% CI [0.84, 0.96], p < 0.0001) has the most promising potential to differentiate patients with (n = 78) versus without (n = 58) hepatic fibrosis. The baseline level of serum miR-146-5p was significantly different in patients with progressive fibrosis (n = 17) compared to those who never developed fibrosis (n = 30, p < 0.01) or those who had fibrosis reversal (n = 20, p < 0.01) after 24 months. These findings demonstrate the potential utility of serum miRNAs, particularly of miR-146a, as a supplementary tool for assessing hepatic fibrosis in chronic schistosomiasis japonica patients.

Spatiotemporal Distribution Pattern of Phytoplankton Community and Its Main Driving Factors in Dongting Lake, China—A Seasonal Study from 2017 to 2019

As it is the second-largest freshwater lake downstream of the Three Gorges Dam and an important international wetland for migratory birds, there have been concerns about the ecological water health of Dongting Lake for a long time. In the present study, we studied the evolutionary characteristics of water quality in Dongting Lake in three recent years. Moreover, the evolution rules and dominant groups of the phytoplankton community were explored, and the major influencing factors of phytoplankton and their distribution were assessed based on the field survey and detection data from 2017 to 2019. The results indicated that the water quality of Dongting Lake improved in recent years. The concentration of dissolved oxygen (DO) increased by 6.91%, whereas the concentrations of the five-day biochemical oxygen demand (BOD5), chemical oxygen demand (CODCr), ammonia nitrogen (NH4+–N), total phosphorus (TP), and total nitrogen (TN) decreased by 17.5%, 13.0%, 33.8%, 7.6%, and 13.3%, respectively. The mean phytoplankton density reached 4.15 × 105 cells·L−1 in September 2017, whereas it was only 1.62 × 105 cells·L−1 in December 2018. There were 15 dominant species belonging to Cyanobacteria, Chlorophyta, Bacillariophyta, Cryptophyta, and Miozoa. Moreover, Fragilaria radians (Kützing) D.M.Williams & Round and Aulacoseiragranulata (Ehrenberg) Simonsen were the dominant populations in all seasons. The Pearson and linear regression analysis also indicated that the composition and distribution of phytoplankton in Dongting Lake were mainly affected by electrical conductivity (Cond), BOD5, potassium permanganate (CODMn), and CODCr, especially in Eastern Dongting Lake. Of course, NH4+–N, TN, and TP were also the main factors affecting the density and species of the phytoplankton community, especially in Western Dongting Lake. Finally, we suggested that local government could take “The relationship between Yangtze River and Dongting Lake”, “The relationship between the seven fed rivers and Dongting Lake”, and “The relationship between human activities and Dongting Lake” as the breakthrough points to guarantee the ecological flow, water environment, and ecological quality of Dongting Lake.

Models for predicting bulinids species habitats in southwestern Nigeria

Background

Schistosomiasis prevalence is high in southwestern Nigeria and planorbids of the genus Bulinus had been implicated in the transmission of the disease in the area. The knowledge of species distribution in relation to environmental variables will be auspicious in planning control strategies.

Methods

Satellite imagery and geographic information system (GIS) were used to develop models for predicting the habitats suitable for bulinid species. Monthly snail sample collection was done in twenty-three randomly selected water contact sites using the standard method for a period of two years. Remotely sensed variables such as Land Surface Temperature (LST), Normalized Difference Vegetation Index (NDVI) were extracted from Landsat TM, ETM⁺; Slope and Elevation were obtained from digital elevation model (DEM) while Rainfall was retrieved from European Meteorology Research Program. These environmental factors and snail species were integrated into QGIS to predict the potential habitats of different bulinid species using an exploratory regression model.

Results

The following environmental variables: flat-moderate slope (0.01–15.83), LST (21.1 °C-23.4 °C), NDVI (0.19–0.52), rainfall (> 1569.34 mm) and elevation (1–278 m) contributed to the model used in predicting habitat suitable for bulinids snail intermediate hosts. Exploratory regression models showed that LST, NDVI and slope were predictors of Bulinus globosus and Bulinus jousseaumei; elevation, LST, rainfall and slope were predictors of Bulinus camerunensis; rainfall, NDVI and slope were predictors of B. senegalensis while NDVI and slope were predictors of Bulinus forskalii in the area. Bulinids in the forskalii group showed clustering in middle belt and south. The predictive risk map of B. jousseaumei was similar to the pattern described for B. globosus, but with a high R-square value of 81%.

Conclusion

The predictive risk models of bulinid species in this study provided a robust output for the study area which could be used as base-line for other areas in that ecological zone. It will be useful in appropriate allocation of scarces resources in the control of schistosomiasis in that environment.

The status of schistosomiasis japonica control in the Philippines: The need for an integrated approach to address a multidimensional problem

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Adequate and updated information is essential to enhance policy and service delivery toward control and elimination. Despite the efforts on schistosomiasis control in the Philippines, some challenges remain in these dimensions. An integrated surveillance system is recommended to determine the prevalence of infection in humans, animal reservoirs, and snail intermediate hosts, allowing the identification of high-priority areas for targeted interventions. This will entail the enhancement of laboratory diagnosis capacity through the use of more sensitive techniques, complemented by capacity building of concerned human and animal health professionals. Given the zoonotic nature of schistosomiasis japonica, adopting the One Health approach is essential to influence policies and interventions that may accelerate control and elimination. This can be achieved through the attainment of mass drug administration coverage targets and intensified case finding and management, robust implementation and integration of veterinary public health activities, the conduct of snail control measures, provision of safe water, sanitation, and hygiene services, and health promotion and education into the national schistosomiasis control and elimination program. This review aimed to describe the status of schistosomiasis japonica control in the Philippines in the context of human health, animal health, vector ecology and management, environmental health, and sociocultural dimensions.

Identification of the high-risk area for schistosomiasis transmission in China based on information value and machine learning: a newly data-driven modeling attempt

BACKGROUND

Schistosomiasis control is striving forward to transmission interruption and even elimination, evidence-lead control is of vital importance to eliminate the hidden dangers of schistosomiasis. This study attempts to identify high risk areas of schistosomiasis in China by using information value and machine learning.

METHODS

The local case distribution from schistosomiasis surveillance data in China between 2005 and 2019 was assessed based on 19 variables including climate, geography, and social economy. Seven models were built in three categories including information value (IV), three machine learning models [logistic regression (LR), random forest (RF), generalized boosted model (GBM)], and three coupled models (IV + LR, IV + RF, IV + GBM). Accuracy, area under the curve (AUC), and F1-score were used to evaluate the prediction performance of the models. The optimal model was selected to predict the risk distribution for schistosomiasis.

