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China used to be one of the most heavily endemic countries for lymphatic filariasis (LF) in the world. Bancroftian filariasis, which is caused by the filarioid nematode Wuchereria bancrofti, is the only filariasis in Shandong Province. A total of 864 endemic counties (cities) in 16 provinces/autonomous regions/municipalities with a total population of 330 million people were at risk of infection. Shandong Province was a highly LF-endemic area in the 1950s, the epidemiological investigation of LF conducted in 1957 indicated that the disease was endemic in 74 counties and the highest microfilaria rate was up to 26%. There were ∼5 million people in the province infected with LF; among which almost 2.5 million people had lymphedema, elephantiasis, or hydrocele. Through vigorous prevention and scientific research, Shandong Province was the first to propose to treat LF with fortified diethylcarbamazine salt, more than 25 million people in the province had taken the salt, and more than 3 million people took intermittent medication. After more than 50 years of unremitting efforts, Shandong Province basically eliminated LF in 1983 and became the first province in China that successfully eradicated LF in 2004, which has played an important role in accelerating the elimination of filariasis in the country in 2007 and has made tremendous contributions to social and economic development of China. Since 1980, Shandong Province has carried out extensive international cooperation as the WHO Collaborating Center for Lymphatic Filariasis. This article is intended to share the experience in eliminating LF to other parts of the world and improve public health capacity in regions such as Africa and Oceania where the disease is still endemic for interest.

Objectives The aim of this study was to investigate the epidemic scope, epidemic pattern and degree of damage of clonorchiasis as well as to summarize the diagnosis and control effect of clonorchiasis in Shandong Province, China. Methods A retrospective study was conducted to summarize the research on the dynamic epidemiology and the prevention and treatment measures of clonorchiasis in Shandong Province, China from 1962 to 2015. Results After unremitting efforts and three nationwide surveys on the distribution and infection of human parasites, the infection rate of clonorchiasis decreased from 1.51% (1,500, 000) in the1960s to 0.16% in 1991, 0.04% in 2000 and 0.007% in 2015, respectively. The infection rate for villages with perennial water accumulation and rainy season water accumulation was higher than that of villages with rainy season water accumulation and non-water accumulation. The egg flotation in 70% potassium iodide solution method was applied to accurately test the specific proportion of C. sinensis eggs, which was 1.42. Using the modified Kato thick smear method, the detection rate of eggs was over 98%; hexachloroparaxylene yielded satisfactory therapeutic effects with slight adverse reactions, it is effective in the treatment of clonorchiasis. Conclusions After 50 years of active prevention and treatment, the disease has been successfully controlled in Shandong Province and had been used for reference in other endemic areas of clonorchiasis in China.

Japanese encephalitis (JE), which is caused by the Japanese encephalitis virus (JEV), is a zoonotic, vector-borne neurotropic disease that remains a major cause of viral encephalitis in Asia. JEV is spread to humans through mosquitoes, and its primary transmission vector is Culex tritaeniorhynchus. Mosquitoes were sampled from three collection sites: Hanzhuang town in Weishan County, Taibai Lake in Jining city, and Dongping Lake in Shandong Province, China. Pyrethroid insecticide resistance bioassays were conducted using adult mosquitoes. Cx. tritaeniorhynchus and C. pipiens pallens populations in Hanzhuang town and Dongping Lake showed resistance to pyrethroid insecticides, and populations in Taibai Lake showed incipient resistance. Coquillettidia ochracea populations in Hanzhuang town presented resistance as well, while in Taibai Lake, resistance was incipient. A total of 16,711 mosquitoes were collected, identified, and divided into 346 pools for JEV testing. Cx. tritaeniorhynchus had the advantage of being a local mosquito species. Overall, 31 (22.96) of the 135 pools of Cx. Tritaeniorhynchus were positive for JEV. The overall maximum likelihood estimates of Cx. tritaeniorhynchus, C. pipiens pallens, and Cq. ochracea indicated pooled infection rates of 5.29/1000 mosquitoes (95% confidence interval [CI] = 3.67–7.42), 1.60/1000 mosquitoes (95% CI = 0.82–2.85), and 6.39/1000 mosquitoes (95% CI = 0.39–32.23), respectively. There were no significant differences in the pooled infection rates between the districts. The resistance to pyrethroids has increased the difficulty in controlling the mosquito vectors, especially JEV-positive mosquitoes. Given the changes in the JEV transmission vectors, the spatial and temporal diversity and the dynamic variety of mosquito species, insecticide resistance and global warming have the potential to facilitate the transmission of JE to humans.

