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Intestinal schistosomiasis caused by S. japonicum has long been a threat to the health of residents within endemic areas, especially along the mid-tier of the Yangtze River basin as well as the Dongting and Poyang lakes. Therefore, we collected monitoring data from 2005 to 2014 in Lushan City, Jiujiang City, Jiangxi Province, which is located downstream of Poyang Lake. We conducted a logistic regression analysis in 2005 and in 2008 and then conducted a time series analysis from 2005 to 2014 in Lushan city. The results of the logistic regression analysis showed that after integrated measures were implemented in Lushan city in 2004, the infection rate of intestinal schistosomiasis decreased sharply in different populations, but fishermen had a greater risk of contracting intestinal schistosomiasis in both 2005 and 2008. From the time series analysis, we found that the infection rate decreased sharply from 2005 to 2009 and then increased slowly from 2009 to 2011 before finally becoming relatively stable and the predicated infection rates in HES, SM2, and SM3 are -1.14%, 0.35%, 0.29%, respectively, compared with 0.41% of schistosomiasis infection in 2014, showing a downward trend. Our study indicated that the integrated measures initiated in 2004 in Lushan city had a positive effect on controlling intestinal schistosomiasis, but we should still emphasize special treatment of particular populations, such as fishermen, and should consider environmental changes, such as changes in the water level of Poyang Lake, in the future., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Anhui Province has been one of typical epidemic areas of schistosomiasis in East China as a wide range of large lake and marshland regions provide an ideal environment for growth and reproduction of the intermediate snail host. With the completion of the Yangtze River-Huaihe River Water Transfer Project (YHWTP), launched by the end of 2016, the epidemic areas are expected to expand and controlling schistosomiasis remains a challenge. Based on annual surveillance data at the county level in Anhui for the period 2006-2015, spatial and temporal cluster analyses were conducted to assess the pattern of risk through spatial (Local Moran's I and flexible scan statistic) and space-time scan statistic (Kulldorff). It was found that schistosomiasis sero-prevalence was dramatically reduced and maintained at a low level. Cluster results showed that spatial extent of schistosomiasis contracted, but snail distribution remained geographically stable across the study area. Clusters, both for schistosomiasis and snail presence, were common along the Yangtze River. Considering the effect of the ongoing YHWTP on the potential spread of schistosomiasis, Zongyang County and Anqing, which will be transected by the new water-transfer route, should be given a priority for strengthened surveillance and control. Attention should also be paid to Guichi since it is close to one of the planned inlets of the YHWTP., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The 10-year (1992-2001) World Bank Loan Project (WBLP) contributed greatly to schistosomiasis control in China. However, the re-emergence of schistosomiasis in recent years challenged the long-term progress of the WBLP strategy. In order to gain insight in the long-term progress of the WBLP, the spatial pattern of the epidemic was investigated in the Yangtze River Valley between 1999-2001 and 2007-2008. Two spatial cluster methods were jointly used to identify spatial clusters of cases. The magnitude and number of clusters varied during 1999-2001. It was found that prevalence of schistosomiasis had been greatly reduced and maintained at a low level during 2007-2008, with little change. Besides, spatial clusters most frequently occurred within 16 counties in the Dongting Lake region and within 5 counties in the Poyang Lake region. These findings precisely pointed out the prior places for future public health planning and resource allocation of schistosomiasis., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Poyang Lake, the largest fresh water lake in China, is the major transmission site of Schistosoma japonicum in China. Epidemics of schistosomiasis japonica have threatened the health of residents and stunted social-economic development there., Objective: This article aims at evaluating the effect of various control measures against schistosomiasis: selective mass treatment (ST), targeted mass treatment (TT), mass treatment for animal reservoirs (MT), and health education (HE), on reduction of the prevalence through simulations based on a mathematical model., Methods: We proposed a mathematical