Different profiles and epidemiological scenarios: past, present and future

The multiplicity of epidemiological scenarios shown by Chagas Disease, derived from multiple transmission routes of the aetiological agent, occurring on multiple geo-ecobiosocial settings determines the complexity of the disease and reveal the difficulties for its control. From the first description of the link between the parasite, the vector and its domestic habitat and the disease that Carlos Chagas made in 1909, the epidemiological scenarios of the American Trypanosomiasis has shown a dynamic increasing complexity. These scenarios changed with time and geography because of new understandings of the disease from multiple studies, because of policies change at the national and international levels and because human movements brought the parasite and vectors to new geographies. Paradigms that seemed solid at a time were broken down, and we learnt about the global dispersion of Trypanosoma cruzi infection, the multiplicity of transmission routes, that the infection can be cured, and that triatomines are not only a health threat in Latin America. We consider the multiple epidemiological scenarios through the different T. cruzi transmission routes, with or without the participation of a Triatominae vector. We then consider the scenario of regions with vectors without the parasite, to finish with the consideration of future prospects.

[Current status and new challenges of three important imported parasitic diseases]

Following the concerted efforts for nearly 70 years, great achievements have been obtained in parasitic diseases control in China, and some important parasitic diseases have been eliminated or moving towards elimination in the country. With the socioeconomic development, the implementation of the "Road and Belt Initiative" and the increase in the international communication and overseas investment, there is a rise in the number of overseas labors, businessmen, students, travelers, visitors and participants in national and international communication activities, resulting in a gradual increase in the number of cases with parasitic diseases imported from endemic to non-endemic areas of China and from foreign countries to China. The increase in the number of imported cases causes new challenges for the elimination of parasitic diseases in China. The paper describes the current status of malaria, schistosomiasis and leishmaniasis, analyzes the challenges for the current control activities, and proposes the control strategies and interventions.

[Intensifying the precision control to facilitate the progress towards schistosomiasis elimination in mountainous and hilly regions of China]

In China, the mountainous and hilly schistosomiasis-endemic regions are mainly distributed in 2 provinces of Sichuan and Yunnan. Following the concerted efforts for more than 60 years, great successes have been achieved in schistosomiasis control in mountainous and hilly regions of China. Recently, Sichuan and Yunnan provinces seized the opportunity created in the rural and agriculture development, implemented the integrated strategy with emphasis on infectious source control, utilized modern information techniques, innovated schistosomiasis control models, built sensitive and highly effective surveillance-response systems, and actively tackled the challenges of schistosomiasis elimination, which greatly facilitated the progress towards elimination of schistosomiasis in mountainous and hilly regions of China.

[Endemic status of schistosomiasis in People's Republic of China in 2017]

This report presents the endemic status of schistosomiasis in the People's Republic of China at national level in 2017, and analyzes the data collected from the national schistosomiasis prevention and control system and 457 national schistosomiasis surveillance sites. Among the 12 provinces (municipality and autonomous region) being endemic of schistosomiasis japonica in P. R. China, 5 provinces (municipality and autonomous region), i.e., Shanghai, Zhejiang, Fujian, Guangdong and Guangxi, continued to consolidate the status of elimination of schistosomiasis. Sichuan Province achieved the transmission interruption and 6 provinces of Yunnan, Jiangsu, Hubei, Anhui, Jiangxi and Hunan kept the transmission control by the end of 2017. There were 450 endemic counties (cities, districts) covering 259 million people, specifically including 28 544 endemic villages of 70 324.5 thousand people at risk. Among the 450 endemic counties (cities, districts), 47.78% (215/450), 34.00% (153/450) and 18.22% (82/450) reached the criteria of elimination, transmission interruption and transmission control, respectively. By the end of 2017, a total of 8 401 113 individuals received schistosomiasis examinations and 14 individuals were parasitologically diagnosed, decreased by 97.67% compared with 600 cases in 2016. It was estimated of 37 601 cases of schistosome infection, decreased by 30.95% compared with 54 454 cases in 2016. One acute schistosomiasis case was reported in 2017. There were 29 407 advanced schistosomiasis cases documented in 2017. Oncomelania hupensis snail surveys were performed in 19 784 endemic villages and O. hupensis snails were found in 7 310 villages, accounting for 36.95% of total villages, with 19 newly detected villages with snails.The snail survey covered an area of 622454.49 hm² and snails were found in an area of 172501.56 hm², including a newly detected area of 208.54 hm². No schistosome-infected snails were found in 2017. A total of 737 016 bovines were raised in the schistosomiasis endemic areas. Of them, 454 830 bovines received the examinations for schistosome infection, and 1 bovine was stool examination positive. There were 119 326 schistosomiasis cases receiving chemotherapy in 2017, with 1 973 968 individuals undergoing expanded chemotherapy; one bovine with schistosomiasis receiving chemotherapy, with 418 925 bovines undergoing expanded chemotherapy. A total of 144 605.31 hm² area with snail was controlled by using molluscicides, with actual molluscicide-treated area of 73 755.37 hm²; and 5 002.92 hm² area with snail was treated by environmental modification. Based on the data from the 457 national schistosomiasis surveillance sites, the mean Schistosoma japonicum infection rate was 0.001 6% and 0 in humans and bovines, respectively. No schistosome-infected snails were found by microscopic examinations in all the surveillance sites, and 7 snail samples with schistosome nucleic acid positive were detected by loopmediated isothermal amplification (LAMP) among 6 surveillance sites. The results demonstrate a continuous decline trend on the endemic situation of schistosomiasis in P. R. China. However, the risk of epidemic rebound still exists in some regions and it is still a challenge to achieve the target set by the Thirteenth Five-Year National Plan for Schistosomiasis Control in 2020.