Background: We aimed to conduct a retrospective analysis of the epidemiological changes and prevention effects for malaria in Weifang, Shandong Peninsula, China from 1957 to 2017. Methods: The malaria data from a web-based reporting system were analyzed to explore malaria epidemiological characteristics and prevention effects in Weifang. Results: Overall, 1, 704, 890 malaria cases were reported in Weifang from 1957 to 2017, of which two major malaria epidemics occurred in 1961 (827.28/10, 000) and 1971 (366.14/10, 000). Prior to 1997, all malaria patients (1, 704, 829) were infected with Plasmodium vivax (P. vivax). After 2007, the cases of Plasmodium falciparum (P. falciparum) showed an upward trend (76.8%). The reported cases after the 21st century were mainly imported cases, and the last indigenous case was a patient that infected with P. vivax in 2006. Overall, 36 imported cases were reported from 2010 to 2017, of which 88.9% were acquired in Africa. Except for one 32-year-old woman, the rest were male (97.2%), in which laborers and farmers represented the vast majority (66.6%). From 1987 to 2017, there were 1, 224, 474 cases of fever with blood tests, and the average blood test rate was 4.9%. From 1957 to 2017, a total of 1, 704, 890 malaria patients were treated, 96 cases were treated during resting phase from 1987 to 2017. Conclusion: Weifang should continue to strengthen the management of the migrant population, making blood tests for fever patients and patient treatment as important means of malaria control and monitoring.

Objective To conduct an analysis of the epidemiological changes in malaria that have occurred in Shanxian county from 2002 to 2016. Methods A retrospective study was conducted and data were collected from web-based reporting system to explore the epidemiological characteristics in Shanxian county from 2002 to 2016. All individual case information was obtained from village malaria servicers organized by the local Shandong Institute of Parasitic Diseases. Results A total of 133 cases were identified as malaria in Shanxian county during this period, including 124 indigenous cases (93.2%) and 9 imported cases (6.8%). The 124 indigenous malaria cases were infected with Plasmodium vivax (P. vivax) , whereas 7 of the 9 confirmed imported cases were infected with Plasmodium falciparum (P. falciparum) , 1 was infected with Plasmodium ovale ( P. ovale ) and 1 patient was infected with P. falciparum mixed with P. vivax . The total number of malaria cases included 86 males (64.7%) and 47 females (35.3%). Age of the patients ranged from 1 to 83 years, although most (64.7%) infections occurred in the 21-to 60-year-old age group. Remarkably, 117 of the total malaria cases (98.0%) were reported from 2006 to 2011. The epidemic season was from June to October, with the peak occurring yearly from July to September. The most common occupation of the infected patients was farmer. In total, 58.1% of the cases occurred in 3 townships, namely, Fugang, Huanggang and Caozhuang. Conclusions In Shanxian county, the local malaria incidence experienced an emerge-peak-control-eliminate status. However, due to the numbers of migrant labourers returning from Africa, imported cases were continuous and presented an increasing annual trend, which became a non-negligible and a significant impediment for malaria elimination. Therefore, the need to eliminate instances of malaria reintroduction to receptive malaria-free areas should drive strategies to align with the epidemiological changes.