model, which is a system of ordinary differential equations for the transmission of S. japonicum among humans, bovines, and snails. The model takes into account the seasonal variation of the water level of Poyang Lake that is caused by the backflow of the Yangtze River and inflow from five small rivers, which influences the transmission of S. japonicum. For the purpose of dealing with the age-specific prevalence and intensity of infection, the human population was classified into four age categories in the model. We carried out several simulations resulting from the execution of ST and TT for elementary school children (E Sch), and combinations of ST, MT, and HE., Results: The simulations indicated that all of the control measures only for humans had a trend of revival after interruption, and a combination of ST and MT has a significant effect on reducing human infection. Although TT and HE had a significant effect on the prevalence in the E Sch group, it had little effect on the overall human population., Conclusion: The simulations indicate that measures targeted to bovines such as chemotherapy besides humans will be vital to eliminate the transmission of S. japonicum in the Poyang Lake region. Moreover, it is desirable to improve health education for fishermen and herdsmen., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Schistosomiasis japonica continues to be an important zoonotic disease in the People's Republic of China (P.R. China), despite decades of dedicated control efforts. Different interventions for its control including chemotherapy of humans and animals, mollusciciding, environmental modification, and health education have been implemented at various stages of the control efforts and in different combinations, resulting in remarkable achievements. Here, we present a systematic review and meta-analysis of the documented effectiveness of health education to reduce schistosomiasis japonica transmission in P.R. China. A total of 10 relevant publications were identified and included in the meta-analysis. The reported results indicate that the prevalence of Schistosoma japonicum infection in humans and schistosomiasis-related knowledge are significantly influenced by health education. The implementation of health education over more than 2 years was associated with an overall schistosomiasis japonica prevalence decrease of 6% (95% CI: 2%, 11%) and an overall increase of 51% (95% CI: 41%, 61%) in schistosomiasis-related knowledge after controlling for confounding factors. Among control groups, the prevalence of schistosomiasis japonica and relevant knowledge levels were not significantly influenced. The relative risk (RR) of an infection with S. japonicum following health education lasting more than 2 years was 0.43 (95% CI: 0.24, 0.78). In summary, a considerable effectiveness of health education with regard to preventing S. japonicum infections in P.R. China and increasing relevant knowledge is documented in the extant literature. This suggests that the effectiveness of health education may be considerable, particularly after its long-term implementation., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The accurate characterization of Schistosoma japonicum has important implications for analyzing genetic variation and would provide basic data for disease control. Previous studies using proteins, coding sequences, and especially antigen-coding genes showed lower genetic variation among S. japonicum isolates from mainland China. Therefore, the present study focused on variations in intron sequences of housekeeping and antigen-coding genes, which may be more informative for genetic analysis. We compared sequence variation between introns of two housekeeping genes and two antigen-coding genes. All 4 genes were polymorphic among all the S. japonicum isolates in mainland China, with 103, 158, 47, and 19 polymorphic (segregating) sites per kilobase in intron sequences of Actin, FBPA, 22.6kDa antigen and GST-26, respectively. Introns of housekeeping genes were slightly more polymorphic than coding and non-coding regions of antigen-coding genes examined in the present study within or among lake/marshland and mountainous types. Phylogenetic analysis based on sequences of single gene or combined sequences of multiple genes showed no specific clustering comprising parasites from single geographical or endemic regions. These results demonstrated that introns of housekeeping and antigen-coding genes were polymorphic, but the intron sequences examined in the present study were not suitable markers for examining genetic relationship among different isolates from endemic regions in mainland China., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