RESULTS

There is a more prone to schistosomiasis epidemic provided that paddy fields, grasslands, less than 2.5 km from the waterway, annual average temperature of 11.5-19.0 °C, annual average rainfall of 1000-1550 mm. IV + GBM had the highest prediction effect (accuracy = 0.878, AUC = 0.902, F1 = 0.920) compared with the other six models. The results of IV + GBM showed that the risk areas are mainly distributed in the coastal regions of the middle and lower reaches of the Yangtze River, the Poyang Lake region, and the Dongting Lake region. High-risk areas are primarily distributed in eastern Changde, western Yueyang, northeastern Yiyang, middle Changsha of Hunan province; southern Jiujiang, northern Nanchang, northeastern Shangrao, eastern Yichun in Jiangxi province; southern Jingzhou, southern Xiantao, middle Wuhan in Hubei province; southern Anqing, northwestern Guichi, eastern Wuhu in Anhui province; middle Meishan, northern Leshan, and the middle of Liangshan in Sichuan province.

CONCLUSIONS

The risk of schistosomiasis transmission in China still exists, with high-risk areas relatively concentrated in the coastal regions of the middle and lower reaches of the Yangtze River. Coupled models of IV and machine learning provide for effective analysis and prediction, forming a scientific basis for evidence-lead surveillance and control.

Patterns of relatedness and genetic diversity inferred from whole genome sequencing of archival blood fluke miracidia (Schistosoma japonicum)

Genomic approaches hold great promise for resolving unanswered questions about transmission patterns and responses to control efforts for schistosomiasis and other neglected tropical diseases. However, the cost of generating genomic data and the challenges associated with obtaining sufficient DNA from individual schistosome larvae (miracidia) from mammalian hosts have limited the application of genomic data for studying schistosomes and other complex macroparasites. Here, we demonstrate the feasibility of utilizing whole genome amplification and sequencing (WGS) to analyze individual archival miracidia. As an example, we sequenced whole genomes of 22 miracidia from 11 human hosts representing two villages in rural Sichuan, China, and used these data to evaluate patterns of relatedness and genetic diversity. We also down-sampled our dataset to test how lower coverage sequencing could increase the cost effectiveness of WGS while maintaining power to accurately infer relatedness. Collectively, our results illustrate that population-level WGS datasets are attainable for individual miracidia and represent a powerful tool for ultimately providing insight into overall genetic diversity, parasite relatedness, and transmission patterns for better design and evaluation of disease control efforts.

Current Status of Schistosomiasis Control and Prospects for Elimination in the Dongting Lake Region of the People's Republic of China

Schistosomiasis japonica is an ancient parasitic disease that has severely impacted human health causing a substantial disease burden not only to the Chinese people but also residents of other countries such as the Philippines, Indonesia and, before the 1970s, Japan. Since the founding of the new People's Republic of China (P. R. China), effective control strategies have been implemented with the result that the prevalence of schistosomiasis japonica has decreased markedly in the past 70 years. Historically, the Dongting Lake region in Hunan province is recognised as one of the most highly endemic for schistosomiasis in the P.R. China. The area is characterized by vast marshlands outside the lake embankments and, until recently, the presence of large numbers of domestic animals such as bovines, goats and sheep that can act as reservoir hosts for Schistosoma japonicum. Considerable social, economic and environmental changes have expanded the Oncomelania hupensis hupensis intermediate snail host areas in the Dongting lake region increasing the potential for both the emergence of new hot spots for schistosomiasis transmission, and for its re-emergence in areas where infection is currently under control. In this paper, we review the history, the current endemic status of schistosomiasis and the control strategies in operation in the Dongting Lake region. We also explore epidemiological factors contributing to S. japonicum transmission and highlight key research findings from studies undertaken on schistosomiasis mainly in Hunan but also other endemic Chinese provinces over the past 10 years. We also consider the implications of these research findings on current and future approaches that can lead to the sustainable integrated control and final elimination of schistosomiasis from the P. R. China and other countries in the region where this unyielding disease persists.

Change patterns of oncomelanid snail burden in areas within the Yangtze River drainage after the three gorges dam operated

BACKGROUND

An "integrated control" strategy has been implemented within seven provinces at highest risk for schistosomiasis along Yangtze River in Peoples' Republic of China (P. R. China) since 2004. Since Oncomelania hupensis is the only intermediate host of the blood fluke (Schistosoma japonicum), controlling the distribution of snails is considered an essential and effective way to reduce the risk of schistosomiasis infection. The study aimed to determine the snail area burden and annual trend among provinces with potential risk for schistosomiasis along the Yangtze River, above and below the Three Gorges Dam (TGD).

METHODS

This retrospective study utilized data previously collected from the National Parasitic Diseases Control Information Management System (NPDCIMS) on annual snail surveys from 2009 to 2017. Descriptive statistics were performed for analyzing the snail burden by provinces, counties, type of environmental location and year, and mapping was conducted to present the snails distribution.

RESULTS

From 2009 to 2017, the total snail infested area decreased by 4.22%, from 372 253 hm2 to 356 553 hm2 within the seven high risk provinces. The majority of snails were found in the marshland and lake regions, outside of control embankments. The total snail burden trend remained relatively stable in upstream regions above the TGD from 2010 to 2015, while the trend decreased within downstream regions during this period. In 2016 and 2017, the total snail burden trend increased in both upstream and downstream provinces, however, upstream saw a larger increase. From 2009 to 2017, there were a total of 5990 hm2 of newly developed snail areas in the seven study provinces and the majority were concentrated in regions below the TGD, accounting for 5610 hm2 (93.70%).

CONCLUSIONS

There has been a decline in total snail counts from 2009 to 2017. Meanwhile, new snail breeding areas were formed mainly within provinces downstream the TGD due to spread of snails, indicated that the oncomelanid snail would be difficult to completely eliminate. We suggest that the national schistosomiasis integrated control strategy, including mollusciding and environmental modification, will need to be enhanced significantly going forward to achieve a greater reduction in snail burden and ultimately to achieve elimination.

Distribution pattern of the snail intermediate host of schistosomiasis japonica in the Poyang Lake region of China

BACKGROUND

With the closure of the Three Gorges Dam in 2003 the hydrology of Poyang Lake was altered dramatically leading to significant changes in the environment. In order to assess the impact on schistosomiasis this study assessed the spatial and temporal patterns of the snail intermediate host, Oncomelania hupensis in the Poyang Lake tributaries. The results of the study have important implications for future snail control strategies leading to disease elimination.

METHODS

The marshland area surrounding Poyang Lake was divided randomly into 200 × 200 m vector grids using ArcGIS software, and the surveyed grids were randomly selected by the software. The snail survey was conducted in each selected grid using a survey frame of 50 × 50 m with one sideline of each grid serving as the starting line. No less than ten frames were used in each surveyed grid with Global Positioning System (GPS) recordings for each. All snails in each frame were collected to determine infection status by microscopy. Altitude data for all frames were extracted from a lake bottom topographic map in order to analyze the average altitude. All snail survey data were collected and statistically analyzed with SPSS 20.0 software in order to determine the difference of the percentage of frames with living snails and mean density of living snails in different regions of Poyang Lake. The altitude of the snail-infested marshlands and snail dens were subsequently identified.