[Transmission risk matrix assessment of imported leishmaniasis in China]

OBJECTIVE

To assess the risk of imported leishmaniasis in China, offering scientific evidences for leishmaniasis prevention and control.

METHODS

The expert consultation method was used to establish a risk index system, and the risk matrix was used to evaluate the risk scales of leishmaniasis.

RESULTS

This risk assessment indicator system included 3 first-grade indexes and 13 second-grade indexes to the aspect of risk probability. Five indexes were also included on the aspect of the risk hazard severity in this system. The transmission risk matrix assessment showed that the risk of imported leishmaniasis transmission in China was in low risk level.

CONCLUSIONS

This risk matrix assessment is applied for the transmission of imported leishmaniasis in China in the first time, indicating the potential risk of imported leishmaniasis in China.

[Progress and challenges of schistosomiasis elimination in China]

Schistosomiasis is an old and geographically widespread parasitic disease that severely damages human health and affects socioeconomic development in China. The implementation of the integrated strategy with emphasis on controlling the source of Schistosoma japonicum infection and the National Mid- and Long-Term Plan for Schistosomiasis Prevention and Control (2004-2015) in China greatly facilitated the progress towards the elimination of schistosomiasis in China. Since transmission control of schistosomiasis was achieved in 2015, the goal of the national schistosomiasis control program has moved to transmission interruption and elimination in China. Because of the impacts of natural and social factors, and the new situation, new task and new demands following the continuous decline in the endemic situation of schistosomiasis, several challenges exist to achieve the goal of schistosomiasis elimination nationwide. This paper analyzed the current endemic status of schistosomiasis, progress and challenges of schistosomiasis elimination, and proposed some suggestions for the national chistosomiasis elimination program in China.

[Interpretation of The Three - year Tough Action Plan for Endemic Diseases Control (2018-2020) ： schistosomiasis]

The Three-year Tough Action Plan for Endemic Diseases Control (2018-2020), which was formulated by 10 ministries of China, was issued on November 29, 2018. Schistosomiasis control is an important part of this plan, and the implementation of the plan provides an important basis for the health poverty alleviation and the fight against schistosomiasis in China. This paper describes the objective and principle of the plan and proposes "six actions" and supporting measures to implement the three-year tough action targeting schistosomiasis, with aims to guide the scientific implementation of the three-year tough action against schistosomiasis and facilitate the progress towards schistosomiasis elimination 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.

[Upholding Chinese spirit on schistosomiasis control in the new era to accelerate the progress towards schistosomiasis elimination in China]

China is one of the schistosomiasis-endemic countries with the highest burden of disease across the world. Following the control efforts for over 60 years, great successes have been achieved in schistosomiasis control in the country, and the control program is moving towards transmission interruption and elimination. To commemorate the 60th anniversary of publishing Chairman Mao Zedong's two poems entitled "Farewell to the God of Plague", a series of activities that disseminate schistosomiasis control achievements have been conducted in China throughout 2018, including the development of Chinese spirit on schistosomiasis control in the new era. After extensive discussion, collection and screening, and "Integration of all efforts, scientific control, willingness to dedication and swearing to wipe out the 'God of Plague' " was proposed as Chinese spirit on schistosomiasis control in the new era. Integration of all efforts is a summary of administrative policy-making and population participation in Chinese schistosomiasis control programs; scientific control is the refinement of the Chinese national schistosmiasis control strategy that is developed and implemented tailoring to time and circumstances; willingness to dedication is a valuable spiritual wealth and inexhaustible source of power for Chinese schistosomiasis control professionals in the new era; and swearing to wipe out the "God of Plague" is a sacred mission assigned to Chinese professionals participating in the national schistosomiasis control program in the new era. Chinese spirit on schistosomiasis control in the new era will further strengthen our belief in achieving the goal of schistosomiasis elimination in China eventually.

[Epidemic and research progress of babesiosis]

Babesiosis is an emerging parasitic disease, distributed globally in Europe, Asia, Africa, North and South America, and Australia, and the United States is still the country with the largest number of babesiosis cases reported. Babesiosis in China is mainly distributed in the northeast, followed by the southwest and other regions. As a new vector-borne infectious disease, babesiosis poses a serious threat to human health, and its research foundation is relatively weak, so it requires more attention and recognition. The research hot spots on babesiosis are screening of diagnostic antigens, and the mechanisms of Babesia and the hosts, co-infections between Babesia and other pathogens. The epidemic distribution, screening of diagnostic antigens, host immune response mechanism and co-infection of babesiosis in our country and abroad are reviewed in this paper.

[Investigation on capacity of provincial parasitic diseases control institutions in main clonorchiasis-endemic areas of China]

OBJECTIVE

To understand the status and capability of professionals at provincial parasitic diseases control institutions in main clonorchiasis-endemic areas of China.

