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Objective: Foodborne zoonotic trematodes (FZT), which infect the liver, lungs and intestines of humans, are an emerging public health concern in tropical countries including Vietnam. In northern Vietnam, Clonorchis sinensis is recognised as the most important species of the FZT. Up to now, small‐scale studies conducted in the country have indicated that health education could improve participants' knowledge and practices related to clonorchiasis, however strong evidence is still lacking. We conducted an intervention trial between 2020 and 2021 in four communes in Yen Bai and Thanh Hoa province, aiming to evaluate the impact of an extended educational package on knowledge, attitude and practices related to clonorchiasis, as well as on knowledge on the large liver fluke and minute intestinal flukes. Methods: To this end, baseline and post‐intervention questionnaires were conducted. Generalised estimating equations models were run to analyse the impact of the intervention on knowledge, attitudes and practices over time in the intervention versus control group. Finally, 172 people in the intervention group and 162 in the control group were included for analysis. Results: Results demonstrated that the intervention significantly improved clonorchiasis knowledge, attitudes and practices, with higher odds for a correct knowledge response (odds ratio (OR) = 2.80, 95% confidence interval (CI) = 1.84–4.27, p‐value < 0.001), increased average mean attitude score (mean = 0.363, 95%CI = 0.182–0.544, p‐value < 0.001), and a reduced odds of consuming raw fish (OR = 0.15, 95%CI = 0.06–0.40, p = 0.002) in the intervention group compared to the control group post‐intervention versus baseline. Additionally, participants in the intervention group exhibited enhanced basic knowledge of the large liver fluke and minute intestinal flukes post‐intervention. Conclusions: These findings demonstrate the potential of health education programs in preventing clonorchiasis in endemic areas, emphasising the importance of continued health education as a critical component of integrated control programs for clonorchiasis. [ABSTRACT FROM AUTHOR]

Background: Clonorchiasis and opisthorchiasis, caused by the liver flukes Clonorchis sinensis and Opisthorchis viverrini respectively, represent significant neglected tropical diseases (NTDs) in Asia. The co-existence of these pathogens in overlapping regions complicates effective disease control strategies. This study aimed to clarify the distribution and interaction of these diseases within Southeast Asia. Methods: We systematically collated occurrence records of human clonorchiasis (n = 1809) and opisthorchiasis (n = 731) across the Southeast Asia countries. Utilizing species distribution models incorporating environmental and climatic data, coupled machine learning algorithms with boosted regression trees, we predicted and distinguished endemic areas for each fluke species. Machine learning techniques, including geospatial analysis, were employed to delineate the boundaries between these flukes. Results: Our analysis revealed that the endemic range of C. sinensis and O. viverrini in Southeast Asia primarily spans across part of China, Vietnam, Thailand, Laos, and Cambodia. During the period from 2000 to 2018, we identified C. sinensis infections in 84 distinct locations, predominantly in southern China (Guangxi Zhuang Autonomous Region) and northern Vietnam. In a stark contrast, O. viverrini was more widely distributed, with infections documented in 721 locations across Thailand, Laos, Cambodia, and Vietnam. Critical environmental determinants were quantitatively analyzed, revealing annual mean temperatures ranging between 14 and 20 °C in clonorchiasis-endemic areas and 24–30 °C in opisthorchiasis regions (P < 0.05). The machine learning model effectively mapped a distinct demarcation zone, demonstrating a clear separation between the endemic areas of these two liver flukes with AUC from 0.9 to1. The study in Vietnam delineates the coexistence and geographical boundaries of C. sinensis and O. viverrini, revealing distinct endemic zones and a transitional area where both liver fluke species overlap. Conclusions: Our findings highlight the critical role of specific climatic and environmental factors in influencing the geographical distribution of C. sinensis and O. viverrini. This spatial delineation offers valuable insights for integrated surveillance and control strategies, particularly in regions with sympatric transmission. The results underscore the need for tailored interventions, considering regional epidemiological variations. Future collaborations integrating eco-epidemiology, molecular epidemiology, and parasitology are essential to further elucidate the complex interplay of liver fluke distributions in Asia. [ABSTRACT FROM AUTHOR]