RESULTS

A total of 1159 potential snail sampling grids were surveyed, of which 15 231 frames (0.1 m2/frame) were investigated. 1241 frames had live Oncomelania snails corresponding to 8.15% of the total number of frames. The mean density of living snails was 0.463/0.1 m2 with a maximum of 57 snails per frame. The percent of frames with snails in the southern sector (8.13%) of Poyang Lake did not differ statistically from the north (8.21%). However, the mean density of live snails in the northern sector (0.164/0.1 m2) of the lake was statistically higher (F = 6.727; P = 0.010) than the south (0.141/0.1 m2). In the south of the lake, the elevation of snail-inhabited marshland ranged between 11 - 16 m, and could be further subdivided into two snail-concentrated belts at 12-13 m of elevation and 15-16 m of elevation respectively. In the north of the lake, the elevation of snail-inhabited marshland ranged between 9- 16 m with the elevation of 12-14 m being the snail-concentrated zone.

CONCLUSIONS

The elevation of snail-infested marshlands in the Poyang Lake region ranged from 9 to 16 m. The snail distribution and habitat has moved north of the lake and to a lower altitude due to changes in the water level post dam closure. Based on the current geological features of the snail habitant focused mollusciciding should occur in snail dense northern regions with frequent bovine and human traffic. Targeting these identified 'hotspots' of transmission will assist in elimination efforts.

Asian Schistosomiasis: Current Status and Prospects for Control Leading to Elimination

Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People's Democratic Republic, Myanmar, and Thailand (S. mekongi); Malaysia (S. malayensis); and Indonesia, People's Republic of China, and the Philippines (S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas.

Prevalence and intensity of Schistosoma mansoni infections among schoolchildren attending primary schools in an urban setting in Southwest, Ethiopia

Objective

To determined both prevalence and intensity of Schistosoma mansoni infections among schoolchildren attending primary schools in Jimma town, an urban setting, Southwest, Ethiopia.

Results

The prevalence of S. mansoni infections was 8.4%. S. mansoni infections were found in all 17 schools, but the school prevalence ranged from 1.7 to 26.7%. This variation in prevalence could be explained by the proximity of the schools to the river crossing the town and water bodies near the schools. Boys were more infected compared to girls (χ² = 31.587, P value = 0.001; 95% CI), and the infection rate increased as a function of age (χ² = 21.187; P value = 0.001; 95 %CI). The majority of the infection intensities were of low intensity (57%), the mean number of eggs per stool equal to 17 eggs per gram of stool. Based on the prevalence (8.4%) school children in Jimma Town is considered as a low risk of morbidity caused by S. mansoni (prevalence ≤ 10% according to WHO threshold), for which it is recommended to implement MDA once every 3 years which should be supplemented with health information to create awareness about Schistosomiasis transmission. Male students were more infected than females with majority of the infection intensity were low.

Electronic supplementary material

The online version of this article (10.1186/s13104-017-3023-9) contains supplementary material, which is available to authorized users.

Identification of Potential High-Risk Habitats within the Transmission Reach of Oncomelania hupensis after Floods Based on SAR Techniques in a Plane Region in China

Schistosomiasis japonica is an infectious disease caused by Schistosoma japonicum, and it remains endemic in China. Flooding is the main hazard factor, as it causes the spread of Oncomelania hupensis, the only intermediate host of Schistosoma japonicum, thereby triggering schistosomiasis outbreaks. Based on multi-source real-time remote sensing data, we used remote sensing (RS) technology, especially synthetic aperture radar (SAR), and geographic information system (GIS) techniques to carry out warning research on potential snail habitats within the snail dispersal range following flooding. Our research result demonstrated: (1) SAR data from Sentinel-1A before and during a flood were used to identify submerged areas rapidly and effectively; (2) the likelihood of snail survival was positively correlated with the clay proportion, core area standard deviation, and ditch length but negatively correlated with the wetness index, NDVI (normalized difference vegetation index), elevation, woodland area, and construction land area; (3) the snail habitats were most abundant near rivers and ditches in paddy fields; (4) the rivers and paddy irrigation ditches in the submerged areas must be the focused of mitigation efforts following future floods.

Establishment of first engineering specifications for environmental modification to eliminate schistosomiasis epidemic foci in urban areas

Snail control is a key link in schistosomiasis control, but no unified methods for eliminating snails have been produced to date. This study was conducted to explore an engineering method for eliminating Oncomelania hupensis applicable to urban areas. The engineering specifications were established using the Delphi method. An engineering project based on these specifications was conducted in Hankou marshland to eliminate snails, including the transformation of the beach surface and ditches. Molluscicide was used as a supplement. The snail control effect was evaluated by field investigation. The engineering results fulfilled the requirements of the design. The snail density decreased to 0/0.11m², and the snail area dropped to 0m² after the project. There was a statistically significant difference in the number of frames with snails before and after the project (P<0.05). Snails were completely eliminated through one year of continuous monitoring, and no new snails were found after a flood disaster. This study demonstrates that engineering specifications for environmental modification were successfully established. Environmental modification, mainly through beach and ditch remediation, can completely change the environment of Oncomelania breeding. This method of environmental modification combined with mollusciciding was highly effective at eliminating snails.

Impact of the Three Gorges project on ecological environment changes and snail distribution in Dongting Lake area

BACKGROUND

The Three Gorges Dam (TGD) is a remarkable, far-reaching project in China. This study was conducted to assess the impact of TGD on changes in the ecological environment, snail distribution and schistosomiasis transmission in Dongting Lake area.

METHODS

Hydrological data were collected from 12 monitoring sites in Hunan section of Yangtze River before and after TGD was established. Data on snail distribution and human schistosomiasis infection were also collected. Correlation analyses were performed to detect the significance of snail distribution to changes in ecological environmental factors and human schistosomiasis infection.

FINDINGS

A series of ecological environmental factors have changed in Dongting Lake area following the operation of TGD. Volume of annual runoff discharged into Dongting Lake declined by 20.85%. Annual sediment volume discharged into the lake and the mean lake sedimentation rate decreased by 73.9% and 32.2%, respectively. From 2003 to 2015, occurrence rate of frames with living snails and mean density of living snails decreased overall by 82.43% and 94.35%, respectively, with annual decrements being 13.49% and 21.29%. Moreover, human infection rate of schistosomiasis had decreased from 3.38% in 2003 to 0.44% in 2015, with a reduction of 86.98%. Correlation analyses showed that mean density of living snails was significantly associated with water level (r = 0.588, p<0.001), as well as the mean elevation range of the bottomland (r = 0.374, p = 0.025) and infection rate of schistosomiasis (r = 0.865, p<0.001).

