[Approaches used for assessment of the burden of advanced schistosomiasis japonica: a comparative study]

OBJECTIVE

To compare the approaches used for the assessment of disability adjust life years (DALYs) for advanced schistosomiasis japonica, so as to provide scientific evidence for accurate assessment of the burden of advanced schistosomiasis japonica.

METHODS

The patients with advanced schistosomiasis japonica receiving treatment and assistance programs in Hunan Province in 2017 were enrolled, and the years lived with disability (YLD) for the patients with advanced schistosomiasis japonica was calculated using the common global burden of disease (GBD) estimation method, the modified GBD method with addition of common syndromes of advanced schistosomiasis japonica, and the quality of life assessment method.

RESULTS

The YLDs of patients with advanced schistosomiasis japonica, the mean YLDs per capita, and the percentages of YLD were 673.94, 728.77 person-years and 1 761.99 person-years; 0.181, 0.196 person-years and 0.474 person-years; and 10.61, 11.48 person-years per 100 thousand persons and 27.75 person-years per 100 thousand persons with the common GBD method, modified GBD method and the quality of life method, respectively. The YLDs of the patients with advanced schistosomiasis japonica in Hunan Province estimated with the modified GBD method and the quality of life method were 8.14% and 2.61 times higher than that with the common GBD method. Of the major symptoms included in the calculation, the 5 symptoms with the greatest contribution to the burden of advanced schistosomiasis japonica included ascites, moderate anemia, severe anemia, diarrhea and hematochezia.

CONCLUSIONS

The quality of life method may more comprehensively assess the YLDs in patients with advanced schistosomiasis japonica than the common and modified GBD methods.

[Evolution and evaluation of schistosomiasis prevention and control institutions in China]

Schistosomiasis is one of a few endemic and infectious diseases, which are controlled by the specific prevention and control institutions in China. Through the review of historical data, this paper describes the construction, continuation and changes of schistosomiasis prevention and control institutions in different historical periods and systems, and analyzes and evaluates its historical function, contribution and status.

[Measures and achievements of schistosomiasis control in the Yangtze River Basin]

This paper reviewed the prevention and control of schistosomiasis in the Yangtze River Basin in three stages, centered on the measures and achievements. It pointed out the key work of prevention and control which are infectious source control and effective surveillance at present stage. It will be beneficial to schistosomiasis control in China.

[Current status and transmission risks of oversea imported schistosomiasis in China]

With the acceleration of the process of global integration, China's international exchanges and cooperation with other countries have been further increased. The personnel exchange has led to the frequent occurrence of imported schistosomiasis from abroad, which seriously endangers people's health. This paper reviews the prevalence and transmission risks of oversea imported schistosomiasis, providing the reference for the entry and exit health quarantine and prevention and control of schistosomiasis in China.

[Global burden and challenges of parasitic diseases in Africa]

Parasitic diseases are common infectious diseases closely related to poverty, which are mainly endemic in the tropical and subtropical regions. Africa is the major epidemic area of parasitic diseases, and the global burden of malaria and schistosomiasis is over 85% in Africa. This paper reviews the disease burden, regional distribution and control strategies of the main parasitic diseases in Africa, in order to promote the prevention and control of parasitic diseases in this area.

[Effect of comprehensive schistosomiasis control strategy with focus on cattle and sheep removal in Junshan District, Yueyang City]

Objective To evaluate the effect of comprehensive schistosomiasis control measures with focus on total removal of cattle and sheep in Junshan District, Yueyang City. Methods The retrospective review and field survey were implemented in the pilot villages in Junshan District. The data of Schistosoma japonicum infection status of human, cattle, sheep and Oncomelania hupensis snails, and density of snails were gathered and modeled in the period of 2006 to 2016. Results The prevalence of schistosome infection in residents in the pilot villages decreased from 3.44% in 2006 to 0.59% in 2012 (F = 14.501, P = 0.013). After removal of all the cattle and sheep in 2013, the prevalence of schistosome infection in the residents decreased to zero in 2016 (F = 14.148, P = 0.033). The density of living snails decreased from 0.883 3/0.1 m² in 2006 to 0.308 8/0.1 m² in 2012 (F = 76.250, P = 0.005). Conclusion The comprehensive schistosomiasis control strategy with focus on cattle and sheep removal is remarkably effective.

