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Background China has increasingly emerged as an important player in global health. However, compared to developed countries, China still lacks a sufficient health workforce for global health engagement with the necessary competencies required. The world has recognized that to solve global health issues, the role of China needs to be strengthened. The priorities for the deployment of the Chinese workforce in global health remain unclear. This study aims to identify the priorities of the deployment of Chinese global health workforce by exploring the core competencies for Chinese global health workforce, factors influencing the deployment and the approach of deployment. Methods Quantitative descriptive statistical analysis was applied to analyze the quantitative data. A total of 148 key respondents from 10 provinces in China conducting global health projects over the last 3 years were selected as the study subjects. A structured questionnaire was developed to collect the data on four aspects, including general information, core competencies, factors influencing deployment, and mode of deployment. The questionnaire was distributed to the respondents through an online survey. All original data were exported to Microsoft Excel 2010 to calculate the frequencies and percentages of each option. A descriptive analysis was carried out of the priorities of deployment of the Chinese global health workforce. Results More than half of the respondents (51.4%, 76/148) regarded “communication” as the most important competency of the Chinese global health workforce, while a large proportion of participants from Chinese embassies (50.0%, 6/12) and international organizations (75.0%, 12/16) believed that “professional skills” were paramount. In addition, 58.1% (86/148) of the participants agreed that incentive factors (salary, professional position, etc.) were the main factors that influenced deployment, whereas 75% (12/16) of participants from international organizations emphasized “security” as the most important determinant. In addition, 60.8% (90/148) of the participants thought that the deployment of staff should be based on the needs of the global health project implementation. Conclusions This study highlights the deployment priorities of the Chinese global health workforce, including strengthening communication and professional skills, focusing on personal security and incentives, and catering to the project implementation. This study also highlights the importance of Chinese agencies in developing global health mindsets through global health practices and proactive integration within the global community.

Background: The Regional Network for Asian Schistosomiasis and other Helminth Zoonoses (RNAS+) launched in 1998, has close partnerships with countries where schistosomiasis and other helminthiasis are endemic. RNAS+ has provided an ideal regional platform for experts involved in policy-making, control, and research of parasitic diseases in Asian countries. China, one of the initiating countries, has provided significant technical and financial support to the regional network. Although Chinese institutions provided great technical and resource support toward the RNAS+ development along with other member countries, its role and Chinese scientists or institutions’ contributions have not been evaluated systematically. This study assessed the Chinese contributions in the support of RNAS+ development.Methods: An assessment research framework was planned to evaluate China’s contribution to RNAS+ based on four aspects, including capacity building, funding support, coordination, and cooperation. An anonymous web-based questionnaire was designed to acquire basic information of the respondents, China’s contributions, challenges, and recommendations for RNAS+ development. Each participant scored from 0 to 10 to assess China’s contribution: “0” no contribution, and “10” 100% contribution. Participants who included their e-mail address in the 2017 - 2019 RNAS+ annual workshops were invited to participate the assessment. Results: Of 71 participants enrolled, 41 responded to the survey, 37 (37/41, 90.2%) of whom were from RNAS+ member countries while the remaining 4 (4/41, 9.8%) were international observers. Most respondents (34/41, 82.93%) are familiar with RNAS+. Respondents reported that China’s contributions were mainly in improving of capacity building, providing funding support, responsible of the coordination, and joint application of the cooperation programmes in the development of RNAS+. The average scores of China’s contributions in the above four fields were 8.92, 8.64, 8.75, and 8.67, respectively, with an overall assessment score of 8.81. The challenges of RNAS+ include the lack of sustainable funding and skills, and most participants indicated their continual need of China’s support.Conclusions This survey showed that China plays an important role in the development of RNAS+. This network-type organization for disease control and research can yet be regarded as a great potential pattern for China to enhance regional cooperation. These findings can be used to promote future cooperation between China and other RNAS+ member countries.