CONCLUSION

Ecological environmental changes caused by the TGD were associated with distribution of snails, and might further affect the transmission and prevalence of schistosomiasis. Risk of schistosomiasis transmission still exists in Dongting Lake area and long-term monitoring is required.

Big-data-driven modeling unveils country-wide drivers of endemic schistosomiasis

Schistosomiasis is a parasitic infection that is widespread in sub-Saharan Africa, where it represents a major health problem. We study the drivers of its geographical distribution in Senegal via a spatially explicit network model accounting for epidemiological dynamics driven by local socioeconomic and environmental conditions, and human mobility. The model is parameterized by tapping several available geodatabases and a large dataset of mobile phone traces. It reliably reproduces the observed spatial patterns of regional schistosomiasis prevalence throughout the country, provided that spatial heterogeneity and human mobility are suitably accounted for. Specifically, a fine-grained description of the socioeconomic and environmental heterogeneities involved in local disease transmission is crucial to capturing the spatial variability of disease prevalence, while the inclusion of human mobility significantly improves the explanatory power of the model. Concerning human movement, we find that moderate mobility may reduce disease prevalence, whereas either high or low mobility may result in increased prevalence of infection. The effects of control strategies based on exposure and contamination reduction via improved access to safe water or educational campaigns are also analyzed. To our knowledge, this represents the first application of an integrative schistosomiasis transmission model at a whole-country scale.

Village-based spatio-temporal cluster analysis of the schistosomiasis risk in the Poyang Lake Region, China

Background

The Poyang Lake Region, one of the major epidemic sites of schistosomiasis in China, remains a severe challenge. To improve our understanding of the current endemic status of schistosomiasis and to better control the transmission of the disease in the Poyang Lake Region, it is important to analyse the clustering pattern of schistosomiasis and detect the hotspots of transmission risk.

Results

Based on annual surveillance data, at the village level in this region from 2009 to 2014, spatial and temporal cluster analyses were conducted to assess the pattern of schistosomiasis infection risk among humans through purely spatial (Local Moran’s I, Kulldorff and Flexible scan statistic) and space-time scan statistics (Kulldorff). A dramatic decline was found in the infection rate during the study period, which was shown to be maintained at a low level. The number of spatial clusters declined over time and were concentrated in counties around Poyang Lake, including Yugan, Yongxiu, Nanchang, Xingzi, Xinjian, De’an as well as Pengze, situated along the Yangtze River and the most serious area found in this study. Space-time analysis revealed that the clustering time frame appeared between 2009 and 2011 and the most likely cluster with the widest range was particularly concentrated in Pengze County.

Conclusions

This study detected areas at high risk for schistosomiasis both in space and time at the village level from 2009 to 2014 in Poyang Lake Region. The high-risk areas are now more concentrated and mainly distributed at the river inflows Poyang Lake and along Yangtze River in Pengze County. It was assumed that the water projects including reservoirs and a recently breached dyke in this area were partly to blame. This study points out that attempts to reduce the negative effects of water projects in China should focus on the Poyang Lake Region.

Cloning and in vitro characterization of a Schistosoma japonicum aquaglyceroporin that functions in osmoregulation

As one of the three major human pathogens that cause schistosomiasis, Schistosoma japonicum is the only one that is endemic in China. Despite great progress on schistosomiasis control over the past 50 years in China, S. japonicum transmission still occurs in certain endemic regions, which causes significant public health problems and enormous economic losses. During different life stages, parasites are able to survive dramatic osmolality changes between its vector, fresh water, and mammal host. However, the molecular mechanism of parasite osmoregulation remains unknown. To address this challenging question, we report the first cloning of an S. japonicum aquaglyceroporin (SjAQP) from an isolate from Jiangsu province, China. Expressing SjAQP in Xenopus oocytes facilitated the permeation of water, glycerol, and urea. The water permeability of SjAQP was inhibited by 1 mM HgCl2, 3 mM tetraethylammonium, 1 mM ZnCl2, and 1 mM CuSO4. SjAQP was constitutively expressed throughout the S. japonicum life cycle, including in the egg, miracidia, cercaria, and adult stages. The highest expression was detected during the infective cercaria stage. Our results suggest that SjAQP plays a role in osmoregulation throughout the S. japonicum life cycle, especially during cercariae transformation, which enables parasites to survive osmotic challenges.

The Three Gorges Dam: Does it accelerate or delay the progress towards eliminating transmission of schistosomiasis in China?

The Three Gorges Dam, located in the largest endemic area of schistosomiasis in China, is one of the world’s largest hydroelectric projects to date. Some large-scale hydro projects have resulted in schistosomiasis emergence or re-emergence. Therefore, the dam’s potential impact on the transmission of Schistosoma japonicum has raised concerns from medical researchers worldwide. A systematic literature review, coupled with an analysis of data on the water level and snail density in the Yangtze River was conducted to assess the impact of the dam on schistosomiasis transmission after more than 10 years of operation. The dam has significantly altered the water levels in the Yangtze River according to different seasons. These changes directly impact the ecology of the schistosome snail host. Due to the dam, there has been a reduction in the density of Oncomelania snails and/or changes in the distribution of snails. The prevalence of infection with S. japonicum has decreased in the downstream areas of the dam, including in the Dongting and Poyang Lakes. The prevalence of infection with S. japonicum in humans has decreased from 6.80 % in 2002 (before the dam began operating) to 0.50 % in 2012, and the number of people infected with S. japonicum have decreased from 94 208 in 2002 to 59 200 in 2011 in the Poyang Lake region. The presence of the dam does not seem to affect snail breeding or the prevalence of schistosomiasis in the Three Gorges Reservoir. Overall, the Three Gorges Dam has significantly contributed to changes in hydrology after more than 10 years of the dam operating. The changes caused by the dam, together with integrated control of schistosomiasis, might be accelerating the progress towards eliminating the transmission of S. japonicum in the middle and lower reaches of the Yangtze River. Despite the positive effect the dam is having in controlling S. japonicum transmission, continued surveillance is required to monitor the future ecological impacts of the dam over the long term.

Integrated Control Strategy of Schistosomiasis in The People's Republic of China: Projects Involving Agriculture, Water Conservancy, Forestry, Sanitation and Environmental Modification

Among the three major schistosome species infecting human beings, Schistosoma japonicum is the only endemic species in The People's Republic of China. Schistosomiasis is endemic in 78 countries and regions and poses a severe threat to public health and socioeconomic development. Through more than 60years of hard work and endeavour, The People's Republic of China has made considerable achievements and reduced the morbidity and prevalence of this disease to the lowest level ever recorded, especially since the introduction of the new integrated control strategy in 2004. This review illustrates the strategies implemented by giving successful examples of schistosomiasis control from the different types of remaining endemic areas. The challenge to control or eliminate S. japonicum is analysed in order to provide useful information to policy makers and scientists.

