Status of Helminthic Infections in Residents around River Basins in the Republic of Korea for 10 Years (2011-2020)

Risk factors for Clonorchis sinensis infections and control measures reinforced with focused interviews

Clonorchiosis, a disease that develops following the consumption of raw freshwater fish that harbors Clonorchis sinensis metacercariae, seriously threatens the health of residents in endemic areas. We aimed to assess the level of awareness of liver fluke infections among infected residents and restaurant workers in liver fluke infection-endemic areas. To identify and provide a more realistic description of C. sinensis infections, we conducted a focused interview and questionnaire survey of local residents in endemic areas in Korea. Most residents knew that freshwater fish are a source of C. sinensis infection. Nevertheless, the consumption of raw freshwater fish was the main risk factor for their infection with C. sinensis. The residents had little knowledge regarding their residential area being endemic to C. sinensis or about the symptoms and complications of C. sinensis infection. Although the participants had no experience with C. sinensis prevention or health education, they preferred on-site education during visits to village halls. The in-depth interviewees had a high level of knowledge about C. sinensis infection but were unaware that eating raw freshwater fish was its cause. Family and social gatherings encourage the habit of eating raw freshwater fish, which is a risk factor for repetitive infections. Based on these findings, to eliminate clonorchiosis, we propose strengthening the capacity of public health care personnel, giving C. sinensis prevention education, and screening educational videos during visits to village halls. Furthermore, intensive education is recommended for reinfected people and community opinion leaders, as well as reservoir host control.

Age, period, and cohort effects of Clonorchis sinensis infection prevalence in the Republic of Korea: Insights and projections

BACKGROUND

With decades of containment efforts, the prevalence of C. sinensis infection in Korea has shown a declining trend. However, well-tailored intervention assessments remain challenging, particularly when considering the potential impacts of cohort variations in raw freshwater fish consumption behavior, a major transmission route to humans, on this observed decline.

METHODOLOGY

We applied an age-period-cohort modeling approach to nationally representative C. sinensis infection prevalence data from 1981-2012 in Korea to assess age, period, and cohort effects on its secular trend and to project the age-stratified prevalence up to 2023.

PRINCIPAL FINDINGS

Our analysis suggests that both cohort and period effects have substantially contributed to the declining prevalence of C. sinensis infection in Korea. Age-stratified projections up to 2023 suggest a decline in prevalence across all age groups, while those aged over 40 are anticipated to maintain prevalences above the elimination threshold of 1%.

CONCLUSIONS

Our study highlights the importance of incorporating cohort effects into intervention assessments aimed at controlling C. sinensis infection. The effectiveness of interventions remains evident in Korea despite adjusting for the cohort effect. This approach, applicable to other endemic countries, would provide valuable insights for intervention assessments and inform future public health planning to eliminate C. sinensis infection.

Efficacy assessment of miltefosine and curcumin against Clonorchis sinensis infection

Praziquantel (PZQ) is currently the only approved drug for treating clonorchiasis, but its poor efficacy against Clonorchis sinensis larvae has highlighted the need to develop newer drugs. In this study, to address this challenge, we investigated the anti-parasitic efficacy of miltefosine (MLT), curcumin (CUR), and PZQ against C. sinensis metacercariae (CsMC), newly excysted juvenile worms (CsNEJs), and adults. Larvicidal effects of MLT and CUR surpassed those elicited by PZQ in vitro. These two drugs exerted their effect against both CsMC and CsNEJs in a dose- and time-dependent manner. To confirm the effect of these drugs in vivo, Syrian golden hamsters were orally infected with 100 CsMC and subsequently treated with MLT, CUR, or PZQ at 1 and 4 weeks post-infection (wpi). MLT and CUR reduced the worm recoveries at 1 and 4 wpi, indicating that these drugs were efficacious against both larvae and adult C. sinensis. PZQ was only efficacious against adult worms. Interestingly, both MLT and CUR showed lower levels of C. sinensis-specific IgG responses than the infection control group, implying that worm burden and bile IgG responses could be correlated. These results indicate that MLT and CUR are efficacious against both larval and adult stages of C. sinensis, thereby highlighting their potential for further development as alternative therapeutic options for clonorchiasis.

A novel kit for enrichment of fecal helminth eggs

We developed a new concentration kit, called the ParaEgg (PE), for easy detection trematode eggs from fecal samples in endemic areas of clonorchiasis and metagonimiasis in Korea. To create a standard of detection efficiency, 120 fecal samples were examined using the water-ether concentration method (WECM). The PE kit and Mini ParaSep (PS) kit were used to compare the detection sensitivity of 100 egg-positive and 20 egg-negative samples in WECM. Additionally, stool samples, which were intentionally spiked with 10, 20, and 30 Clonorchis sinensis eggs, were evaluated to assess the sensitivity in lowinfection cases. The PE and PS kits showed detection rates of 100% and 92%, respectively, from 100 egg-positive samples in WECM. Meanwhile, eggs were detected in 3 (PE) and 2 (PS) out of 20 egg-negative samples in WECM. The PE kit detected the highest number of eggs per gram of feces (727 on average), followed by the WECM (524) and PS kit (432). In fecal samples that were intentionally spiked with 10, 20, and 30 C. sinensis eggs, PE only detected eggs 2 out of 5 samples in 10 eggs spiked (40%), and the detection rates were 80% and 100%, respectively. The PE kit enabled a more accurate identification of trematode eggs because of the clearance of small fecal debris in the microscopic field. In conclusion, the PE kit is obviously helpful to detect and identify trematode eggs in stool examinations especially in endemic areas of clonorchiasis and metagonimiasis.

Relationship between Clonorchis sinensis Infection and Cholangiocarcinoma in Korea

This study provides an overview of the current status of clonorchiasis and cholangiocarcinoma (CCA), and their relationship in Korea during 2012–2020. Data were obtained from the Health Insurance Review & Assessment Service of Korea. Cluster, trend, and correlation analyses were performed. Gyeongsangnam-do and Seoul had the highest average number of cases (1,026 and 4,208) and adjusted rate (306 and 424) for clonorchiasis and CCA, respectively. The most likely clusters (MLC) for clonorchiasis and CCA were Busan/Gyeongsangnam-do/Ulsan/Daegu/Gyeongsangbuk-do (Relative Risk; RR=4.55, Likelihood Ratio; LLR=9,131.115) joint cluster and Seoul (RR=2.29, LLR=7,602.472), respectively. The MLC for clonorchiasis was in the southeastern part of Korea, while that for CCA was in the southern part. Clonorchiasis showed a decreasing trend in the southeastern districts, while increased in the southwestern districts. Cities in the central region had a decreasing trend, while the western districts had an increasing trend. In most adults (30–59), infection rate of clonorchiasis showed a significant decrease until 2018, while thereafter increased, although not significant. CCA showed a sharply decreasing tendency. The incidence of clonorchiasis and CCA were positively correlated. In general, the correlation was weak (r=0.39, P<0.001), but it was strongly positive around the 4 river basins (r=0.74, P<0.001). This study might provide an analytic basis for developing an effective system against clonorchiasis and CCA.