Schistosomiasis Control Program In China Research Articles

Sharing the WHO guideline on control and elimination of human schistosomiasis to achieve the goal of schistosomiasis elimination in China

Currently, the national schistosomiasis control program of China is moving from transmission interruption to elimination, and there are multiple challenges during the stage moving towards the progression of schistosomiasis elimination, including a high difficulty in shrinking snail-infested areas, unstable achievements for infectious source control, imperfect surveillance system and a reduction in schistosomiasis control and administration. Based on the core suggestions proposed in the 2022 WHO guideline on control and elimination of human schistosomiasis, recommendations on schistosomiasis surveillance system building, development of novel diagnostics, adjustment of the schistosomiasis control strategy and maintaining and improvements of the schistosomiasis control capability are proposed for the national schistosomiasis control program of China in the new era according to the actual status of schistosomiasis control in China. Formulation of the national schistosomiasis control strategy and goal from One Health perspective, verification of transmission interruption and elimination of schistosomiasis, precision implementation of schistosomiasis control interventions with adaptations to local circumstances, development and application of highly sensitive and specific diagnostics are recommended for elimination of schistosomiasis in China. In addition, the implementation of the 2022 WHO guideline on control and elimination of human schistosomiasis may guide the elimination of schistosomiasis in China.

Analysis of the new WHO guideline to accelerate the progress towards elimination of schistosomiasis in China

On February 2022, WHO released the evidence-based guideline on control and elimination of human schistosomiasis, with aims to guide the elimination of schistosomiasis as a public health problem in disease-endemic countries by 2030 and promote the interruption of schistosomiasis transmission across the world. Based on the One Health concept, six evidence-based recommendations were proposed in this guideline. This article aims to analyze the feasibility of key aspects of this guideline in Chinese national schistosomiasis control program and illustrate the significance to guide the future actions for Chinese national schistosomiasis control program. Currently, the One Health concept has been embodied in the Chinese national schistosomiasis control program. Based on this new WHO guideline, the following recommendations are proposed for the national schistosomiasis control program of China: (1) improving the systematic framework building, facilitating the agreement of the cross-sectoral consensus, and building a high-level leadership group; (2) optimizing the current human and livestock treatments in the national schistosomiasis control program of China; (3) developing highly sensitive and specific diagnostics and the framework for verifying elimination of schistosomiasis; (4) accelerating the progress towards elimination of schistosomiasis and other parasitic diseases through integrating the national control programs for other parasitic diseases.

Contribution to global implementation of WHO guideline on control and elimination of human schistosomiasis by learning successful experiences from the national schistosomiasis control program in China

Schistosomiasis is a parasitic disease that seriously hinders socioeconomic developments and threatens public health security. To achieve the global elimination of schistosomiasis as a public health problem by 2030, WHO released the guideline on control and elimination of human schistosomiasis on February, 2022, with aims to provide evidence-based recommendations for schistosomiasis morbidity control, elimination of schistosomiasis as a public health problem, and ultimate interruption of schistosomiasis transmission in disease-endemic countries. Following concerted efforts for decades, great achievements have been obtained for schistosomiasis control in China where the disease was historically highly prevalent, and the country is moving towards schistosomiasis elimination. This article reviews the successful experiences from the national schistosmiasis control program in China, and summarizes their contributions to the formulation and implementation of the WHO guideline on control and elimination of human schistosomiasis. With the progress of the "Belt and Road" initiative, the world is looking forward to more China's solutions on schistosomiasis control.

Emergency responses to schistosomiasis outbreak during the stage moving towards elimination in China

Currently, the national schistosomiasis control program of China is moving from transmission control and transmission interruption to elimination; however, there is still a threat of schistosomiasis outbreak in area where the transmission of schistosomiasis has not been interrupted, and in areas where transmission interruption and even elimination have been achieved because of the complex factors relating to schistosomiasis transmission, as well as socioeconomic factors and natural environments, which greatly affects the consolidation of schistosomiasis control outcomes and the achievement of the goal of schistosomiasis elimination in the country. Here, we summarized the outbreaks of schistosomiasis in China during the past six decades, evaluated the impact of schistosomiasis outbreak on the national schistosomiasis control program and proposed management of schistosomiasis outbreak and prevention of schistosomiasis resurgence as the key point and difficulty for schistosomiasis control in the current stage. Improving the surveillance-response mechanisms and minimizing the development of schistosomiasis outbreak and the resultant damages and losses are recommended to provide technical supports for elimination of schistosomiasis in China.