Assessing the influence of water level on schistosomiasis in Dongting Lake region before and after the construction of Three Gorges Dam

Schistosomiasis is a severe public health problem in the Dongting Lake region, and its distribution, prevalence, and intensity of infection are particularly sensitive to environmental changes. In this study, the human and bovine schistosomiasis variations in the Dongting Lake region were studied from 1996 to 2010, and the relationships between schistosomiasis and water level were examined. Furthermore, based on these results, the potential effects of the Three Gorges Dam (TGD) on schistosomiasis were investigated. Results showed an increase in human schistosomiasis and in the scope of seriously affected regions, along with a decrease in bovine schistosomiasis. Human schistosomiasis was negatively correlated with water level during wet season (from May to October), particularly the average water level in October. This finding indicated that the decreasing water level may be highly related to the increasing of human schistosomiasis in the Dongting Lake region. Based on this result and the variation of schistosomiasis before and after the construction and operation of TGD, the impoundment of the Three Gorges reservoir is believed to decrease the water level and increase the contact between people and schistosomiasis. Therefore, the TGD, which is operated by regulating water and scheduling water operations, is not good for the control of human schistosomiasis in the Dongting Lake region. Although the extent of the influence of the TGD on schistosomiasis remains unclear, the influence of the TGD on preventing and controlling schistosomiasis should not be ignored.

Identification of optimum scopes of environmental factors for snails using spatial analysis techniques in Dongting Lake Region, China

BACKGROUND

Owing to the harmfulness and seriousness of Schistosomiasis japonica in China, the control and prevention of S. japonica transmission are imperative. As the unique intermediate host of this disease, Oncomelania hupensis plays an important role in the transmission. It has been reported that the snail population in Qiangliang Lake district, Dongting Lake Region has been naturally declining and is slowly becoming extinct. Considering the changes of environmental factors that may cause this phenomenon, we try to explore the relationship between circumstance elements and snails, and then search for the possible optimum scopes of environmental factors for snails.

METHODS

Moisture content of soil, pH, temperature of soil and elevation were collected by corresponding apparatus in the study sites. The LISA statistic and GWR model were used to analyze the association between factors and mean snail density, and the values in high-high clustered areas and low-low clustered areas were extracted to find out the possible optimum ranges of these elements for snails.

RESULTS

A total of 8,589 snail specimens were collected from 397 sampling sites in the study field. Besides the mean snail density, three environmental factors including water content, pH and temperature had high spatial autocorrelation. The spatial clustering suggested that the possible optimum scopes of moisture content, pH, temperature of the soil and elevation were 58.70 to 68.93%, 6.80 to 7.80, 22.73 to 24.23°C and 23.50 to 25.97 m, respectively. Moreover, the GWR model showed that the possible optimum ranges of these four factors were 36.58 to 61.08%, 6.541 to 6.89, 24.30 to 25.70°C and 23.50 to 29.44 m, respectively.

CONCLUSION

The results indicated the association between snails and environmental factors was not linear but U-shaped. Considering the results of two analysis methods, the possible optimum scopes of moisture content, pH, temperature of the soil and elevation were 58.70% to 68.93%, 6.6 to 7.0, 22.73°C to 24.23°C, and 23.5 m to 26.0 m, respectively. The findings in this research will help in making an effective strategy to control snails and provide a method to analyze other factors.

New integrated strategy emphasizing infection source control to curb Schistosomiasis japonica in a marshland area of Hubei Province, China: findings from an eight-year longitudinal survey

Background

Schistosomiasis remains a major public health problem in China. The major endemic foci are the lake and marshland regions of southern China, particularly the regions along the middle and lower reach of the Yangtze River in four provinces (Hubei, Hunan, Jiangxi, and Anhui). The purpose of our study is to assess the effect of a new integrated strategy emphasizing infection source control to curb schistosomiasis in marshland regions.

Methods

In a longitudinal study, we implemented an integrated control strategy emphasizing infection source control in 16 villages from 2005 through 2012 in marshland regions of Hubei province. The interventions included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water, building lavatories and latrines, praziquantel chemotherapy, controlling snails, and environmental modification.

Results

Following the integrated control strategy designed to reduce the role of bovines and humans as sources of Schistosoma japonicum infection, the prevalence of human S. japonicum infection declined from 1.7% in 2005 to 0.4% in 2012 (P<0.001). Reductions were also observed in both sexes, across all age groups, and among high risk occupations. Moreover, the prevalence of bovine S. japonicum infection decreased from 11.7% in 2005 to 0.6% in 2012 (P<0.001). In addition, all the 16 villages achieved the national criteria of infection control in 2008.

Conclusion

Our findings indicate that the integrated strategy was likely effective in controlling the transmission of S. japonicum in marshland regions in China.

Health access livelihood framework reveals potential barriers in the control of schistosomiasis in the Dongting Lake area of Hunan Province, China

Background

Access to health care is a major requirement in improving health and fostering socioeconomic development. In the People's Republic of China (P.R. China), considerable changes have occurred in the social, economic, and health systems with a shift from a centrally planned to a socialist market economy. This brought about great benefits and new challenges, particularly for vertical disease control programs, including schistosomiasis. We explored systemic barriers in access to equitable and effective control of schistosomiasis.

Methodology

Between August 2002 and February 2003, 66 interviews with staff from anti-schistosomiasis control stations and six focus group discussions with health personnel were conducted in the Dongting Lake area, Hunan Province. Additionally, 79 patients with advanced schistosomiasis japonica were interviewed. The health access livelihood framework was utilized to examine availability, accessibility, affordability, adequacy, and acceptability of schistosomiasis-related health care.

Principal Findings

We found sufficient availability of infrastructure and human resources at most control stations. Many patients with advanced schistosomiasis resided in non-endemic or moderately endemic areas, however, with poor accessibility to disease-specific knowledge and specialized health services. Moreover, none of the patients interviewed had any form of health insurance, resulting in high out-of-pocket expenditure or unaffordable care. Reports on the adequacy and acceptability of care were mixed.

Conclusions/Significance

There is a need to strengthen health awareness and schistosomiasis surveillance in post-transmission control settings, as well as to reduce diagnostic and treatment costs. Further studies are needed to gain a multi-layered, in-depth understanding of remaining barriers, so that the ultimate goal of schistosomiasis elimination in P.R. China can be reached.