[Analysis of characteristics of medical assistance to advanced schistosomiasis patients in Hunan Province, 2015]

OBJECTIVE

To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015, so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients.

METHODS

The patients who had been diagnosed as advanced schistosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics, history of diagnosis and treatment, and medical assistance to these persons.

RESULTS

There were 3 850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015, and among them, 2 664 patients were male (69.19%), and 1 186 were female (30.81%). Most of them (92.82%) came from the main schistosomiasis endemic areas, such as Yueyang, Changde and Yiyang. There were 2 369 cases of ascites (61.53%), 1 466 cases of splenomegaly (38.08%), 15 cases of colon proliferation and dwarf (0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67) years old, with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistosomiasis was (53.85 ± 21.32) years old, and it was concentrated in 40-60 years old (68.57%). The mean duration of advanced schistosomiasis was (9.58 ± 10.06) years, and it was mainly distributed in 10 years (75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was (22.33 ± 14.20) years. The priority of the medical assistance to advanced schistosomiasis patients was given to the county hospitals (76.57%); and the effective rate of assistance was 94.46%. Totally 86.57% of the patients with advanced schistosomiasis got the medical insurance (rural cooperative medical care, urban medical care, etc.).

CONCLUSIONS

The burden of the medical assistance to advanced schistosomiasis patients is still heavy because of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

[Cost-effectiveness of comprehensive schistosomiasis control strategy with focus on cattle and sheep removal in Junshan District, Yueyang City]

OBJECTIVE

To evaluate the cost-effectiveness of comprehensive schistosomiasis control measures with focus on total removal of cattle and sheep in Juanshan District, Yueyang City.

METHODS

The schistosome infection status of human, cattle, sheep and Oncomelania hupensis snails and costs of control measures were gathered during the period of 2006 to 2016. The costs for different periods and cost-effectiveness ratios were calculated.

RESULTS

The prevalence of schistosome infection in residents in the pilot villages decreased from 3.44% in 2006 to 0 in 2016. The annual costs of schistosomiasis prevention and control were 4 708 500 yuan from 2006 to 2008, 5 094 700 yuan from 2009 to 2012 and 9 522 700 yuan from 2013 to 2016. The cost-effectiveness analysis showed that the average annual cost of reduction in the residents'infection rate by 1% were 79 500 yuan from 2006 to 2008, 101 200 yuan from 2009 to 2012, and 95 200 yuan from 2013 to 2016, respectively.

CONCLUSIONS

The comprehensive schistosomiasis control strategy with focus on cattle and sheep removal in Junshan District is cost effective which could be extended to other lake and marshland schistosomiasis endemic areas.

[Strategy and effect of Oncomelania hupensis snail control in inside-embankment areas in Junshan District, Hunan Province from 1998 to 2017]

OBJECTIVE

To explore the strategy and countermeasures of Oncomelania hupensis snail control and evaluate the effect in inside-embankment areas of lake-type schistosomiasis endemic area, for providing the effective method for controlling and interrupting the schistosomiasis transmission.

METHODS

The data of schistosomiasis epidemic and its control and prevention were collected in Junshan District, Hunan Province, and the effect of snail control countermeasures were evaluated and the trend of indexes of snails was drafted in the inside-embankment areas of Junshan District, Hunan Province from 1998 to 2007.

RESULTS

The area with snails in the inside embankment areas of Junshan District decreased by 98.43%, from 1 496.66 hm² in 1998 to 23.48 hm² in 2017. The occurrence rate and average density of of living snails decreased from 20.61% and 0.45 snail/0.1 m² in 2003 to 2.06% and 0.03 snail/0.1 m² in 2017. The highest area with schistosome infected snails was found in 2001 and the total area was 79.36 hm², however, no infected snails were found since 2007. The total fiscal investment for schistosomiasis prevention and control was 398.857 million RMB in Junshan District, including molluscicide (81.770 9 million RMB) and environment reform (213.5 million RMB) respectively.