Schistosomiasis control in the evolution of China's international discourse power

As a successful example of global public health, Chinese schistosomiasis control technology and experiences have been included in global public health governance. Chinese schistosomiasis control program progresses with China's international discourse power. During the period from the initial stage of the founding of the People's Republic of China to China's Reform and opening-up, the national schistosomiasis control program of China achieved great successes through mobilizing multi-sectorial resources under the policy of Independence and Self-reliance. Following China's Reform and opening-up, all advantageous opportunities were captured to solve problems pertaining to schistosomiasis control in the context of complex international situations. As a consequence, transmission control of schistosomiasis was achieved across China in 2015. Since the Eighteenth National Congress of the Communist Party of China, China has contributed the discourse system with distinct Chinese characteristics to the world, and has actively participated in health cooperation projects between China and other "Belt and Road" countries, which has contributed China's wisdom to global schistosomiasis control program and conveyed China's voice to the world.

Progress of researches on the diagnostic techniques for schistosomiasis

Schistosomiasis is an important zoonotic parasitic disease, and is categorized as a neglected tropical disease by the World Health Organization. Following the concerted efforts for more than 70 years, great achievements have been made in the national schistosomiasis control program in China, and the prevalence, disability and mortality due to schistosomiasis has remarkably dropped. Nevertheless, the frequent identification of imported schistosomiasis and the resulting potential transmission risk in mainland China have been recently paid much attention following the implementation of the "Belt and Road Initiative" and the China-Africa Cooperation Forum. This review describes the advances in the diagnostic tools for schistosomiasis, including pathogenic techniques, immunodiagnostic techniques and nucleic acid assays, in order to consolidate schistosomiasis control achievements and promote the capability for detection of external biological safety risks.

Intensified surveillance promotes the process towards elimination of schistosomiasis in China

Surveillance is an important part of the national schistosomiasis control program of China, which play a critical role in facilitating the progress towards elimination of schistosomiasis in China. The coverage of schistosomiasis surveillance has shifted from the high-risk regions at the initial stage of the national schistosomiasis control program of China to the current all endemic counties (cities, districts), and the surveillance contents have extended from single surveillance of endemic status to comprehensive surveillance of endemic status, epidemic factors and transmission risks. With the continuous progress towards schistosomiasis elimination, the national schistosomiasis control program has shifted from "extensive control" to surveillance and early warning-based "precision control" in China, which proposes much higher requirements for schistosomiasis surveillance. Currently, the surveillance of schistosomiasis has been covered in all schistosomiasis-endemic counties (cities, districts) of China, and the development of rapid and early identification of Schistosoma japonicum cercariae and S. japonicum-infected Oncomelania hupensis snails will greatly improve the sensitivity of and the duration of responses to schistosomiasis surveillance, which will provide powerful tools for elimination of schistosomiasis in China.

Expert consensus on the strategy and measures to interrupt the transmission of schistosomiasis in China

Since 2015 when the transmission of schistosomiasis was controlled in China, the country has been moving towards elimination of schistosomiasis, with the surveillance-response as the main interventions for schistosomiasis control. During the period of the 13th Five-Year Plan, the transmission of schistosomiasis had been interrupted in four provinces of Sichuan, Jiangsu, Yunnan and Hubei and the prevalence of schistosomiasis has been at the historically lowest level in China. As a consequence, the goal set in The 13th Five-Year National Schistosomiasis Control Program in China is almost achieved. However, there are multiple challenges during the stage moving towards elimination of schistosomiasis in China, including the widespread distribution of intermediate host snails and complicated snail habitats, many types of sources of Schistosoma japonicum infections and difficulty in management of bovines and sheep, unmet requirements for the current schistosomiasis control program with the currently available tools, and vulnerable control achievements. During the 14th Five-Year period, it is crucial to consolidate the schistosomiasis control achievements and gradually solve the above difficulties, and critical to provide the basis for achieving the ultimate goal of elimination of schistosomiasis in China. Based on the past experiences from the national schistosomiasis control program and the challenges for schistosomiasis elimination in China, an expert consensus has been reached pertaining to the objectives, control strategy and measures for The 14th Five-Year National Schistosomiasis Control Program in China, so as to provide insights in to the development of The 14th Five-Year National Schistosomiasis Control Program in China.