Background The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+) was established in 1998, which has developed close partnerships with Asian countries endemic for schistosomiasis and other helminthiasis in Asia. RNAS+ has provided an ideal regional platform for policy-makers, practitioners and researchers on the prevention, control and research of parasitic diseases in Asian countries. China, one of the initiating countries, has provided significant technical and financial support to the regional network. However, its roles and contributions have not been explored so far. The purpose of this study was to assess China's contributions on the supporting of RNAS+ development. Methods An assessment research framework was developed to evaluate China’s contributions to RNAS+ in four aspects, including capacity building, funding support, coordination, and cooperation. An anonymous web-based questionnaire was designed to acquire respondents’ basic information, and information on China’s contributions, challenges and recommendations for RNAS+development. Each participant scored from 0 to 10 to assess China’s contribution: “0” represents no contribution, and “10” represents 100% contribution. Participants who included their e-mail address in the 2017–2019 RNAS+ annual workshops were invited to participate in the assessment. Results Of 71 participants enrolled, 41 responded to the survey. 37 (37/41, 90.24%) of them were from RNAS+ member countries, while the other 4 (4/41, 9.76%) were international observers. Most of the respondents (38/41, 92.68%) were familiar with RNAS+. Respondents reported that China’s contributions mainly focused on improving capacity building, providing funding support, coordination responsibility, and joint application of cooperation programs on RNAS+ development. The average scores of China’s contributions in the above four fields were 8.92, 8.64, 8.75, and 8.67, respectively, with an overall assessment score of 8.81 (10 for a maximum score). The challenge of RNAS+ included the lack of sustainable funding, skills, etc. and most participants expressed their continual need of China’s support. Conclusions This survey showed that China has played an important role in the development of RNAS+ since its establishment. This network-type organization for disease control and research can yet be regarded as a great potential pattern for China to enhance regional cooperation. These findings can be used to promote future cooperation between China and other RNAS+ member countries.

Background: China has made significant progress towards malaria elimination by achieving zero reports of indigenous malaria cases over two consecutive years. The diagnosis of malaria, which is based on microscopic examination, still remains a challenge, due to a lack of sensitivity for detecting low-level parasitaemia. This study aimed to evaluate the diagnostic value of a novel immunochromatographic test strip for imported malaria. Methods: After obtaining informed consent, blood samples were collected from migrants returning home from Africa to Shanglin County in Guangxi, PR China, in 2018-2019, and were tested with the novel test strips. The test results were compared with those of microscopic examination, commercial malaria rapid diagnostic test (RDT), and polymerase chain reaction (PCR) assay. Results: A total of 535 samples were tested. Both microscopy and PCR test results showed a total of 162 (30.28%) malaria-positive samples, of which 99 were positive for Plasmodium falciparum (P. falciparum), three for P. vivax, five for P. malariae, and 50 for P. ovale, whereas five had mixed infections. The sensitivity, specificity, and efficiency of the novel RDT were 74.1%, 93.0%, and 87.3%, respectively, whereas its sensitivity of detecting P. falciparum, P. vivax, P. malariae, and P. ovale was 91.9%, 100%, 20.0%, and 44.0%, respectively. Furthermore, the sensitivity, specificity, and efficiency of the commercial RDT were 86.0%, 89.3%, and 88.2%, respectively, whereas its sensitivity of detecting P. falciparum, P. vivax, P. malariae, and P. ovale was 96.0%, 100%, 40.0%, and 70.0% respectively. The differential detection of Plasmodium species using the new RDT was significantly better compared to that of the commercial RDT (c2 = 14.73; P = 0.0001), which can detect only P. falciparum. This was consistent with Kappa analysis (Kappa = 0.881). A significant difference (c2 = 24.50; P < 0.0001) in the detection rate of other Plasmodium species was observed with an average consistency using Kappa analysis (Kappa = 0.716). Conclusion: The novel malaria RDT test strip had high sensitivity and specificity in detecting P. falciparum and P. vivax. Improvement in P. ovale and P. malariae detection efficiency may lead to the scale-up of this RDT in the future.