The aim of the present study was to assess the effect of floods on the transmission of schistosomiasis in the Yangtze River valley, People's Republic of China. Retrospective analyses of malacologic, clinical and epidemiologic data, covering a 22-year period, were carried out to elucidate the dispersal patterns of intermediate host snails (Oncomelania hupensis), and acute and chronic infections with Schistosoma japonicum in humans in relation to floods. Potential O. hupensis habitats in years with floods were 2.6-2.7 times larger than in years when water levels were normal. Both the density and infection rate of O. hupensis dropped in the first two years after a flood, but significantly increased in the third year. The number of acute cases with schistosomiasis japonica was markedly higher in years characterized by floods; on average, 2.8 times more cases were observed when compared to years that the Yangtze River had normal water levels. In view of our findings, emergency responses are warranted as soon as possible after the occurrence of a flood in order to avoid or mitigate the reemergence and spread of human schistosomiasis in the People's Republic of China.

The first two phases of a national prevalence survey of schistosomiasis in The Philippines were completed in Mindanao in 2005 and the Visayas in the first quarter of 2007. The design was a stratified two-step systematic cluster sampling, with two Kato-Katz thick smears examined from each participant. In Mindanao, a total of 22 provinces spread in six regions were covered by the survey with five barangays (equivalent to a village) per province for a total of 110 barangays. The response rate was 70.9% with a total of 21,390 individuals examined. The province of Maguindanao, a known endemic area for schistosomiasis japonica, failed to take part in the survey. In the Visayas, 10 out of 11 provinces, spread out in three regions, participated in the survey. There were 6321 respondents for an overall participation rate of 32.2%. Mindanao showed a wider coverage of the disease than the Visayas (60% versus 45%). By region, Caraga or Region 13 ranked first in Mindanao and Region 8 in the Visayas. By province, Agusan del Sur is first on the list, followed by Northern Samar and then Eastern Samar. Overall, the prevalence rate among males is higher than that of females suggesting the occupational hazard of farming and fishing among the males. The higher exposure among farmers and fishermen is also borne out by the age distribution of the disease. Prevalence remains consistently high among the adults compared with the younger age groups. The survey also covered other helminth infections that can be detected in a stool survey, notably soil-transmitted helminthes and food-borne trematodes.

Schistosomiasis is endemic in Indonesia in two isolated areas, Lindu valley and Napu valley, both located in the Province of Central Sulawesi. In 1940, a prevalence survey was initiated in Lake Lindu, which indicated a Schistosoma japonicum infection prevalence of 56% among the population of Anca, Tomado and Langko villages. Another survey was conducted in 1973 in Napu valley and very high infection prevalences of up to 72% were found among the population in Winowanga village. Since then, comprehensive studies on the epidemiology and the effects of control have been carried out in 24 endemic villages in both areas. Over the past six decades, schistosomiasis control has been implemented and the average prevalence is now much lower than before the control programme was launched. In 2006, it was 0.49% in 7 villages in Lindu valley. In Napu valley, the average infection prevalence among the population of 17 villages was 1.08% in the same year. Again in 2006, the prevalence of infection in snails ranged from 0 to 13.4% and from 0 to 9.1% in Napu and Lindu valleys, respectively. The highest prevalence among snails was found in Dodolo village. The prevalence of S. japonicum in the reservoir host Rattus spp. ranged from 0 to 20% and the highest prevalence was again found in Dodolo village. Contemporary data suggest that transmission of schistosomiasis is still ongoing in Indonesia despite regular surveillance and control activities covering the whole endemic area.

There is an evidence that the Kato-Katz technique lacks sensitivity and may hence be an unsuitable method for the assessment of the 'real infection status' in community with low-intensity infections. In this study, six Kato-Katz thick smears (examination of two stool samples with three thick smears each) were used as the diagnostic 'gold' standard for estimating the prevalence of Schistosoma japonicum infection and the results were compared with results based on fewer Kato-Katz thick smear readings. A total of 1055 individuals in 2005 and 725 in 2006 from an endemic village were recruited for the study. The observed prevalence increased gradually with the number of Kato-Katz thick smears examined, and hence the rate of underestimation decreased accordingly. The prevalence based on single Kato-Katz thick smear readings was significantly lower than that obtained using five or six thick smears. The rate of underestimation based on using two and three Kato-Katz thick smears, a typical diagnostic effort in the national schistosomiasis control programme, was about 36.0% (28.4-48.9%) and 25.0% (15.9-40.7%). The number of Kato-Katz thick smears required to secure detection of a S. japonicum infection varies with the infection intensity level. Indeed, examination of a single thick smear was sufficient when the geometric mean of the fecal content of eggs per gram (EPG) was 250 or higher in infected individuals, while six Kato-Katz thick smears were required when the EPG score was lower than 10. In conclusion, our results confirm that the prevalence of S. japonicum infection in a community is generally considerably "underestimated". Moreover, our findings provide a benchmark for the proper application of the Kato-Katz technique and the rational evaluation of the epidemic situation, as well as a scientific basis for constructing a mathematic diagnostic model.