Key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period

Schistosomiasis was once endemic in 12 provinces (municipalities, autonomous regions) along and south of the Yangtze River basin, which seriously damages human health and hinders socioeconomic developments in China. Following the concerted efforts for 70 years, remarkable achievements have been gained in the national schistosomiasis control program of China. However, there are still multiple challenges for elimination of schistosomiasis in the country. This paper describes the current status of schistosomiasis and the challenges during the progress towards the elimination of schistosomiasis, and proposes the goals, key points and research priorities of schistosomiasis control in China during the 14th Five-Year Plan Period.

Challenges of schistosomiasis control in China during the coronavirus disease 2019 (COVID-19) epidemic

To investigate the implementation of schistosomiasis control activities in China during the coronavirus disease 2019 (COVID-19) epidemic, so as to evaluate the impact of COVID-19 epidemic on the national schistosomiasis control program in China. On April 2020, 3 counties (districts) were randomly selected from each of the 12 schistosomiasis-endemic provinces (municipality, autonomous region), and a questionnaire survey was conducted to investigate the implementation of schistosomiasis control activities in these counties (districts) from January to March 2020. Then, the impact of the COVID-19 epidemics on the national schistosomiasis control program of China was evaluated using a comparative analysis approach. Among the 36 counties (cities, districts) sampled from 12 provinces (municipality, autonomous region), 66.67% were at a high and medium risk of COVID-19 epidemics. The implementation of schistosomiasis control activities assignment, human schistosomiasis examination and treatment, snail control with chemical treatment and health education reduced by 44.26% to 91.56% as compared to 2019 during the same time period, and the schistosomiasis control program was more affected by COVID-19 in transmission-controlled provinces. The gross funds invested into the schistosomiasis control program reduced by 23.39% in relative to the expected, while the total expenditure increased by 41.22%. In addition, all 36 surveyed counties (districts) considered that the COVID-19 epidemic had a short-term impact on the schistosomiasis control program, with the most predominant impact on schistosomiasis control activities assignment, human resources and monitoring of endemic situation of schistosomiasis. The COVID-19 epidemics affect the routine schistosomiasis control program across the endemic-foci of China. Policy and financial support should be strengthened to ensure the completion of the schistosomiasis control program.

Healthy China Strategy and schistosomiasis control

This paper summarizes the changes in the policy associated with schistosmiasis control in the new era, analyzes the background of Health China Strategy and its association with the current schistosomiasis control program in China, describes several schistosomiasis control models and proposes some suggestions responding to the challenges in current schistosomiasis control program of China, so as to provide insights into the development of the effective control strategy for schistosomiasis.

Strategy for the South-South cooperation on schistosomiasis control under the Belt and Road Initiative

Following the concerted efforts for nearly 70 years, great successes have been achieved in the national schistosomiasis control programme in China. Currently, the national schistosomiasis control programme in China is facing the challenges to solve the problems during the"final mile"stage towards schistosomiasis elimination, and contribute Chinese experiences, Chinese strategy and Chinese wisdom to the global schistosomiasis control programmes, so as to facilitate the transformation of the joint efforts in the Belt and Road Initiative to a high-quality development, thereby well supporting the activities on global health security. This paper analyzes the current global status of schistosomiasis and the challenges of the global schistosomiasis control programmes, describes the basis for the cooperation on schistosomiasis control among the countries along the Belt and Road Initiative, illustrates the challenges for translation of Chinese experiences and techniques in schistosomiasis control to other diseaseendemic countries, and proposes the patterns and prospects of the South-South cooperation on schistosomiasis control under the Belt and Road Initiative.