METHODS

The status and capacity of professionals at four provincial parasitic diseases control institutions were collected using questionnaire surveys, including Guangdong, Guangxi, Heilongjiang and Jilin, and the data were analyzed.

RESULTS

There were totally 37 professionals working on parasitic diseases control in the four provincial institutions in 2018, including 33 full-time and 4 part-time professionals, and there were 12, 16, 3 and 6 professionals working at Guangdong, Guangxi, Heilongjiang and Jilin provincial institutions, respectively. Of the 37 professionals, there were 24.32%, 37.84% and 37.84% at ages of 35 years and lower, 35 to 45 years, and greater than 45 years. Men consisted of 54.05% of all professionals, and 86.49% had an education of bachelor and above, while 78.38% had a title of moderate or above. Among all professionals, there were 29 responsible for clonorchiasis prevention and control; however, they all participated in the prevention and control of other parasitic diseases; 33 professionals were able to prepare Kato-Katz smears and 34 read the smears; 30 professionals were able to detect metacercaria in fishes, and 24 and 16 professionals were able to perform immunological and mo-lecular tests. In addition, 26 professionals participated in provincial projects, 19 in national projects; however, few professionals participated in international projects or undertook provincial, national or international projects. Furthermore, there were 34 professionals (91.89%) participating in national trainings on parasitic diseases; however, only 12 (32.43%) completed a training for more than one week.

CONCLUSIONS

There are few professionals at provincial parasitic diseases control institutions in main clonorchiasis-endemic areas of China, and they have a relative high capability in parasitic disease control; however, their research capacity is relative weak.

[Discussion on strategies of health literacy promotion for echinococcosis control in China]

This article analyzes recent progresses on health education and health promotion targeting echinococcosis control in the major endemic foci of China, and describes the problems, including lack of human echinococcosis control knowledge, low human health literacy levels, incomplete establishment of health promotion mode, and urgent efforts to achieve the goal of Health for All. In addition, the feasible measures and strategies on health literacy promotion for echinococcosis control are discussed in combination with the national health literacy promotion strategy according to Healthy China 2030.

[Status and working principals of soil-transmitted nematodiasis during new period in China]

The current status of soil-transmitted nematodiasis in China is analyzed. The achievements in prevention and control of soil-transmitted nematodiasis are illustrated. Moreover, the challenges in condition of the decline of soil-transmitted nematodiasis in China are demonstrated. Finally, the working principals for prevention and control of soil-transmitted nematodiasis in the new period are proposed, combining with the health poverty alleviation project, focusing on the goals of control plan for important parasitic diseases, establishing monitoring system for soil-transmitted nematodiasis, and implementing the principles of precise prevention and control.

[Analysis of current drug treatment against clonorchiasis in China]

OBJECTIVE

To analyze the current drug treatment against clonorchiasis in China, in order to promote the standardization of drug treatment and national deworming for clonorchiasis.

METHODS

All the 10 provinces were enrolled, which reported clonorchiasis in the work report for important helminthiasis in 2016. Then, 20 counties were selected from these 10 provinces. The data on drug treatment including both mass chemotherapy and individual treatment against clonorchiasis were collected and compared.

RESULTS

All the 10 provinces had no guideline for mass chemotherapy, while only 3 had that for individual treatment against clonorchiasis. Out of 20 counties, only 1 implemented mass chemotherapy. Among these 20 counties, 13 applied praziquantel in individual treatment, while other 7 employed albendazole. In the 12 counties with clear protocol for praziquantel, the total dosage for a man of 60 kg ranged from 3.6 to 18.0 g, the days and times for administration ranged from 1 to 6 and from 3 to 18, respectively. In the 4 counties with clear protocol for albendazole, the total dosage for a man of 60 kg ranged from 0.8 to 8.4 g, the days and times for administration ranged from 2 to 7 and from 2 to 14, respectively.

CONCLUSIONS

Nowadays, the guideline on mass chemotherapy for clonorchiasis is inadequate in China. Although individual treatment is applied in many areas, the protocols vary in drugs, dosage, and days and times for treatment. Thus, the national guideline of mass chemotherapy for clonorchiasis should be established, while the protocols for individual treatment should be standardized.

[Challenges and strategies of health education and health promotion in stage of schistosomiasis elimination]

Health education and health promotion are important measures for comprehensive control of schistosomiasis in China, which can improve the compliance rate of residents involved in schistosomiasis control activities, reduce the water contact behavior of the target population, thus avoiding or decreasing the infection of schistosome in endemic areas. In recent years, the comprehensive control of schistosomiasis in China has achieved remarkable results. China has reached the goal of transmission control and is moving toward the transmission interruption or even elimination of schistosomiasis. This article analyzes the role of health education and health promotion in schistosomiasis control programme and the current challenges. Meanwhile, suggestions are also put forward on how to conduct health education and health promotionin the stage of schistosomiasis elimination.

[Development and role of Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses]

The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS⁺) plays an important role in promoting the research and control of helminthes in Asia. The development course of RNAS⁺ is summarized in this article and the information of RNAS⁺ annual meeting is collected. The questionnaire survey and expert interview are used to evaluate the role of RNAS⁺ in promoting the prevention and control of helminthes in various Asian countries. The experience of RNAS⁺ operation and its future development are summarized.