The Kato-Katz technique (duplicate 41.7 mg fecal smears), hatching test and indirect hemagglutination assay (IHA) were compared for their ability to detect human Schistosoma japonicum infection in two endemic villages (Zhonjiang and Zhuxi) in rural China. The hatching test (using a nylon bag, and based on about 30 g of feces) and IHA are conventional Chinese diagnostic methods. In both villages, the trends of prevalences with age and sex were comparable for the different methods. In Zhuxi, Kato-Katz examinations of stools from 7 different days and hatching were available, which could be used as a reliable gold standard. This resulted for IHA in a sensitivity of 80% and a specificity of 48%. The sensitivity of the Kato-Katz technique using one stool specimen was 68%, twice that of hatching (33%). In Zhonjiang, however, hatching resulted in more positive cases than Kato-Katz (prevalence 31% vs. 24%). Apparently, the result of the hatching test depends on environmental factors such as temperature and water quality. Although imperfect, Kato-Katz is recommended out of the three evaluated techniques as the method of choice for large-scale screening of S. japonicum. Hatching is much more tedious, provides inconsistent and only qualitative results, and is not much more sensitive than Kato-Katz. Its poor specificity makes IHA unsuitable for individual screening, but it may be more effective for community diagnosis.

We have investigated a mathematical model for the transmission of Schistosoma japonicum in the infested region of northeastern Bohol island in the Philippines. The development of transmission models is important for planning control strategies. Since S. japonicum has a complicated mode of transmission, the rates of transmission among its hosts cannot be measured directly by field observation. Instead, they have been estimated through model analysis. The model takes into account the seasonal variations and includes a function of control measures. In 1981, a project to eliminate schistosomiasis started on Bohol island. The prevalence decreased dramatically and has kept low level less than 1%. The simulations based on the model predicted that there is little probability of resurgence of an epidemic in the northeastern endemic villages of Bohol island due to the fact that the project has attained a high coverage of selective mass treatment based on stool examination accompanied by a successful snail control operation.

A descriptive study was carried on the schistosomiasis problem in the Philippines from the time the disease was discovered in 1906 to the latter part of the 1990 s. Some research findings were reviewed including the nature of the disease itself. Based on the thrust of the control program which is centered mainly on selective mass treatment and progressed to disease stratification and mass treatment using praziquantel, a downward trend in the prevalence of the disease was observed-from an average of 10.4% in 1981-1985 to 4.1% in 1996. Recommended prospective action, among others, include the development of strategies on environmental sanitation and snail control/eradication in the thrust of the schistosomiasis control program. Other policy related concerns should be formulated subject to the results of further research activities such as on (a) chemotherapy; (b) drug delivery schemes; (c) diagnosis; (d) search for a safe, economical and effective chemical(s) for vector control; and (e) prophylaxis and vaccine production for protection against infection for disease modulation or reduction of pathology.

Poyang Lake, the largest fresh water lake in China, is the major transmission site of Schistosoma japonicum in China. This paper reviews the history of prevalence, efforts and achievements of controlling schistosomiasis and current status of endemicity. The epidemiological characteristics including descriptions of the endemic areas, snail host, definitive hosts, infection source, transmission and impacts of water conservancy, as well as objectives and strategy of control in Poyang Lake are discussed.

Three hundred and forty-nine autopsy cases of schistosomiasis japonica were divided into two groups, based on the pathomorphology. Frequent regressive hepatic lesions such as active schistosomal lesion and destruction of limiting plates characterized the first group. The second group showed reparative hepatic lesions such as regeneration of the collapsed parenchyma, newly formed limiting plates and subsequent narrowing and disappearance of fibrous septa. Complications of liver cirrhosis and hepatocellular carcinoma related to viral hepatitis B and/or C also increased. Clonorchiasis was consistently found in both groups.

Except for imported cases, we have had no new Schistosoma japonicum infection in Japan since 1977. But there are still two habitats of the intermediate snail host: Oncomelania nosophora in the previous endemic areas of Kofu Basin and Obitsu. O. nosophora from Kofu Basin and Obitsu are susceptible to Chinese and Philippine strains of S. japonicum. The number of immigrants from current endemic areas in China or the Philippines is increasing. In order to prevent re-emerging of S. japonicum infections in Japan, we should continue monitoring on those existing snail hosts and investigate an adequate quarantine system. In Japan, elimination of schistosomiasis has been mainly accomplished by control of the snail host. As measures of snail control, cement-lining of ditches and chemical mollusciciding were most effective in Japan. But the cost of this joint program is too expensive compared with health budget in almost developing countries. In endemic areas of Japan, land reformation from paddy field to fruit farm was also effective. The intermediate snail host in the Philippines, Oncomelania quadrasi is much more aquatic than O. nosophora. For control of O. quadrasi, small drainage of the water and land reclamation from swampy field to rice-field were effective. Based on biological characteristics of Oncomelania spp., we can modify the past successful snail control program in Japan to be adapted ecologically and economically to each endemic area of developing countries.