In 2005, the network decided to increase its number of target diseases to include other helminthic zoonoses such as fascioliasis, clonorchiasis, opisthorchiasis, paragonimiasis and cysticercosis and in the process expanding membership to include South Korea, Vietnam, Thailand and Japan. NTDs were eventually included as awareness is heightened on these diseases affecting poor and developing countries. Researches on clonorchiasis and opisthorchiasis unravel the mechanism by which these diseases eventually predispose to cholangiocarcinoma. The liver cancer associated with these liver fluke infections necessitate the need to clarify the global burden of disease of these infections. The magnitude of these liver fluke diseases in endemic countries like China, Vietnam, Laos, Cambodia and Thailand is described. Success in elimination of lymphatic filariasis in PR China and Cambodia is highlighted to show how intensified multisectoral collaboration and strong political become strong ingredients in elimination of parasitic diseases like LF. New advances are presented that clarify species and strain differences in Fasciola spp., Paragonimus spp., Taenia spp. and Echinococcocus spp. Conventional diagnostic techniques are compared with new serologic techniques that are being developed. New control strategies such as the Lawa model are presented. [ABSTRACT FROM AUTHOR]

Clonorchis sinensis is major fish-borne trematode, endemic in North Vietnam. Risk factors described so far include individual eating behaviors and environmental factors. Here, additional to conventional risk factors, we report on socially influenced liver fluke transmission in endemic communities. A cross-sectional study on risk factors and fish sharing networks was conducted in 4 villages of Gia Thinh Commune, Ninh Binh Province. A total of 510 residents in 272 households were recruited for risk factor analysis while 220 households, 28 fishermen and 10 fish-sellers were enrolled for social network study. Fecal examination for C. sinensis eggs was performed. Average C. sinensis infection rate at Gia Thinh commune was 16.5% (range 2% to 34.4%). Higher infection rates were significantly associated with males, lower educational levels, eating raw fish, and location of the villages. Social network analysis (SNA) showed a strong positive correlation between ego network size (number of households in fish sharing network) and quantity of raw fish consumed ( r = 0.603, P < 0.05). The infection rate in people who ate raw-fish caught from a nearby river was significantly higher than those who consumed fish taken from farmed ponds ( P < 0.05). The amount of raw-fish meal consumed per resident/year was significantly higher in villages that had a strong network of sharing raw-fish food ( P < 0.001). This study reports for the first time on fish-food sharing among neighbors, proximity to water bodies, frequency of eating raw fish from natural water bodies and low education were key risk factors in C. sinensis infection transmission in northern Vietnam. [ABSTRACT FROM AUTHOR]

Freshwater snails have received much attention for their role as intermediate hosts for trematodes causing disease in people and animals such as schistosomiasis and various food-borne trematodes. While effective medical treatment exists for some of these diseases there is need for preventive measures to reduce transmission, e.g. control of intermediate hosts because transmission patterns are often complicated due to presence of reservoir final hosts. In order to implement control measures against the intermediate host snails with minimal impact on the freshwater ecosystems and their biodiversity, a profound knowledge on transmission patterns of the trematodes is required and this is partly related to distribution, habitat preferences, and seasonal variation in density of the intermediate host species. Identification of snail species can be problematic on the basis of morphological and anatomical characters alone as some species show morphological plasticity and similarly morphological differentiation of cercariae found in snails may be difficult and this could lead to biased perceptions of intermediate host spectra and transmission patterns. In this paper, we give an overview of the snail families and their medical and veterinary importance in Asia but with main focus on Vietnam. [ABSTRACT FROM AUTHOR]