[Remain true to our original aspiration for farewell to the God of Plague, compose the new chapter for the national schistosomiasis control programme scientifically-Commemoration of 60th anniversary of publishing Chairman Mao Zedong's two poems "Farewell to the God of Plague"]

This paper reviews the huge promotion of Chairman Mao Zedong's two poems entitled "Farewell to the God of Plague" which were published 60 years ago, and the great achievements of the national schistosomiasis control programme in China. The publication of the two poems promotes the establishment of the mechanism for the national schistosomiasis control programme in China, and in addition, the schistosomiasis control spirit of the people from Yujiang County is still the source of power for the promotion of transferring the schistosomiasis control to elimination stage in China. Now, that we commemorate the 60th anniversary of publishing Chairman Mao Zedong's two poems entitled "Farewell to the God of Plague" means we remain the true to our original aspiration to serve the people forever, which is also to promote the progress of schistosomiasis elimination in China according to the law, the scientific principle, and local conditions, so as to contribute our efforts for realizing the healthy China's dream.

[Study on the ARIMA model application to predict echinococcosis cases in China]

OBJECTIVE

To predict the monthly reported echinococcosis cases in China with the autoregressive integrated moving average (ARIMA) model, so as to provide a reference for prevention and control of echinococcosis.

METHODS

SPSS 24.0 software was used to construct the ARIMA models based on the monthly reported echinococcosis cases of time series from 2007 to 2015 and 2007 to 2014, respectively, and the accuracies of the two ARIMA models were compared.

RESULTS

The model based on the data of the monthly reported cases of echinococcosis in China from 2007 to 2015 was ARIMA (1, 0, 0) (1, 1, 0)₁₂, the relative error among reported cases and predicted cases was -13.97%, AR (1) = 0.367 (t = 3.816, P < 0.001), SAR (1) = -0.328 (t = -3.361, P = 0.001), and Ljung-Box Q = 14.119 (df = 16, P = 0.590) . The model based on the data of the monthly reported cases of echinococcosis in China from 2007 to 2014 was ARIMA (1, 0, 0) (1, 0, 1)₁₂, the relative error among reported cases and predicted cases was 0.56%, AR (1) = 0.413 (t = 4.244, P < 0.001), SAR (1) = 0.809 (t = 9.584, P < 0.001), SMA (1) = 0.356 (t = 2.278, P = 0.025), and Ljung-Box Q = 18.924 (df = 15, P = 0.217).

CONCLUSIONS

The different time series may have different ARIMA models as for the same infectious diseases. It is needed to be further verified that the more data are accumulated, the shorter time of predication is, and the smaller the average of the relative error is. The establishment and prediction of an ARIMA model is a dynamic process that needs to be adjusted and optimized continuously according to the accumulated data, meantime, we should give full consideration to the intensity of the work related to infectious diseases reported (such as disease census and special investigation).

Strengthening community support, resilience programmes and interventions in infectious diseases of poverty

Background

There is an urgent need to promote innovative partnerships, community leadership and commitment toward strengthening coherent and sustainable community support, resilience programmes, engagement and social mobilization for resiliency.

Aims

This paper aims to strengthen coherent, scalable and sustainable community participation, resilience policies and innovative programmes to accelerate elimination and eradication of infectious diseases of poverty.

Methods

An unstructured and retrospective review approach was used to determine and to define full papers, reviewed publications, and grey literature on the topics of community resilience, infectious diseases of poverty elimination and eradication, and the global health security agenda.

Results

Little is documented on individual and community responsibility cooperation in elimination of infectious diseases of poverty through surveillance and resilience, eradication programmes and interventions. Hence, it is essential to develop joint ownership of community infectious diseases, or emerging outbreaks projects, that can play an important role in research and policy decisions, and advance new cultural and psychobehavioural public health directions. Such an enabling environment is imperative to improve accessibility and availability to essential medical and pharmaceutical commodities in the supply chain management.

Conclusions

It is essential to strengthen effective community-based access to drugs and vaccine coverage and effectiveness procurement systems. This is required to improve access to and uptake of care service delivery and management, monitoring and evaluation of integrated and cost-effective programmes, Sustainable Development Goals, and upholding global health security.

[Endemic status of schistosomiasis in People's Republic of China in 2016]