SWOT analysis on snail control measures applied in the national schistosomiasis control programme in the People\u2019s Republic of China

BackgroundSnail control is an important component in the national schistosomiasis control programme in China, by application of chemical molluscicides, forestry projects, agriculture projects and water conservancy projects in recent decades. However, there are still wide areas of snail inhabited in China which remains a great challenge to achieve the goal of schistosomiasis elimination by 2025. Therefore, a SWOT (strengths, weaknesses, opportunities and threats) analysis on snail control measures is required for precision schistosomiasis control.MethodsThe SWOT approach, which is a well-known structured analysis tool, was used to identify and evaluate the specific characteristics of four types of snail control measures in China, including chemical mollusciciding, forestry, agriculture, and water conservancy projects. The analysis were carried out based on the information collection from literature review, of research papers, books, annual report database of national schistosomiasis control programme in China, reports from the academic forums, and so on.ResultsFor chemical mollusciciding, application strategy needs to focus on specific local settings, such as stage of schistosomiasis control, environmental factors, and limitations from external policies and internal deficiencies. Regarding forestry projects, the optimal strategies are to cooperate with other national forestry programmes to share the investment costs and pay attention on wetland protection. In agriculture projects, it is necessary to develop related cash crop industries and combine with national farmland consolidation projects simultaneously to increase the total economic benefits. Concerning water conservancy projects, the main purpose is to control snail migration from snail area to snail-free areas nationwide.ConclusionsIntegrated strategies for various measures application and a top-level designed cooperation mechanism will be the necessary to eliminate snail and schistosomiasis in China.

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.

Strengthening the control of goat schistosomiasis to facilitate the progress towards elimination of schistosomiasis in China

Although great success has been achieved in schistosomiasis control, schistosomiasis japonica remains a publichealth concern in China. Schistosoma japonicum is found to naturally infect over 40 mammalian animals. The implementation of the integrated schistosomiasis control strategy emphasizing infectious source control since 2004, which integrates replacement of bovines with machines, breeding domestic animals in fences, building safe pastures and chemotherapy of infected bovines, results in a clear-cut reduction in the prevalence of S. japonicum infection in both humans and bovines, as well as the areas of infected snail habitats, and the national schistosomiasis control program is moving from transmission control towards transmission interruption and elimination. It has been found that goat is highly susceptible to S. japonicum infection, and previous epidemiological data have shown a high prevalence of infection in goat. However, the role of goat in the transmission of schistosomiasis japonica has not been paid much attention, and there are few systematic surveys to evaluate the role of goat in schistosomiasis transmission in China to date. Professor Liang Yousheng's group investigated S. japonicum development and reproduction (egglaying) in goat body, environmental contamination by goat feces, and the effect of temperature and humidity on the survival of S. japonicum eggs in goat feces. Their findings further demonstrate the role of goat in the transmission of schistosomiasis japonica. In addition, they proposed, based on their findings and previous reports, that the management of goat should be integrated into the national schistosomiasis control program in China, since goat is virtually one of the major infectious sources of schistosomiasis japonica in China. Moreover, this group improved the fecal hatching test and optimized the parasitological technique for diagnosis of S. japonicum infection in goats. These innovative studies fill in the gaps of goat schitsosomiasis japonica research in China, and the research outcomes will enrich the currently implemented integrated schistosomiasis control strategy emphasizing infectious source control, and are believed to play a critical role in schistosomiasis elimination in China. Since schistosomiasis seriously affects goat husbandry development and local famer income, and goat has become a major infectious source of schistosomiasis japonica in China, the control of goat schistosomiaiss will facilitate the progress towards the elimination of schistosomiasis in China, and the following research priorities are suggested: (1) to emphasize the control of goat schistosomiasis, and to integrate the comprehensive management of goat into the national schistosomiasis control program in China; and (2) to develop new techniques, products and interventions for the control of goat schistosomiasis.

Role of goat in transmission of schistosomiasis japonica IV Goat breeding in endemic regions and role of goat in schistosomiasis transmission

This review describes the major species, number, breeding pattern, ratio of fenced to freely grazed goat, susceptibility to Schistosoma japonicum, pattern of S. japonicum infection, infection rate, intensity of infection, fecal contamination of goat that were bred in 5 marshland and lake provinces of Hunan, Hubei, Jiangxi, Anhui and Jiangsu, and two mountainous provinces of Yunnan and Sichuan, and demonstrates the associations of infected goat distribution with the distribution of infected Oncomelania hupensis snails and humans. Considering the huge number of goat which were predominantly grazed freely in marshland and lake endemic regions of China, the high infection rate, numerous environmental pollution by goat feces, as well as the close correlation between the infected goat distribution and infected snail distribution, goat is considered as a major infectious source for schistosomiasis japonica in China, and to play a critical role in the transmission of the disease. Since the control of schistosomiasis in animals is critical to schistosomiasis interruption and elimination, it is suggested that the integrated management of goat schistosomiasis should be included in the national schistosomiasis control program of China.