Clonorchiasis is a parasitic disease of high public health importance in many countries in southeastern Asia and is caused by the Chinese liver fluke Clonorchis sinensis . However, the genetic structure and demographic history of its populations has not been sufficiently studied throughout the geographic range of the species and available data are based mainly on partial gene sequencing. In this study, we explored the genetic diversity of the complete 1560 bp cytochrome c oxidase subunit 1 ( cox1 ) gene sequence for geographically isolated C. sinensis populations in Russia and Vietnam, to our knowledge for the first time. The results demonstrated low nucleotide and high haplotype differentiation within and between the two compared regions and a clear geographical vector for the distribution of genetic diversity patterns among the studied populations. These results suggest a deep local adaptation of the parasite to its environment including intermediate hosts and the existence of gene flow across the species’ range. Additionally, we have predicted an amino acid substitution in the functional site of the COX1 protein among the Vietnamese populations, which were reported to be difficult to treat with praziquantel. The haplotype networks consisted of several region-specific phylogenetic lineages, the formation of which could have occurred during the most extensive penultimate glaciations in the Pleistocene Epoch. The patterns of genetic diversity and demographics are consistent with population growth of the liver fluke in the late Pleistocene following the Last Glacial Maximum, indicating the lack of a population bottleneck during the recent past in the species’ history. The data obtained have important implications for understanding the phylogeography of C. sinensis , its host-parasite interactions, the ability of this parasite to evolve drug resistance, and the epidemiology of clonorchiasis under global climate change. [ABSTRACT FROM AUTHOR]

Abstract: Clonorchis sinensis, the causative agent of clonorchiasis, is widespread in East and Southeast Asia, including China, Vietnam and the Republic of Korea. We identified antigenic proteins from adult C. sinensis liver flukes using immunoproteomic analysis. In this study, we found 23 candidate antigenic proteins with a pI in the range of 5.4–6.2 in total lysates of C. sinensis. The antigenic protein spots reacted against sera from clonorchiasis patients and were identified as cysteine proteases, glutathione transferases, gelsolin, propionyl-CoA carboxylase (PCC), prohibitin and 14-3-3 protein (14-3-3) using LC-coupled ESI-MS/MS and an EST database for C. sinensis. PCC and 14-3-3 were identified for the first time as serological antigens for the diagnosis of C. sinensis. To validate the antigenicity of PCC and 14-3-3, recombinant proteins were immunoblotted with sera from clonorchiasis patients. The structural, functional and immunological characteristics of the putative amino acid sequence were predicted by bioinformatics analysis. Our novel finding will contribute to the development of diagnostics for clonorchiasis. These results suggest that immunoproteomic approaches are valuable tools to identify antigens that could be used as targets for effective parasitic infection control strategies. [Copyright &y& Elsevier]

Summary: Clonorchiasis is an emerging food-borne trematode infection in Vietnam. Due to the absence of cost-effective preventive measures its control largely relies on morbidity reduction by chemotherapy with praziquantel. We performed a comparative cost estimation of three different diagnostic and intervention approaches in areas of high and low prevalence of clonorchiasis in northern Vietnam in order to select more cost-effective chemotherapy. Our study confirmed that a questionnaire investigating the habit of eating raw, freshwater fish was a rapid, cost-effective and operationally feasible tool for identifying individuals at risk of clonorchiasis in both high-prevalence and low-prevalence areas. The cost of diagnosis and intervention per person and per true positive case was 20-fold higher in low-prevalence areas, regardless of the type of approach. Geographical mapping of high-risk areas prior to screening is, therefore, recommended to maximize the cost-effectiveness of the intervention activities. [Copyright &y& Elsevier]