Objective. The elder diabetic patients increases rapidly in China and often accompany with hyperuricemia. Recently evidences show that renal function has been impaired in part of diabetic patients with normoalbuminuria. Therefore, we investigated the relationship between serum uric acid (SUA) and renal function in Chinese elder diabetes with normoalbuminuria. Methods. The physical examination data from 1052 cases of diabetic residents with normoalbuminuria aged 70 years and over in the Jiangchuan community of Minhang District, Shanghai, from October 2011 to September 2014 was analyzed retrospectively. Each received height, body weight, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure (BP), and collected samples of fasting blood and morning urine to detect blood routine, blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, serum creatinine, urinary albumin, urine creatinine, and urine PH value. Correlation between SUA and renal function, an index of which is estimated using estimated glomerular filtration rate (eGFR), was analyzed. Results. The prevalence of hyperuricemia was 21.10%. Levels of WC and triglyceride (TG) increased and the levels of HbA1c, high density lipoprotein-cholesterol (HDL-C), eGFR, and urine PH decreased while the levels of SUA increased. Moreover, negative correlation of eGFR with age, WC, leukocyte, and SUA (Pearson r=0.415) was observed via Pearson correlation analysis. It indicates the strong association between SUA and eGFR. Furthermore, eGFR independently associated with SUA, age, leukocyte, hemoglobin (Hb), and fasting blood glucose (FBG) was confirmed by multiple linear stepwise regression analysis. Conclusion. SUA may play an important role in the decrease of eGFR in elderly Chinese diabetic patients with normoalbuminuria.

BackgroundWHO focused and gave priority on ten serious tropical diseases, while China has made remarkable achievements on tropical diseases control. In addition, China has a history of more than 60 years in the health assistance, however, its assistance for tropical diseases started late.MethodsA qualitative questionnaire was distributed to inquiry the opinions of professionals on China’s health assistance on tropical diseases and published articles were searched to collect those data. SWOT analysis, as a tool of qualitative analysis, was used to classify and evaluate the current strengths, the weakness, the opportunities, and the threats of health assistance on tropical diseases in China.ResultsBased on SWOT analysis, the internal factors and external environments are obtained. The strengths are focused on China’s achievements on tropical diseases control, surveillance response system of tropical diseases, and human resources of public health; the weakness laid on sustainability of aid projects and funding, applicability of Chinese experience, and lack of composite talents; the opportunities are mainly in the global need of tropical diseases control, China’s health cooperation in Belt & Road and Africa, and the actively participating of international organizations in health assistance; as well as the threats are reflected in the complex international situation, domestic needs of tropical diseases control, and the significant gaps between China and developed countries.ConclusionThe internal strengths and weaknesses of development assistance for health on tropical diseases are clearly presented in the SWOT framework, as well as the external opportunities and threats and corresponding coping strategies. In the era of global health, China should strengthen and improve the health assistance for tropical diseases.Author summaryTropical diseases are serious infections in tropical and sub-tropical regions, with billions of persons infected and millions of deaths every year, especially in Africa. WHO also called for global efforts to control and eliminate tropical diseases. In the era of global health, development assistance on tropical diseases is important to demonstrate the soft power of national diplomacy, and China has started its health assistance in 1963. In this paper, a qualitative questionnaire and published articles were combined to collect data, and then SWOT analysis was used to analyze the internal factors and external environment, that is the current strengths, the weakness, the opportunities, and the threats of the China’s Health Assistance on key tropical diseases. Based on those results, we put forward the countermeasures and suggestions for the future cooperation of tropical diseases. At the end of this paper, we call on Chinese professionals should make use of their own advantages and actively improve the global tropical diseases control.

Small non-coding RNA controls the expression of target genes and is related with mRNA degradation, chromatin modification and genome stability. Recent studies showed that small non-coding RNA is not only associated with the incidence of schistosomiasis, but also acts as a potential biomarker. In this article, we will review the applications of small non-coding RNA in schistosomiasis diagnosis and its potential role in schistosome development and pathogenesis, in the aim to provide hints for developing detection methods and vaccines for schistosomiasis and for drug development.