CONCLUSIONS

The comprehensive measures, mainly including the combination of molluscicide and environment reform have gotten a significant effect in snail control and elimination in the inside-embankment areas, but the snail surveillance still need to be strengthened in the historic areas with snails.

[Study on spatial - temporal characteristics of Schistosoma japonicum infections among human in Hunan Province, 2004-2011]

Objective To explore the spatial-temporal characteristics and changing regularities of Schistosoma japonicum infections among human from 2004 to 2011. Methods The township level spatial databases of schistosomiasis in Hunan Province from 2004 to 2011 were established, and the related spatial analysis was performed by SPSS 17.0, ArcGIS 10.1 and SaTScan 7.03. Results The schistosome infection rate among human in Hunan Province sharply decreased from 3.0% in 2004 to 0.8% in 2011. However, the rate among residents in parts of some townships in 2011 was still hovering at a higher level (P₉₀ = 2.12%), and the higher rate was distributed along the Oncomelania hupensis snail ridden areas outside embankment. The autocorrelation analysis showed that the global Moran's I for schistosome infection rate among human was 0.34 to 0.53 from 2004 to 2011, and was higher than the expected value (Z > 8.71, P < 0.05). The local G statistics indicated that the positive hotspot high-high clustering areas were mainly near the coast of Dongting Lake from 2004 to 2011, and the number of townships with schistosomiasis endemic in the clustering areas reached 30 to 70. The spatial scan analysis showed that the number of townships in the clustering areas ran up to 145 to 183 from 2004 to 2011. Conclusions The schistosome infection rate among human decreased significantly in Hunan Province from 2004 to 2011. However, the rate in parts of some townships still remains at a comparatively high level, and there are positive spatial correlation and spatial agglomerations in the schistosome infection rate among human, suggesting that the prevention and control work on schistosomiasis in these areas should be strengthened in the future.

[Discussion on multidisciplinary treatment mode of advanced schistosomiasis and its standardized implementation]

Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are related to many special departments, such as gastroenterology, general surgery, neurology, endocrinology, radiology, traditional Chinese medicine, blood purification, endoscopy, intervention, and ICU. It is necessary to apply a multidisciplinary treatment (MDT) mode. However, the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team, formulate the formal working procedures, and standardize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.

[Management strategy and technology of medical assistance to advanced schistosomiasis patients in Hunan Province]

The medical assistance to advanced schistosomiasis patients established by the Chinese government is a major public facility for patients with advanced schistosomiasis. Since the medical assistance to advance schistosomiasis patients in Hunan Province started ten years ago, a set of mature and operable programs with whole program management and related technologies has been developed. The author investigated the data on medical assistance to advanced schistosomiasis patients in Hunan Province during the last 10 years (from 2006 to 2015) retrospectively, and found that the program had high therapeutic effect and high satisfaction degree of both patients and the society. In order to improve the management of the medical assistance to advanced schistosomiasis patients and share our experiences of the whole program management and related technologies with the colleagues of other provinces, this paper mainly illustrates the experiences of the program, as well as the existing problems and related strategies.

[Diagnosis and treatment of imported African schistosomiasis]

This paper summarizes the clinical diagnosis and treatment of imported African schistosomiasis, in order to make the therapeutic standards. Imported African schistosomiasis includes mainly schistosomiasis haematobia and schistosomiasis mansoni in China. In order to set up the operational standards, enhance diagnostic and cure rates, and reduce the complications, we review the related literature combined with our experience over years, and summarize, in this paper, the pathogenic mechanism, and key points of clinical diagnosis and treatment of schistosomiasis haematobia and schistosomiasis mansoni, so as to provide the reference for clinical doctors.