China has made great strides toward reducing the burden of schistosomiasis, facilitated by sustained political commitment and a multi-faceted, integrated control strategy. The ultimate goal is disease elimination, which might be challenging due to high rates of re-infection, clusters of re-emergence, and growing health disparities. Market-oriented reforms and system-wide policies within the health care system offer new opportunities, but also entail challenges for the national schistosomiasis control program. Few studies have examined systemic barriers to equitable and effective schistosomiasis control in China. We explored the five core dimensions of access to health care, placing emphasis on schistosomiasis in the Dongting Lake area of Hunan Province. We collected and analyzed perspectives from staff working at local anti-schistosomiasis control stations and designated schistosomiasis hospitals, and from patients with advanced schistosomiasis. Our data suggest that a lack of affordability and high out-of-pocket expenditure posed a major barrier to the health care users, as did a lack of relevant health-information, and poorly accessible diagnostic and specialized surgical services. The lessons learned from this work are important in the design and development of disease control programs and entail key policy implications for schistosomiasis elimination.

Water-related parasitic diseases in China

Water-related parasitic diseases are directly dependent on water bodies for their spread or as a habitat for indispensable intermediate or final hosts. Along with socioeconomic development and improvement of sanitation, overall prevalence is declining in the China. However, the heterogeneity in economic development and the inequity of access to public services result in considerable burden due to parasitic diseases in certain areas and populations across the country. In this review, we demonstrated three aspects of ten major water-related parasitic diseases, i.e., the biology and pathogenicity, epidemiology and recent advances in research in China. General measures for diseases control and special control strategies are summarized.

Five-year longitudinal assessment of the downstream impact on schistosomiasis transmission following closure of the Three Gorges Dam

BACKGROUND

Schistosoma japonicum is a major public health concern in the Peoples' Republic of China (PRC), with about 800,000 people infected and another 50 million living in areas at risk of infection. Based on ecological, environmental, population genetic and molecular factors, schistosomiasis transmission in PRC can be categorised into four discrete ecosystems or transmission modes. It is predicted that, long-term, the Three Gorges Dam (TGD) will impact upon the transmission of schistosomiasis in the PRC, with varying degree across the four transmission modes.

METHODOLOGY/PRINCIPAL FINDINGS

We undertook longitudinal surveillance from 2002 to 2006 in sentinel villages of the three transmission modes below the TGD across four provinces (Hunan, Jiangxi, Hubei and Anhui) to determine whether there was any immediate impact of the TGD on schistosomiasis transmission. Eight sentinel villages were selected to represent both province and transmission mode. The primary end point measured was human incidence. Here we present the results of this five-year longitudinal cohort study. Results showed that the incidence of human S. japonicum infection declined considerably within individual villages and overall mode over the course of the study. This is also reflected in the yearly odds ratios (adjusted) for infection risk that showed significant (P<0.01) downward trends in all modes over the follow-up period.

CONCLUSIONS/SIGNIFICANCE

The decrease in human S. japonicum incidence observed across all transmission modes in this study can probably be attributed to the annual human and bovine PZQ chemotherapy. If an increase in schistosome transmission had occurred as a result of the TGD, it would be of negligible size compared to the treatment induced decline seen here. It appears therefore that there has been virtually no immediate impact of the TGD on schistosomiasis transmission downstream of the dam.

From innovation to application: social-ecological context, diagnostics, drugs and integrated control of schistosomiasis

Compared to malaria, tuberculosis and HIV/AIDS, schistosomiasis remains a truly neglected tropical disease. Schistosomiasis, perhaps more than any other disease, is entrenched in prevailing social-ecological systems, since transmission is governed by human behaviour (e.g. open defecation and patterns of unprotected surface water contacts) and ecological features (e.g. living in close proximity to suitable freshwater bodies in which intermediate host snails proliferate). Moreover, schistosomiasis is intimately linked with poverty and the disease has spread to previously non-endemic areas as a result of demographic, ecological and engineering transformations. Importantly though, thanks to increased advocacy there is growing awareness, financial and technical support to control and eventually eliminate schistosomiasis as a public health problem at local, regional and global scales. The purpose of this review is to highlight recent progress made in innovation, validation and application of new tools and strategies for research and integrated control of schistosomiasis. First, we explain that schistosomiasis is deeply embedded in social-ecological systems and explore linkages with poverty. We then summarize and challenge global statistics, risk maps and burden estimates of human schistosomiasis. Discovery and development research pertaining to novel diagnostics and drugs forms the centrepiece of our review. We discuss unresolved issues and emerging opportunities for integrated and sustainable control of schistosomiasis and conclude with a series of research needs.

Schistosomiasis research in the dongting lake region and its impact on local and national treatment and control in China

Schistosomiasis is a chronic and debilitating parasitic disease that has often been neglected because it is a disease of poverty, affecting poor rural communities in the developing world. This is not the case in the People's Republic of China (PRC), where the disease, caused by Schistosoma japonicum, has long captured the attention of the Chinese authorities who have, over the past 50–60 years, undertaken remarkably successful control programs that have substantially reduced the schistosomiasis disease burden. The Dongting Lake region in Hunan province is one of the major schistosome-endemic areas in the PRC due to its vast marshland habitats for the Oncomelania snail intermediate hosts of S. japonicum. Along with social, demographic, and other environmental factors, the recent completion and closure of the Three Gorges dam will most likely increase the range of these snail habitats, with the potential for re-emergence of schistosomiasis and increased transmission in Hunan and other schistosome-endemic provinces being a particular concern. In this paper, we review the history and the current status of schistosomiasis control in the Dongting Lake region. We explore the epidemiological factors contributing to S. japonicum transmission there, and summarise some of the key research findings from studies undertaken on schistosomiasis in Hunan province over the past 10 years. The impact of this research on current and future approaches for sustainable integrated control of schistosomiasis in this and other endemic areas in the PRC is emphasised.

Risk factors for helminth infections in a rural and a peri-urban setting of the Dongting Lake area, People's Republic of China

Schistosomiasis japonica and soil-transmitted helminthiasis are endemic parasitic diseases in the People's Republic of China (PR China). As very few studies have reported on the distribution and interaction of multiple species helminth infections, we carried out a comparative study of households in a rural village and a peri-urban setting in the Dongting Lake area of Hunan province in November and December 2006 to determine the extent of single and multiple species infections, the underlying risk factors for infection, and the relationships with clinical manifestations and self-reported morbidity. In each household, stool samples were collected and subjected to the Kato-Katz method for identifying Schistosoma japonicum, Ascaris lumbricoides, hookworm and Trichuris trichiura infections. Clinical examinations were performed and questionnaire surveys conducted at both household and individual subject levels. Complete parasitological, clinical and questionnaire data were obtained for 1,298 inhabitants of the two settings. The overall prevalences of single infections of S. japonicum, A. lumbricoides, hookworm and T. trichiura were 6.5%, 5.5%, 3.0% and 0.8%, respectively; the majority of the infections were of light intensity. We found significant negative associations between wealth and infections with S. japonicum and A. lumbricoides. Clinical manifestations of splenomegaly, hepatomegaly and anaemia were prevalent (9.0%, 3.7% and 10.9%, respectively), the latter two being significantly (P<0.05) associated with schistosomiasis. Self-reported symptoms were more common among females but there was considerable under-reporting in both sexes when relying only on spontaneous recall. Our findings may guide the design and targeting of a more equitable, comprehensive and integrated parasitic disease control programme in Hunan province and in other areas of PR China.