This report presents the endemic status of schistosomiasis in the People's Republic of China at national level in 2016, and analyzes the data collected from the national schistosomiasis prevention and control system and 454 national schistosomiasis surveillance sites. Among the 12 provinces (municipality and autonomous region) of endemic of schistosomiasis japonica in P. R. China, 5 provinces (municipality and autonomous region), i.e., Shanghai, Zhejiang, Fujian, Guangdong and Guangxi, had achieved elimination, and 7 provinces of Sichuan, Yunnan, Jiangsu, Hubei, Anhui, Jiangxi and Hunan had achieved transmission control by the end of 2016. There are 451 endemic counties (cities, districts) covering 257 million people, specifically including 29 692 endemic villages of 69.39 million people at risk. Among the 451 endemic counties (cities, districts), 35.25 % (159/451), 42.35% (191/451) and 22.39% (101/451) reached the criteria of elimination, transmission interruption and transmission control, respectively in 2016. By the end of 2016, it was estimated of 54 454 infections of schistosome, decreased by 29.46% compared with 77 194 in 2015. No acute schistosomiasis case was reported in 2016. There were 30 573 advanced schistosomiasis cases documented in 2016. A total of 8 500 710 individuals received schistosomiasis examinations and 600 individuals were parasitologically diagnosed, decreased by 83.36% compared with 3 606 in 2015. The Oncomelania hupensis snail survey was performed in 22 140 endemic villages and O. hupensis snails were found in 7 106 villages, accounting for 32.109% of the total villages, with 20 newly detected villages with snails. The snail survey covered area of 813 963.91 hm² and snails were found in an area of 235 096.04 hm², including a newly detected area of 1 346.48 hm². No schistosome-infected snails were found in 2016. A total of 881 050 bovines were raised in the schistosomiasis endemic area. Of them, 510 468 bovines received examinations, resulting in 8 schistosome-infected bovines. There were 147 642 schistosomiasis cases receiving drug treatment in 2016, with 2 303 555 individuals undergoing expanded chemotherapy; there were 9 bovines with schistosomiasis receiving drug treatment, with 439 857 bovines undergoing expanded chemotherapy; a total of 139 483.84 hm² area with snail control by using molluscicides, with actual molluscicide-treated area of 73 941.75 hm²; and 3 101.52 hm² snail habitants were treated by environmental modification. Based on the data from the 454 national schistosomiasis surveillance sites, the mean Schistosoma japonicum infection rate was 0.02% and 0.0078% in humans and bovines, respectively. No schistosome-infected snails were found in all the surveillance sites. The results demonstrate a decline in the endemicity of schistosomiasis in P. R. China compared with the level of 2015. However, the distribution area of snails in China is still large and the infection source of schistosomiasis still exists to some extent in some endemic areas; in some regions, the task to reach the standard of transmission interruption is still arduous. There are still objective factors of epidemic and transmission and risk factors of endemic reversal and rebound for schistosomiasis. So, further control and effective surveillance as well as accurate prevention and control should be implemented to promote the elimination process on schistosomiasis in P. R. China.

[Surveillance of schistosomiasis in People's Republic of China in 2015]

OBJECTIVE

To analyze the investigation data of the national schistosomiasis surveillance sites in 2015, so as to provide scientific evidences for schistosomiasis control, elimination and surveillance.

METHODS

According to National Schistosomiasis Surveillance Programme (version 2014), 457 surveillance sites were selected, and the investigation data in residents, floating population, domestic animals and Oncomelania hupensis snails were collected and analyzed from four types of endemic counties.

RESULTS

A total of 4 468 seropositive cases were detected from 133 350 residents, among which 4 457 residents with seropositive results received the etiological tests, and 71 of them were identified with positive results. Most of them were fishermen and farmers in the middle and old-aged group. The schistosomiasis infection rate was 0.05% in local population. Totally 977 seropositive cases were examined from 85 047 migrant individuals, and 16 positive cases were found out from 966 individuals who took etiological tests, which showed the schistosomiasis infection rate was 0.02% in floating population. Imported cases were found among floating people in four provinces, namely Zhejiang, Hunan, Hubei and Anhui provinces. No acute schistosomiasis cases were reported. A total of 13 406 head of cattle received examinations and only 5 were determined as stool positives. The cattle infection rate was 0.04%. The snail survey covered an area of 22 295.13 hm² and snails were found in an area of 7 426.63 hm², including 3.47 hm² newly detected area with snails. No schistosome-infected snails were found.

CONCLUSIONS

Based on the collected data from 457 national schistosomiasis surveillance sites of China, the Schistosoma japonicum infection rate is 0.05% in local population which maintains a stably descending trend. In floating population, there are imported schistosome-in-fected persons. Cattle are still a vulnerable species infected with schistosome. Although no infected snails are found, snails are widely distributed in endemic areas. Some provinces detect areas with snails for the first time or the reproduction of snails. The staff in endemic provinces should carry out the surveillance work according to National Schistosomiasis Surveillance Programme (version 2014) to improve the surveillance system, and enhance the sensibility and effectiveness of surveillance work.

[Playing the guiding roles of national criteria and precisely eliminating schistosomiasis in P. R. China]

Schistosomiasis Control and Elimination (GB 15976-2015) and Diagnostic Criteria for Schistosomiasis (WS 261-2006) are the only two national health criteria related to schistosomiasis control program implemented in P. R. China. The roles of criteria to guide and accelerate the transition from schistosomiasis control to elimination are concluded, based on this systematic review how the criteria led the implementation of the medium- and long-term national plan and provided the guidance when drafting the thirteen-five years national plan for schistosomiasis, and the suggestion to draft more criteria related to schistosomiasis elimination program and strengthening the implementation of current criteria, so as to precisely guide the schistosomiasis elimination program in P. R. China.