BACKGROUND Many studies have evaluated the correlation between N-acetyltransferase 2 (NAT2) slow acetylation genotype and bladder cancer risk. However, the results are inconsistent and remain to be confirmed in each ethnic group. To assess the effects of NAT2 acetylation status on the risk of bladder cancer in the Chinese population, a meta-analysis was performed. METHODS Studies were identified using PubMed and Chinese databases through February 2016. The associations were assessed with pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS This meta-analysis included 10 studies with 896 bladder cancer cases and 1188 controls. In the overall analysis, NAT2 slow acetylation phenotype was significantly associated with an increased risk of bladder cancer in the Chinese population (OR = 1.68, 95% CI = 1.11 - 2.53). In the subgroup analyses by geographic areas and sources of controls, significant risk was found in Mainland China (OR = 1.83, 95% CI = 1.04 - 3.20) and hospitalbased studies (OR = 1.74, 95% CI = 1.27 - 2.38), but not in Taiwan China. CONCLUSIONS This meta-analysis suggested that the NAT2 slow acetylation genotype is associated with an increased bladder cancer risk in Chinese individuals.

Schistosoma infection in snails can be monitored by microscopy or indirectly by sentinel mice. As both these approaches sometimes miss infections, more sensitive tests are needed, particularly in low-level transmission settings. In this study, the loop-mediated isothermal amplification (LAMP) technique, designed to detect a specific 28S ribosomal S. japonicum gene with high sensitivity, was compared to microscopy using snail samples from 51 areas endemic for schistosomiasis in five Chinese provinces. The results were compared with those by polymerase chain reaction (PCR) adding DNA sequencing as a reference when needed. The testing of pooled snail samples showed that a dilution factor of 1/50, i.e., one infected snail plus 49 non-infected ones, would still result in a positive reaction after the recommended number of amplification cycles. Testing a total of 232 pooled samples, emanating from 4,006 snail specimens, with the LAMP assay showed a 6.5% rate of infection, while traditional microscopy found only 0.04% positive samples in the same materials. Parallel PCR analysis confirmed the diagnostic accuracy of the LAMP assay, with DNA sequencing even giving LAMP a slight lead. Microscopy and the LAMP test were carried out at local schistosomiasis-control stations demonstrating that the potential of the latter assay to serve as a point-of-care (POC) test with results available within 60–90 minutes, while the more complicated PCR test had to be carried out at the National Institute of Parasitic Diseases (NIPD) in Shanghai, China. In conclusion, LAMP was found to be clearly superior to microscopy and as good as, or better, than PCR. Application of LAMP testing would be useful for surveillance and risk prediction as it requires less time than other techniques and can be used under field conditions, which improves and accelerates schistosomiasis control.

Oncomelania hupensis is the unique intermediate host of Schistosoma japonicum, which plays a key role in the transmission of human blood fluke Schistosoma. The complete mitochondrial (mt) genome of O. hupensis has been characterized; however, the phylogenetic performance of mt protein-coding genes (PCGs) of the snail remain unclear. In this study, 11 whole mt genomes of snails collected from four different ecological settings in China and the Philippines were sequenced. The mt genome sizes ranged from 15 183 to 15 216 bp, with the G + C contents from 32.4% to 33.4%. A total of 15 251 characters were generated from the multiple sequence alignment. Of 2711 (17.8%) polymorphic sites, 56.22% (1524) were parsimony sites. The mt genomes' phylogenetic trees were reconstructed using minimum evolution, neighbor joining, maximum likelihood, maximum parsimony, and Bayesian tree estimate methods, and two main distinct clades were identified: (i) the isolate from mountainous regions; (ii) the remaining isolate which included three inner branches. All phylogenetic trees of the 13 PCGs were generated by running 1000 bootstrap replicates and compared with the complete mtDNA tree, the classification accuracy ranging from 21.23% to 87.87%, the topological distance of phylogenetic trees between PCGs ranging from 5 to 14. Therefore, the performance of PCGs can be divided into good condition (COI, ND2, ND5, and ND3), medium (COII, ATP6, ND1, ND6, Cytb, ND4, and COIII), poor (ATP8 and ND4L). This study represents the first analysis of mt genome diversity of the O. hupensis snail and phylogenetic performance of mt PCGs. It presents clear evidence that the snail populations can be separated into four landscape genetic populations in mainland China based on whole mt genomes. The identification of the phylogenetic performance of PCGs provides new insight into the intensive genetic diversity study using mtDNA markers for the snail.