Schistosomiasis japonica control and research needs

Schistosomiasis japonica, a chronic and debilitating disease caused by the blood fluke Schistosoma japonicum, is still of considerable economic and public health concern in the People's Republic of China, the Philippines, and Indonesia. Despite major progress made over the past several decades with the control of schistosomiasis japonica in the aforementioned countries, the disease is emerging in some areas. We review the epidemiological status and transmission patterns of schistosomiasis japonica, placing it into a historical context, and discuss experiences and lessons with national control efforts. Our analyses reveal that an integrated control approach, implemented through intersectoral collaboration, is essential to bring down the prevalence and intensity of Schistosoma japonicum infections and disease-related morbidity, and to sustain these parameters at low levels. The need for innovation and a sufficiently flexible control approach to adapt interventions in response to the changing nature and challenges of schistosomiasis control from the initial phase of morbidity control to the final state of elimination is emphasised. The aim of the presentation and the analyses is to inspire researchers and disease control managers elsewhere in Asia, Africa, and the Americas to harness the experiences gained and the lessons presented here to improve the control and eventual elimination of schistosomiasis and parasitic diseases.

Schistosomiasis in the People's Republic of China: the era of the Three Gorges Dam

The potential impact of the Three Gorges Dam (TGD) on schistosomiasis transmission in China has invoked considerable global concern. The TGD will result in changes in the water level and silt deposition downstream, favoring the reproduction of Oncomelania snails. Combined with blockages of the Yangtze River's tributaries, these changes will increase the schistosomiasis transmission season within the marshlands along the middle and lower reaches of the Yangtze River. The changing schistosome transmission dynamics necessitate a comprehensive strategy to control schistosomiasis. This review discusses aspects of the epidemiology and transmission of Schistosoma japonicum in China and considers the pathology, clinical outcomes, diagnosis, treatment, immunobiology, and genetics of schistosomiasis japonica together with an overview of current progress in vaccine development, all of which will have an impact on future control efforts. The use of synchronous praziquantel (PZQ) chemotherapy for humans and domestic animals is only temporarily effective, as schistosome reinfection occurs rapidly. Drug delivery requires a substantial infrastructure to regularly cover all parts of an area of endemicity. This makes chemotherapy expensive and, as compliance is often low, a less than satisfactory control option. There is increasing disquiet about the possibility that PZQ-resistant schistosomes will develop. Consequently, as mathematical modeling predicts, vaccine strategies represent an essential component in the future control of schistosomiasis in China. With the inclusion of focal mollusciciding, improvements in sanitation, and health education into the control scenario, China's target of reducing the level of schistosome infection to less than 1% by 2015 may be achievable.

Schistosomiasis-associated pulmonary hypertension: pulmonary vascular disease: the global perspective

Inflammation is likely a critical underlying etiology in many forms of severe pulmonary hypertension (PH), and schistosomiasis-associated PH, one of the most common causes of PH worldwide, is likely driven by the host response to parasite antigens. More than 200 million people are infected with schistosomiasis, the third most common parasitic disease, and approximately 1% of those chronically infected develop PH. Acute cutaneous infection causes inflammation at the site of parasite penetration followed by a subacute immune complex-mediated hypersensitivity response as the parasite migrates through the lungs. Chronic schistosomiasis infection induces a granulomatous inflammation around ova deposited in the tissue. In particular, Schistosoma mansoni migrates to the portal venous system and causes preportal fibrosis in a subset of individuals and appears to be a prerequisite for PH. Portal hypertension facilitates shunting of ova from the portal system to the pulmonary arterial tree, resulting in localized periovular pulmonary granulomas. The pulmonary vascular remodeling is likely a direct consequence of the host inflammatory response, and portopulmonary hypertension may be a significant contributor. New specific therapies available for PH have not been widely tested in patients with schistosomiasis and often are unavailable for those infected in resource-poor areas of the world where schistosomiasis is endemic. Furthermore, the current PH therapies in general target vasodilation rather than vascular remodeling and inflammation. Further research is needed into the pathogenic mechanism by which this parasitic infection results in pulmonary vascular remodeling and PH, which also may be informative regarding the etiology of other types of PH.

Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of caution

In May 2001, the World Health Assembly (WHA) passed a resolution which urged member states to attain, by 2010, a minimum target of regularly administering anthelminthic drugs to at least 75% and up to 100% of all school-aged children at risk of morbidity. The refined global strategy for the prevention and control of schistosomiasis and soil-transmitted helminthiasis was issued in the following year and large-scale administration of anthelminthic drugs endorsed as the central feature. This strategy has subsequently been termed 'preventive chemotherapy'. Clearly, the 2001 WHA resolution led the way for concurrently controlling multiple neglected tropical diseases. In this paper, we recall the schistosomiasis situation in Africa in mid-2003. Adhering to strategic guidelines issued by the World Health Organization, we estimate the projected annual treatment needs with praziquantel among the school-aged population and critically discuss these estimates. The important role of geospatial tools for disease risk mapping, surveillance and predictions for resource allocation is emphasised. We clarify that schistosomiasis is only one of many neglected tropical diseases and that considerable uncertainties remain regarding global burden estimates. We examine new control initiatives targeting schistosomiasis and other tropical diseases that are often neglected. The prospect and challenges of integrated control are discussed and the need for combining biomedical, educational and engineering strategies and geospatial tools for sustainable disease control are highlighted. We conclude that, for achieving integrated and sustainable control of neglected tropical diseases, a set of interventions must be tailored to a given endemic setting and fine-tuned over time in response to the changing nature and impact of control. Consequently, besides the environment, the prevailing demographic, health and social systems contexts need to be considered.

Toward holistic evaluation and assessment: linking ecosystems and human well-being for the three gorges dam

A significant challenge exists in assessing the social and ecological impacts of development projects in a holistic and comprehensive manner. Our objective is to elucidate the linkages between ecological change and human well-being, and its importance in integrated assessment policy for development projects, using the Three Gorges Dam (China) as a case study. A collaborative research initiative was undertaken to review and synthesize published information on the ecological and human health effects of the Three Gorges Dam. Our synthesis suggests that the Three Gorges Dam has altered social-ecological dynamics of human health and ecosystem function in the Yangtze River basin with significant consequences for human well-being. Direct impacts to human well-being were grouped into four primary categories, including: (1) toxicological impacts; (2) shifting infectious disease dynamics; (3) natural hazards; and (4) social health. Social-ecological relationships were altered in complex ways, with both direct and indirect effects, positive and negative interactions, and chronic and acute impacts on human well-being. Our synthesis supports a comprehensive evaluation of development projects via integrated assessments of human and environmental consequences. This is probably best achieved through a coupled social-environmental impact assessment to ensure holistic and comprehensive analyses of expected costs and benefits. The role of research can thereby be to elucidate the linkages between ecosystems and human health to better inform the assessment process. A synthesis of the existing information on the Three Gorges suggests that this is best achieved through institutional collaboration and transdisciplinary integration of expertise.