• Opisthorchiasis and clonorchiasis are major public health problems affected over 15 million in the GMS. • Opisthorchis viverrini is endemic in Lower Mekong Basin while Clonorchis sinensis is endemic in Guangxi and northern Vietnam. • Snail intermediate hosts and geographical barrier are key determinants in distribution difference. • Emerging human liver fluke infections occur in Cambodia, Myanmar, and Guangxi over the past 20 years. • Systematic exploring of the disease burdens and integrated control using One Health approach are warranted. The Greater Mekong Subregion (GMS) is a trans-national region of the Mekong River basin in Southeast Asia comprising Cambodia, the People's Republic of China (specifically Yunnan Province and Guangxi Zhuang Autonomous Region), Lao People's Democratic Republic (Lao PDR), Myanmar, Thailand, and Vietnam home to more than 340 million people or almost 4.5% of the global population. Human liver fluke infections caused by Opisthorchis viverrini and Clonorchis sinensis have been major public health problems in this region for decades. Opisthorchiasis caused by O. viverrini is prevalent in Thailand, Lao PDR, Cambodia and central-southern Vietnam with more than 12 million people infected. Clonorchiasis caused by C. sinensis is endemic in northern Vietnam and Guangxi with estimated 3.5 -5 million infected. The infections can cause several liver and biliary diseases such as cholangitis, periductal fibrosis, gallstones, and cholangiocarcinoma (CCA), a fatal bile duct cancer. Key determinants of the geographical distribution differences of the two liver fluke species are snail species and geographic barriers. Main risk behaviour of the infections is the culture of eating raw fish "the raw attitude" of people in the GMS, especially the Tai/Dai/Thai/Laos ethnic groups, the major population in the GMS. Over the past 20 years, there is a big change in prevalence of the infections. Opisthorchiasis has long been endemic, particularly in northern and northeastern Thailand and Lao PDR with over 8-10 million cases estimated. However, after several rounds of national campaign against opisthorchiasis using integrated control approach in Thailand over the past three decades, the prevalence of O. viverrini infection has reduced from over 15% in 1996 to 2.2% in 2019. High prevalence of O. viverrini infection continues in Lao PDR and central Vietnam. Emerging high prevalence, up to a maximum of 47.5%, has been noted in Cambodia during the past 10 years possibly due to more studies being conducted rather than increasing prevalence. O. viverrini infection has now also been reported in Lower Myanmar in recent years. Clonorchiasis has been known in northern Vietnam and southern China for a long time. Several surveys have reported infections in Guangxi in the last 10 years, and until now liver fluke infected cases have not been reported in Yunnan. Overall, nowadays, there is a shift in high risk areas for GMS liver fluke infection from northeastern Thailand to Lao PDR, Cambodia, Vietnam, Myanmar, and Guangxi P.R. China. Urgent systematic disease mapping and integrated liver fluke control using One Health approaches should be implemented nationwide in GMS countries. [ABSTRACT FROM AUTHOR]

Summary: A high prevalence of the liver flukes Clonorchis sinensis and Opisthorchis viverrini has been reported in a number of provinces in Vietnam. Knowledge about C. sinensis infection gained from Thailand over the past decade suggests that the habit of eating raw freshwater fish is a major risk factor for infection. However, further information to confirm this is needed. In the present study 1155 villagers in two communes in northern Vietnam were interviewed and their stools were examined for the presence of liver flukes. The prevalence of infection was 26% and was 3.6 times higher in males than in females. The habit of eating raw fish increased the risk of C. sinensis infection 53-fold. These results provide evidence of a strong correlation between the intensity of C. sinensis infection and the cumulative quantity of freshwater fish consumed in a lifetime and suggest that simple questionnaires could be used in endemic areas to quickly identify populations at risk and enable targeted treatment. [Copyright &y& Elsevier]

The first choice for treatment of Clonorchis sinensis infections is praziquantel. Experimental data suggest that artemisinin derivatives are active against C. sinensis. The efficacy of both drugs against clonorchiasis was evaluated in a pilot study in clonorchiasis patients in an endemic area in the North of Vietnam. Twenty-one patients received praziquantel 25 mg/kg o.d. for three days, the regular regimen in that area, and 21 patients were treated with artemisinin 500 mg b.i.d. for 5 days. Faecal egg counts were performed before as well as 6 days and 5 weeks after treatment. In the praziquantel group the faecal egg count decreased significantly from a mean value of 1632 eggs per gram faeces (epg) to 37 epg 5 weeks after treatment (P < 0.01) but, surprisingly, the eradication rate (95% confidence limit) at week 5 was only 29% (11-52%). In the artemisinin-treated group the reduction of the egg count was insignificant: from 1103 to 542 epg (P > 0.05). The proportion of patients (95% c.l.) with C. sinensis eggs in their stool on week 5 was 90% (70-99%) in the artemisinin group and 71% (48-89%) in the praziquantel group (P > 0.05) and the eradication rate (95% c.l.) at week 5 was only 10% (1-30%). With a sensitivity of detection of eggs in stool > 0.89, this implies a statistically significant but clinically unsatisfactory reduction for treatment with praziquantel. Sensitivity is probably less. For artemisinin there was no significant reduction. In conclusion, for human clonorchiasis in the North of Vietnam, the efficacy of praziquantel 25 mg/kg o.d. for 3 days was unsatisfactory and artemisinin for 5 days is not an effective alternative. [ABSTRACT FROM AUTHOR]