Neurocysticercosis (NCC) has a wide spectrum of neurologic and psychiatric manifestations, including epileptic seizures, high intracranial pressure, cognitive dysfunction, and meningoencephalitis. This study presents the clinical diagnosis of 2539 NCC patients in Shandong Province, Eastern China, from 1997 to 2015. The diagnosis was based primarily on clinical features, neuroimaging, immunology, and electroencephalogramy studies. In all age groups, seizures were found to be the most common manifestation, followed by headaches, memory loss, and limb numbness, and disability. After antiparasitic treatment, computed tomography and magnetic resonance imaging showed that most of the lesions had been completely absorbed in 2106 (82.95%) patients, most of the lesions had been absorbed and a small proportion was converted into calcifications in 433 (17.05%) cases. Indirect hemagglutination (IHA), enzyme-linked immunosorbent assay (ELISA), and circulating antigen (CAg) serum tests initially gave 76.45%, 86.37%, and 80.66% positive results, respectively. After antiparasitic therapy, the positive rates of the IHA, ELISA, and CAg tests were 74.77%, 84.70%, and 3.75%, respectively, showing no significant difference in antibody levels (p > 0.05), but a significant difference in CAg levels (p

Background Culex pipiens pallens is the most abundant Culex mosquito species in northern China and is an important vector of bancroftian filariasis and, potentially, West Nile virus. Insecticides, particularly pyrethroids, are widely used for adult mosquito control. Insecticide resistance has become common in several mosquito species, and vector control is the main method currently available to prevent disease transmission. The voltage-gated sodium channel (Vgsc) gene is the target site of pyrethroids, and mutations in this gene cause knockdown resistance (kdr). Methods Culex pipiens pallens larvae were collected from May to November over two decades, from 1992 to 2018, in four cities in Shandong Province, China. The World Health Organization (WHO) standard resistance bioassay was applied to test the resistance levels of Cx. p. pallens larvae to five different insecticides and to test deltamethrin resistance in adults, using the F1 generation. Mutations at Vgsc codon 1014 were also screened in 471 adult samples collected in 2014 to determine the association between kdr mutations and phenotypic resistance. Results Larval resistance against deltamethrin showed an increasing trend from the 1990s until 2018, which was statistically significant in all populations; resistance to cypermethrin increased significantly in mosquitoes from the Zaozhuang population. However, larval resistance to other insecticides remained relatively stable. Larval resistance against deltamethrin was consistent with adult bioassays in 2014, in which all tested populations were highly resistant, with mortality rates ranging from 39.4 to 55.23%. The L1014S and L1014F mutations were both observed in five Cx. p. pallens populations, with L1014F significantly associated with deltamethrin resistance. Conclusions The long-term dataset from Shandong demonstrates major increases in pyrethroid resistance over a 20-year period. The L1014F kdr mutation may be considered a viable molecular marker for monitoring pyrethroid resistance in Cx. p. pallens. Electronic supplementary material The online version of this article (10.1186/s13071-019-3416-9) contains supplementary material, which is available to authorized users.

Antimalarial drug resistance is a major public health problem in China. From 2012 to 2015, more than 75% of malaria cases in Shandong Province were P. falciparum returned from Africa. However, molecular marker polymorphisms of drug resistance in imported P. falciparum cases have not been evaluated. In this study, we analyzed polymorphisms of the Pfcrt, Pfmdr1, and Pfkelch13 genes in 282 P. falciparum cases returned from Africa to Shandong between 2012 and 2015. Among the isolates, polymorphisms were detected in codons 74–76 of Pfcrt and 86, 184, 1246 of Pfmdr1, among which K76T (36.6%) and Y184F (60.7%) were the most prevalent, respectively. Six Pfcrt haplotypes and 11 Pfmdr1 haplotypes were identified and a comparison was made on the prevalence of haplotypes among East Africa, West Africa, Central Africa and South Africa. One synonymous and 9 nonsynonymous mutations in Pfkelch13 were detected in the isolates (4.6%), among which a candidate artemisinin (ART) resistance mutation P553L was observed. The study establishes fundamental data for detection of chloroquine resistance (CQR) and ART resistance with molecular markers of the imported P. falciparum in China, and it also enriches the genetic data of antimalarial resistance for the malaria endemic countries in Africa.