The Schistosoma japonicum genome reveals features of host-parasite interplay

Schistosoma japonicum is a parasitic flatworm that causes human schistosomiasis, which is a significant cause of morbidity in China and the Philippines. Here we present a draft genomic sequence for the worm. The genome provides a global insight into the molecular architecture and host interaction of this complex metazoan pathogen, revealing that it can exploit host nutrients, neuroendocrine hormones and signalling pathways for growth, development and maturation. Having a complex nervous system and a well-developed sensory system, S. japonicum can accept stimulation of the corresponding ligands as a physiological response to different environments, such as fresh water or the tissues of its intermediate and mammalian hosts. Numerous proteases, including cercarial elastase, are implicated in mammalian skin penetration and haemoglobin degradation. The genomic information will serve as a valuable platform to facilitate development of new interventions for schistosomiasis control.

Spatial distribution of human Schistosoma japonicum infections in the Dongting Lake Region, China

Background

The aim of this study was to spatially model the effect of demographic, reservoir hosts and environmental factors on human Schistosoma japonicum infection prevalence in the Dongting Lake area of Hunan Province, China and to determine the potential of each indicator in targeting schistosomiasis control.

Methodology/Principal Findings

Cross-sectional serological, coprological and demographic data were obtained from the 2004 nationwide periodic epidemiologic survey for Hunan Province. Environmental data were downloaded from the USGS EROS data centre. Bayesian geostatistical models were employed for spatial analysis of the infection prevalence among study participants. A total of 47,139 participants from 47 administrative villages were selected. Age, sex and occupation of residents and the presence of infected buffaloes and environmental factors, i.e. NDVI, distance to the lake and endemic type of setting, were significantly associated with S. japonicum infection prevalence. After taking into account spatial correlation, however, only demographic factors (age, sex and occupation) and the presence of infected buffaloes remained significant indicators.

Conclusions/Significance

Long established demographic factors, as well presence of host reservoirs rather than environmental factors are driving human transmission. Findings of this work can be used for epidemiologic surveillance and for the future planning of interventions in the Dongting Lake area of Hunan Province.

Conquering 'snail fever': schistosomiasis and its control in China

Schistosomiasis japonica is a serious parasitic disease and a major health risk for more than 60 million people living in the tropical and subtropical zones of south China. The disease is a zoonosis and its cause, the parasitic trematode Schistosoma japonicum, has a range of mammalian reservoirs, making control efforts difficult. Current control programs are heavily based on community chemotherapy with a single dose of the highly effective drug praziquantel. However, vaccines (for use in bovines and in humans) in combination with other control strategies are needed to eliminate the disease. In this review, we provide an overview of the transmission, clinical features, pathogenesis, diagnosis, treatment, genetics and susceptibility, epidemiology, and prospects for control of schistosomiasis japonica in China. The threat posed by the Three Gorges Dam may undermine control efforts because it will change the local ecology and associated schistosomiasis transmission risks over the next decade and beyond.

Host-parasite relations and implications for control

This paper considers the various measures available to control several of the neglected tropical diseases (NTDs). To develop the optimum methods for controlling the parasites that cause these NTDs, knowledge of the life cycles of both the parasites and their vectors are essential. Each NTD requires its own strategy for control based on detailed knowledge of the life cycle, and vector control, chemotherapy, better water supplies and better hygiene are all components that may be appropriate. For some diseases, improved drugs are urgently required, for some the tools are available for elimination, while uniquely guinea worm could be eradicated without any chemotherapeutic drug being used. Several NTDs lend themselves to mass drug administration (MDA) in which human populations are annually offered safe, effective and usually donated drugs with a view to morbidity control and/or elimination. The drugs could and should be used to improve the quality of millions of lives, prevent suffering, stigma, disfigurement and early death. The role of pharmaceutical companies who have donated their drugs for the treatment of millions of disadvantaged people in the developing world is acknowledged. One result of such drug pressure however is that evolutionary change may result, and it is incumbent on scientists during monitoring and evaluation of control programmes to ensure that such changes are recognised. One other unfortunate development is that a paucity of newly trained vector-borne disease experts may constrain future control efforts.

Bayesian geostatistical modelling for mapping schistosomiasis transmission

Progress has been made in mapping and predicting the risk of schistosomiasis using Bayesian geostatistical inference. Applications primarily focused on risk profiling of prevalence rather than infection intensity, although the latter is particularly important for morbidity control. In this review, the underlying assumptions used in a study mapping Schistosoma mansoni infection intensity in East Africa are examined. We argue that the assumption of stationarity needs to be relaxed, and that the negative binomial assumption might result in misleading inference because of a high number of excess zeros (individuals without an infection). We developed a Bayesian geostatistical zero-inflated (ZI) regression model that assumes a non-stationary spatial process. Our model is validated with a high-quality georeferenced database from western Côte d'Ivoire, consisting of demographic, environmental, parasitological and socio-economic data. Nearly 40% of the 3818 participating schoolchildren were infected with S. mansoni, and the mean egg count among infected children was 162 eggs per gram of stool (EPG), ranging between 24 and 6768 EPG. Compared to a negative binomial and ZI Poisson and negative binomial models, the Bayesian non-stationary ZI negative binomial model showed a better fit to the data. We conclude that geostatistical ZI models produce more accurate maps of helminth infection intensity than the spatial negative binomial ones.

Spatial epidemiology in zoonotic parasitic diseases: insights gained at the 1st International Symposium on Geospatial Health in Lijiang, China, 2007

The 1st International Symposium on Geospatial Health was convened in Lijiang, Yunnan province, People's Republic of China from 8 to 9 September, 2007. The objective was to review progress made with the application of spatial techniques on zoonotic parasitic diseases, particularly in Southeast Asia. The symposium featured 71 presentations covering soil-transmitted and water-borne helminth infections, as well as arthropod-borne diseases such as leishmaniasis, malaria and lymphatic filariasis. The work made public at this occasion is briefly summarized here to highlight the advances made and to put forth research priorities in this area. Approaches such as geographical information systems (GIS), global positioning systems (GPS) and remote sensing (RS), including spatial statistics, web-based GIS and map visualization of field investigations, figured prominently in the presentation.