[Impact of schistosomiasis transmission by catastrophic flood damage and emergency response in China]

Flood damage is one of the ordinary natural calamities. The areas of middle and down of the Yangtze River and its south are the endemic area of schistosomiasis. As the flood damage, it causes property loss, and harm public and people health severely even. This paper aims at the status of catastrophic flood damage again in the Yangtze River basin, analyzes the impact of schistosomiasis transmission by it, and indicates that at present, the process of schistosomiasis control in China is marching from transmission control to transmission interruption and elimination, but the frequent flooding exacerbates Oncomelania hupensis snail breeding area and schistosomiasis source spreading, which may influence, in a certain extent, the realization of the goal of schistosomiasis control in China. We should timely assess and monitor the impact and risk of schistosomiasis transmission by flood damage, and give the early warning and adopt emergency handling measures in time. This paper also proposes the disaster prevention measures according to flood damage stages (the early, middle, later, and post-flood) and the occurrence and development of damage and endemic situation, so as to control the risk and damage of the disease transmission in a high limit, to consolidate the current achievements of schistosomiasis prevention and control and guarantee the realization of the goal of schistosomiasis interruption and elimination in China on the schedule.

[Endemic status of schistosomiasis in People's Republic of China in 2015]

This report presented the endemic status of schistosomiasis in the People's Republic of China at a national level in 2015, and analyzed the data collected from the national schistosomiasis prevention and control system and 457 national schistosomiasis surveillance sites. Among the 12 provinces (municipality, autonomous region) endemic for schistosomiasis japonica in P. R. China, 5 provinces (municipality, autonomous region), i.e., Shanghai, Zhejiang, Fujian, Guangdong and Guangxi, had achieved transmission interruption, and 7 provinces of Sichuan, Yunnan, Jiangsu, Hubei, Anhui, Jiangxi and Hunan had achieved transmission control by the end of 2015. There were 453 endemic counties (city, district) covering 252 million people, specifically including 29 980 endemic villages of 68.61 million people at risk of infection. Among the 453 endemic counties (city, district), 75.72% (343/453) and 24.28% (110/453) reached the criteria of transmission interruption and transmission control, respectively. By the end of 2015, it was estimated of 77 194 cases of schistosomiasis, which were decreased by 33.23% compared with 115 614 cases in 2014. No acute schistosomiasis cases were reported in 2015. There were 30 843 advanced schistosomiasis cases documented in 2015. A total of 8 736 036 individuals received schistosomiasis examinations and 3 606 individuals were parasitologically diagnosed, which were decreased by 56.40% compared with 8 270 cases in 2014. An Oncomelania hupensis snail survey was performed in 19 965 endemic villages and the snails were found in 5 609 villages, accounting for 28.09% of total villages, with 31 newly detected villages with snails. The snail survey covered an area of 593 572.66 hm² and snails were found in an area of 173 462.50 hm², including a newly detected area of 666.04 hm². No infected snails were found in 2015. A total of 879 373 bovines were raised in the schistosomiasis endemic regions. Of them, 526 062 bovines received stool examinations, resulting in 315 infected bovines. There were 170 438 schistosomiasis cases receiving drug treatment in 2015, with 2 449 696 individuals undergoing expanded chemotherapy. There were 318 bovines with schistosomiasis receiving drug treatment, with 483 213 bovines undergoing expanded chemotherapy. A total of 144 305.52 hm² area was subject to snail control by using molluscicides, with an actual molluscicide-treated area of 69 221.57 hm², and 4 572.06 hm² snail habitats were treated by environmental modification. Based on the data from the 457 national schistosomiasis surveillance sites, the mean Schistosoma japonicum infection rate was 0.05% and 0.04% in humans and bovines, respectively. No infected snails were found in all the surveillance sites. The results demonstrate a decline in the endemicity of schistosomiasis in P. R. China and the country reached the criteria of transmission control at the national level. However, the endemic situation of schistosomiasis is unstable in some regions with newly-reached transmission control, and further control and effective surveillance should be strengthened to consolidate the achievements and reduce the endemic situation of schistosomiasis in P. R. China.

[Study on value of IHA in diagnosis of schistosomiasis japonica]

OBJECTIVE

To evaluate the value of indirect hemagglutination test (IHA) in schistosomiasis diagnosis.

METHODS

The literature concerned schistosomiasis diagnosis with IHA in the databases of Medline, CNKI, VIP and Wanfang Data from 1982 to 2014 was collected and evaluated.

RESULTS

Totally 21 articles which were satisfied with the research criteria were analyzed with the Meta-analysis method. The IHA method had high value in schistosomiasis diagnosis, the AUC_SROC of IHA in laboratory evaluation was 0.990 6, while in filed evaluation was 0.832 9, and the difference between them was significant (Z = 4.50, P < 0.05).

CONCLUSIONS

The diagnosis value of IHA in field evaluation is less than that in laboratory. In the process of the elimination of schistosomiasis, developing a new and higher sensitive reagent in schistosomiasis diagnosis is needed.

[Epidemiological analysis of imported malaria cases in 20 counties at border region of Yunnan Province from 2012 to 2014]

OBJECTIVE

To analyze the epidemiological characteristics of the imported malaria cases in 20 counties at the border region of Yunnan Province from 2012 to 2014, so as to provide the evidence-based proof for adjusting the strategies in the elimination stage.

METHODS

The malaria epidemic data of the 20 border counties in Yunnan Province from 2012 to 2014 were collected and analyzed by using Microsoft Excel 2010.