Historical account of Katayama disease is presented as a centenary record since the discovery of Schistosoma japonicum in Japan in 1904. The ever unknown endemic disease was called Katayama disease. Katayama district, Hiroshima Prefecture is one of endemic areas of schistosomiasis japonica in Japan. The causative parasite was first discovered in a human case in Katayama district. After the discovery of the parasite, life history, diagnosis, treatment, control measures and even eradication have been worked out, attempted and succeeded in Katayama district together with other endemic areas in Japan. Hiroshima Prefecture declared safety from the disease in 1980.

There are still many Oncomelania snails that inhabit the Kofu Basin, Yamanashi Prefecture, Japan, which had been declared free of schistosomiasis japonica. Due to the need to monitor the situation, a fixed-point observation system using GIS from GPS is being examined. In addition, in broad present or former endemic areas, survey areas are being managed by remote sensing with satellite images or aerial photographs. A simple and effective monitoring method by mobile GIS using PDAs was developed, risk or hazard maps were prepared and a system that would enable a response in the event of reemergence is being examined.

Ongoing efforts over the last 50 years, aiming at the elimination of schistosomiasis in the People's Republic of China, have been spectaculary successful in reducing the prevalence and intensity of the infection. The endemic areas have been reduced to core regions with particular problems such as the middle and lower reaches of the Changjiang River (Yangtze), the land adjacent to the lakes of central China and certain mountainous areas in Sichuan and Yunnan. An effort to eradicate schistosomiasis as a public health problem in these areas, by means of mass chemotherapy in regions of high prevalence and selective chemotherapy in others, provided good results initially but a lasting effect proved unattainable with chemotherapy alone. A small part of the funds available for this effort were used for research and training. Overseen by a Joint Research Management Committee (JRMC), research training was intensified resulting in improved applications and a better quality of the scientific level of the research finally carried out. Several new control tools were produced which may improve future control approaches, which might achieve a more than temporary relief. In evaluating the contributions made, it was found that the great environmental variations between the eight provinces where control activities were implemented was the main reason why general use of chemotherapy only could not be entirely successful. The inclusion of a research component proved beneficial both for the short- and long-term control and the JRMC proved useful in exposing that sustained progress cannot be achieved without back-up by other approaches, e.g. snail control. Suggested future activities include strengthening of intersectoral and industrial collaboration but finding financial support for continuing the JRMC initiative in some form. It is crucial to consolidate progress made.

Interleukin-10 (IL-10) cytokine production was assessed using peripheral blood mononuclear cells (PBMC) from 67 individuals living in an area endemic for schistosomiasis japonica in China (Dongting Lake, Hunan Province), and 11 control subjects from a non-endemic part of the same Province. Production of IL-10 was measured following in vitro stimulation of PBMC using whole parasite extract (SWAP) or a panel of recombinant Schistosoma japonicum antigens (22-kDa tegumental membrane-associated antigen, glyceraldehyde-3-phosphate dehydrogenase, paramyosin, 14-kDa fatty acid-binding protein and 28-kDa glutathione S-transferase) which are of recognized interest in the development of protective immunity to schistosomiasis. Significantly, PBMC isolated from the exposed population compared with the non-exposed population produced higher levels of IL-10. There was a trend towards higher mean levels of IL-10 release in putatively resistant (insusceptible) (consistently egg negative but highly exposed) individuals compared with susceptible (egg-positive) subjects from the exposed population. Analysis of individual exposure (the duration of water contact and the percent body surface area in contact with water, expressed as m2 h/day) vs. IL-10 production indicated a weak but consistent and statistically significant inverse correlation, with lower levels of exposure being associated with higher levels of IL-10. These results suggest an association between IL-10 production and resistance to S. japonicum in subjects from this Chinese population exposed to infection.

This review on the control of schistosomiasis in China consists of the disease in the past, epidemiology, control programme, control approaches, achievements, problems existed and an appendix: the criteria for control and elimination of schistosomiasis in China.