The aim of this study was to investigate the expression of C35, an oncogene previously found in breast and prostate cancers, and its clinicopathological significance in colorectal cancer (CRC). Qualitative and quantitative detection of C35 mRNA expression was performed using reverse transcription-PCR (RT-PCR) and real-time PCR. C35 protein expression was determined using immunohistochemistry. C35 mRNA was detected in none of 10 normal colorectal tissue samples, 55 of 65 (84.6%) CRC tissue samples, and 43 of 55 (78.2%) adjacent non-cancerous tissue samples. In addition, the level of C35 mRNA in CRC tissue samples was markedly higher than that in tumor adjacent non-cancerous tissue samples. C35 protein expression was detected in 58 of 80 (72.5%) CRC tissue samples and was closely associated with tumor serosal invasion, lymphnode metastasis, and an advanced Dukes stage. These results suggest that C35 might serve as a biomarker or therapeutic target for management of CRC.

We analyzed demographic and clinical data and estimated the incidence of cysticercosis in Shandong Province, China, during 1975–2014. Our analyses showed that a cysticercosis-endemic area is present in Shandong Province, especially in its western regions. Improved surveillance and control are needed to address the elevated risk for cysticercosis in this region.

Background Shandong Province experienced a declining malaria trend of local-acquired transmission, but the increasing imported malaria remains a challenge. Therefore, understanding the epidemiological characteristics of malaria and the control and elimination strategy and interventions is needed for better planning to achieve the overall elimination goal in Shandong Province. Methods A retrospective study was conducted and all individual cases from a web-based reporting system were reviewed and analysed to explore malaria-endemic characteristics in Shandong from 2005 to 2015. Annual malaria incidence reported in 2005–2015 were geo-coded and matched to the county-level. Spatial cluster analysis was performed to evaluate any identified spatial disease clusters for statistical significance. The space–time cluster was detected with high rates through the retrospective space–time analysis scanning using the discrete Poisson model. Results The overall malaria incidence decreased to a low level during 2005–2015. In total, 1564 confirmed malaria cases were reported, 27.1% of which (n = 424) were indigenous cases. Most of the indigenous case (n = 339, 80.0%) occurred from June to October. However, the number and scale of imported cases have been increased but no significant difference was observed during months. Shandong is endemic for both Plasmodium vivax (n = 730) and Plasmodium falciparum (n = 674). The disease is mainly distributed in Southern (n = 710) and Eastern region (n = 424) of Shandong, such as Jinning (n = 214 [13.7%]), Weihai (n = 151 [9.7%]), and Yantai (n = 107 [6.8%]). Furthermore, the spatial cluster analysis of malaria cases from 2005 to 2015 indicated that the diseased was not randomly distributed. For indigenous cases, a total of 15 and 2 high-risk counties were determined from 2005 to 2009 (control phase) and from 2010 to 2015 (elimination phase), respectively. For imported cases, a total of 26 and 29 high-risk counties were determined from 2005 to 2009 (control phase) and from 2010 to 2015 (elimination phase), respectively. The method of spatial scan statistics identified different 13 significant spatial clusters between 2005 and 2015. The space–time clustering analysis determined that the most likely cluster included 14 and 19 counties for indigenous and imported, respectively. Conclusions In order to cope with the requirements of malaria elimination phase, the surveillance system should be strengthened particularity on the frequent migration regions as well as the effective multisectoral cooperation and coordination mechanisms. Specific response packages should be tailored among different types of cities and capacity building should also be improved mainly focus on the emergence response and case management. Fund guarantees for scientific research should be maintained both during the elimination and post-elimination phase to consolidate the achievements of malaria elimination.