RESULTS

From 2012 to 2014, a total of 1 558 malaria cases were reported in the 20 border counties in Yunnan Province, among which, 1 336 were imported cases, accounting for 85.75% (1 336/1 558), and 222 were indigenous cases, accounting for 14.25% (222/1 558). The number of the imported cases in the above years took up 80.00% (544/680), 89.10% (425/477) and 91.52% (367/401) of the total reported cases in the whole year, respectively. Among all the 1 336 imported cases, 1 045 (78.22%) were infected with Plasmodium vivax, 284 (21.26%) were infected with P. falciparum, 3 were infected with P. malariae, 3 were mixed infection and 1 was an unclassified case; 2 patients died. And 95.58% of the cases were mainly infected in Myanmar (1 277 cases). Young and middle-aged adult of 20-40 years who worked overseas were the predominant (802 cases, 60.03%) and most of the cases occurred from April to June of the year (679 cases, 50.82%). Those cases mainly distributed in Tengchong (459 cases), Ruili (366 cases), Yingjiang (191 cases) and Mangshi (78 cases).

CONCLUSIONS

The epidemic situation of imported malaria is serious in the border region of Yunnan Province. Therefore, the surveillance system of malaria control needs to be well planned and managed to ensure timely case detection and prompt response at the elimination and post-elimination stage.

[Epidemiological characteristics of echinococcosis death cases in China from 2008 to 2016]

OBJECTIVE

To understand the epidemiological characteristics of death cases of echinococcosis in China from 2008 to 2016, so as to provide an important reference for the prevention and control of echinococcosis.

METHODS

The death information registration and management system data were selected to analyze the epidemiological characteristics of the death cases of echinococcosis. The data were analyzed by SPSS 21.0 and the map was drawn by ArcGIS 10.1 software.

RESULTS

From 2008 to 2016, a total of 367 death cases of echinococcosis were reported in China, and the number of deaths in turn was 33, 30, 21, 32, 35, 54, 55, and 81 in each year, with an annual average crude mortality of 129.29 /10⁵. The average age of death was (56 ± 18) years; the sex ratio of male to female was 100∶94. There was no statistical difference between the male and female death cases (χ² = 0.33, P > 0.05).The death cases of echinococcosis were mainly distributed in endemic areas of Qinghai, Sichuan, Ningxia, Xinjiang, Gansu, Inner Mongolia, Yunnan and non-endemic areas of Heilongjiang, Jiangsu, Henan and Shandong. The death cases in the first eleven provinces accounted for 87.5% (321/367) of the total death cases, among which the highest proportions of the nationality, occupation, educational level, highest diagnostic units, and the place of death were Han (52.0%, 191/367), farmer (46.6%, 171/367), junior high school or below (57.2%, 210/367), provincial or three-level hospitals (46.6%, 171/367), and at home (59.9%, 220/367).

CONCLUSIONS

Since 2014, the death cases of echinococcosis in China have been increasing year by year, indicating that the prevention and treatment of echinococcosis is still very serious. The causes for the rise of the fatality rate remain to be further studied.

[Investigation on unhealthy related behaviors of echinococcosis patients in Garzê Prefecture, Sichuan Province]

OBJECTIVE

To understand the unhealthy related behaviors of echinococcosis patients in Tibetan region in Sichuan Province, so as to provide the references for the health education of echinococcosis.

METHODS

The echinococcosis patients who were registered in the Tibetan region in Sichuan Province were selected as target population. The basic situation and unhealthy related behaviors of them were surveyed by individual interviews.

RESULTS

Totally 368 echinococcosis patients were investigated. The proportion of patients who lived with dogs was 53.3%, who did not wash hands before meals was 23.4%, who ate raw food was 15.5%, who fed dogs with diseased livestock visceral organs was 9.8%, who drank unboiled water was 8.7%, and who played with dogs was 5.4%. The proportion of nomads' unhygienic behaviors was higher than that of sedentary residents' unhygienic behaviors. The proportion of playing with dogs and feeding dogs with diseased livestock visceral organsin students was higher than that in nomads.

CONCLUSIONS

There are some unhealthy related behaviors in echinococcosis patients in Garzê Prefecture, and the different health education modes for echinococcosis patients with different characteristics should be applied.

[Establishment of response system to emergency parasitic disease affairs in China]

China's prevention and control of parasitic diseases has made remarkable achievements. However, the prevalence and transmission of parasitic diseases is impacted by the complicated natural and social factors of environment, natural disasters, population movements, and so on. Therefore, there are still the risks of the outbreak of emergency parasitic diseases affairs, which may affect the control effectiveness of parasitic diseases and endanger the social stability seriously. In this article, we aim at the analysis of typical cases of emergency parasitic disease affairs and their impacts on public health security in China in recently years, and we also elaborate the disposal characteristics of emergency parasitic disease affairs, and propose the establishment of response system to emergency parasitic disease affairs in China, including the organizational structure and response flow path, and in addition, point out that, in the future, we should strengthen the system construction and measures of the response system to emergency parasitic disease affairs, so as to control the risk and harm of parasitic disease spread as much as possible and to realize the early intervention and proper disposal of emergency parasitic disease affairs.