The Schistosoma japonicum self-cure phenomenon in water buffaloes: potential impact on the control and elimination of schistosomiasis in China

Schistosomiasis japonica, caused by Schistosoma japonicum, is an important zoonotic disease in China, the Philippines and small pockets of Indonesia. In addition to infecting people, S. japonicum can infect over 40 species of wild and domestic animals which have varying impacts on human infection. It is now generally accepted that bovines, particularly water buffaloes, are the major reservoir for human infection in China as they are naturally infected with schistosomes and deposit more eggs into the environment than humans or any other animal host. This complicates control efforts and the economic burden associated with schistosomiasis morbidity and mortality has taken its toll on both human and livestock populations. Over the last 50years, the schistosomiasis control program in China has made great strides in reducing prevalence and morbidity, and the Chinese authorities now aim to eliminate the disease nationwide in the next decade. Current Chinese control strategies place particular importance on interventions targeting bovines including: praziquantel treatment, barrier farming to prevent grazing in transmission areas, their replacement with mechanized tractors and possible bovine vaccination. A number of studies have shown that in the period following S. japonicum infection, the worm burden drops sharply in water buffaloes and some other animal hosts such as pigs. This is due to a self-cure phenomenon whereby there is parasite clearance by both immune and non-immune factors. Here we review studies investigating the self-cure effect, paying particular attention to S. japonicum infection in water buffaloes, and discuss its potential impact on the future schistosomiasis control and elimination efforts in China. Further understanding of the mechanism of self-cure in water buffaloes could be important for future schistosome vaccine design and delivery.

An economic evaluation of the national schistosomiasis control programme in China from 1992 to 2000

The World Bank Loan Project, by far the largest effort in China for schistosomiasis control since control activities were initiated in the mid 1950s, was carried out for a 9-year period commencing in 1992 in the 8 provinces where Schistosoma japonicum remained endemic when the project started. To evaluate its impact, a retrospective economic evaluation was done in 2001. Six representative counties, i.e. Huarong in Hunan province, Qianjiang in Hubei province, Yugan in Jiangxi province, Tongling in Anhui province, Xichang in Sichuan province and Dali in Yunnan province, were selected for the study. The total financial input in these counties from 1992 to 2000 was RMB Yuan 90.334 million with the World Bank loan accounting for 40.9%. Control efforts resulted in reduction of human prevalence rates in the six counties from 0.7–9.0% in 1992 to 0.1–2.7% in 2000. With regard to S. japonicum infection in bovines, a high reduction was observed in Qianjiang, and smaller decreases were noted in four counties, while there was an increase in Dali. In general, the areas infested by the intermediate host snail fluctuated around the initial level. The net benefit-cost ratio was 6.20, which means that this project gained US$ 6.20 for every dollar spent. The correlation coefficients of the net benefit-cost ratio to the human and bovine infection rates at the beginning of the project were 0.55 and 0.66, respectively. It is conceivable that further progress in schistosomiasis control is an important feature for sustained growth of the local economy, particularly in areas where control of the disease has been most challenging.

Use of praziquantel for clinical treatment and morbidity control of schistosomiasis japonica in China: a review of 30 years’ experience

Chemotherapy is widely acknowledged as the most important, rapid and cost-effective method of reducing morbidity due to schistosome infections. The discovery of praziquantel in the 1970s has been a breakthrough for treatment of patients infected with schistosomes, including Schistosoma japonicum in China, and entire communities at risk of schistosomiasis. Praziquantel is usually administered in a single oral dose and has no or only mild and transient side effects. The drug is highly efficacious against S. japonicum, both in patients with acute and chronic stages of the infection, among subjects with extensive hepatosplenic involvement, and in patients with other complicated diseases. The cost of praziquantel has been reduced significantly over the past years. Hence, praziquantel has become the backbone of the national schistosomiasis control programme in China and in other countries where the disease remains endemic, most notably in sub-Saharan Africa. Chemotherapy with praziquantel also plays a role in transmission control of schistosomiasis, although transmission interruption cannot be reached by chemotherapy alone. Here, I review 30 years’ of experiences gained with the use of praziquantel for clinical treatment and larger-scale control of schistosomiasis japonica in China.