[Evaluation on human resource allocation in certain national institute of parasitic diseases in ten years]

OBJECTIVE

To evaluate the human resource in a national institute of parasitic diseases from 2007 to 2016, so as to provide a reference for the construction of a well-crafted human resource of national parasitic diseases control and prevention.

METHODS

The basic information of the staff in the national institute of parasitic diseases was investigated and a related database was established to analyze the quantity and structure of the human resource allocation in 10 years through the annual statistics each year.

RESULTS

The number of staff in the institute increased by 6.25% in 2016 compared with that in 2007, and 43.32% of the staff were under 35 years old. In 2016, 59.36% of the staff had a master degree or a higher level degree, and 37.97% of the staff had senior technical titles. The difference value of the inflows and outflows was 3.21%.

CONCLUSIONS

The change of the structure and quality of human resource in this institute has a good tendency in the past ten years. The organization should optimize the human resource allocation and improve its capacity in disease control and prevention to broaden the methods of talent introduction and control the brain drain problem.

[Investigation of tick bites in outpatients with fever from health care facilities in Tengchong County]

OBJECTIVE

To study the prevalence of tick bites and relative factors of outpatients with fever from health care facilities in Tengchong County.

METHODS

From July to August, 2014, the outpatients with fever in five health care facilities namely Tengchong Center for Disease Control and Prevention, Hehua Health Center, Jietou Health Center, Qushi Health Center and Xinhua Health Center were investigated by questionnaires. The factors related to tick bites were explored with the univariate analysis and multiple regression models.

RESULTS

Totally 884 effect questionnaires were acquired. Among the 884 participants, 85 (9.6%) had experienced tick bites. The frequency of tick bites was associated with locations, gender, age group, ownership of cattle, working at foreign country, firewood cutting and lumbering in the forest (all P < 0.05). The multiple regression revealed that the male and people raising cattle, working at foreign country, engaging in firewood cutting and lumbering in the forest had a more risk for tick bites.

CONCLUSIONS

Tick bites are common in the residents of Tengchong County. The risk of being bitten varies in different populations. The local health departments should promote health education in the high-risk population to reduce the risk of infecting tick-borne diseases.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

BACKGROUND AND INTRODUCTION

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs.

METHODS

We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences.

RESULTS

Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning.

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity.

Acquired immunity and asymptomatic reservoir impact on frontline and airport ebola outbreak syndromic surveillance and response

The number of surveillance networks for infectious disease diagnosis and response has been growing. In 2000, the World Health Organization (WHO) established the Global Outbreak Alert and Response Network, which has been endorsed by each of the 46 WHO African members since then. Yet, taming the dynamics and plague of the vicious Ebola virus disease (EVD) in African countries has been patchy and erratic due to inadequate surveillance and contact tracing, community defiance and resistance, a lack of detection and response systems, meager/weak knowledge and information on the disease, inadequacies in protective materials protocols, contact tracing nightmare and differing priorities at various levels of the public health system. Despite the widespread acceptance of syndromic surveillance (SS) systems, their ability to provide early warning alerts and notifications of outbreaks is still unverified. Information is often too limited for any outbreak, or emerging or otherwise unexpected disease, to be recognized at either the community or the national level. Indeed, little is known about the role and the interactions between the Ebola infection and exposure to other syndemics and the development of acquired immunity, asymptomatic reservoir, and Ebola seroconversion. Can lessons be learnt from smallpox, polio, and influenza immunity, and can immunization against these serve as a guide? In most endemic countries, community health centers and disease control and prevention at airports solely relies on passive routine immunization control and reactive syndromic response. The frontline and airport Ebola SS systems in West Africa have shown deficiencies in terms of responding with an alarming number of case fatalities, and suggest that more detailed insights into Ebola, and proactive actions, are needed. The quest for effective early indicators (EEE) in shifting the public and global health paradigm requires the development and implementation of a comprehensive and effective community or regional integrated pandemic preparedness and surveillance response systems tailored to local contexts. These systems must have mechanisms for early identification, rapid contact tracing and tracking, confirmation, and communication with the local population and the global community, and must endeavor to respond in a timely manner.

[Status and future focus of the national control program on parasitic diseases]

The achievements and challenges in the national control program on parasitic diseases in PR China were presented after trend analysis of the national and international control activities and programs. The future focus on research and control of parasitic diseases in PR China was put forward in order to achieve the long-term goal of eliminating the parasitic diseases as public health problem in the country.

Morbidity control of schistosomiasis in China

After reviewing the schistosomiasis control program in China with focusing on the socio-economic impact on schistosomiasis endemicity, we introduce the promotion process of morbidity control strategy undertaken before and during the World Bank Loan Project (WBLP) on Schistosomiasis Control. We analyzed the data derived from case study of morbidity control for schistosomiasis, and evaluated the efficacy of chemotherapy. It is suggested that appropriate drug treatment declines worm burden and the intensity of infection as well as prevalence, but chemotherapy alone can hardly reduce the transmission because zoonotic Schistosoma japonicum infection has a great impact on the transmission of the disease. Therefore, the strategies in different (high, medium, and low) transmission areas during the maintenance stage were put forward in consideration of challenges in national control program in the future.