Schistosomiasis, a disease caused by a trematode, parasitic worm, is a worldwide public health problem. In spite of great progress with regard to morbidity control, even elimination of this infection in recent decades, there are still challenges to overcome in sub-Saharan Africa and endemic areas in Southeast Asia. Regarded as one of the most successful countries with respect to schistosomiasis control, The People's Republic of China has accumulated considerable experience and learnt important lessons in various local settings that could benefit schistosomiasis control in other endemic countries. Based on an analysis of conceived strengths, weaknesses, opportunities and threats (SWOT) of potential collaborative activities with regard to schistosomiasis in Africa and Asia, this article addresses the importance of collaborative efforts and explores the priorities that would be expected to facilitate the transfer of Chinese experience to low- and middle-income countries in Africa and Asia.

To establish a monitoring and evaluation indicator framework in the context of malaria elimination in pilot areas in China, so as to further assess the malaria elimination work in the future.Based on the consultancy, and according to the government documents such as Action Plan for Malaria Elimination in China (2010-2020), Technical Guidance for Malaria Elimination, Programme Evaluation on Malaria Elimination, the indicators were set up at both provincial and county levels and their application was conducted in Yunnan and Anhui provinces to assess the accountability, accessibility and applicability.An indicator framework was built up including four key components, which were input, process, output and impact indicators, in which 95 were provincial indicators and 98 were county indicators. The completion rate of the indicators of Yunnan and Anhui provinces were 94.7% (90/95) and 95.8% (91/95) respectively; and the completion rate of indicators of Tengchong and Feidong counties were 93.9% (92/98) and 92.9% (91/98) respectively.The established indicator framework is reliable and applicable, which could effectively help to track the malaria elimination progress and identify gaps.

To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination.Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis, Malaria and Echinococcosis, published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention, the malaria incidence and intervention data were selected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interventions in the target provinces was analyzed based on the Panel Data Regression Model, and the key interventions were determined.Four provinces namely Anhui, Yunnan, Hainan and Henan were targeted with 87.56% of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence, X1 as the log of the number of historical cases receiving radical treatment in the pre-transmission stage (RTPT) (F = 14.53, P0.01, R2 = 0.72), X2 as the log of risk population receiving RTPR (F = 15.90, P0.01, R2 = 0.71) and X3 as the number of technicians trained in microscopy (F = 11.53, P0.01, R2 = 0.61), three space-fixed effect models were established respectively, and X1, X2, as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence, X1 as the accumulated technicians trained in microscopy (F = 11.06, P0.01, R2 = 0.87), X2 as the log of technicians trained in entomology (F = 15.28, P0.01, R2 = 0.89) , two two-way (space and time) fixed effect models were established respectively, and both X1 and X2 had negative effects on Y value.RTPT among historical patients and at-risk populations as well as microscopy training influences the variation of vivax malaria incidence, while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Based on the requirement analysis and functional design of the command system for parasitic disease outbreaks, the system was constructed by workflow technique, function modules and technical architecture. The command system was a multi-platform system, could achieve multiple functions, such as monitoring and early warning of parasitic diseases, emergency video communication, emergency dispatcher, and emergency management. The system can meet the needs in emergency events of parasitic diseases, and increase preparedness level.

To understand the current status of the malaria control programme at the county level in accordance with the criteria of the World Health Organisation, the gaps and feasibility of malaria elimination at the county and national levels were analysed based on three kinds of indicators: transmission capacity, capacity of the professional team, and the intensity of intervention. Finally, a roadmap for national malaria elimination in the People's Republic of China is proposed based on the results of a feasibility assessment at the national level.

The historical patterns of malaria transmission in the People's Republic of China from 1949 to 2010 are presented in this chapter to illustrate the changes in epidemiological features and malaria burden during five decades. A significant reduction of malaria incidence has resulted in initiation of a national malaria elimination programme. However, challenges in malaria elimination have been identified. Foci (or hot spots) have occurred in unstable transmission areas, indicating an urgent need for strengthened surveillance and response in the transition stage from control to elimination.

With the shrinking of indigenous malaria cases and endemic areas in the People's Republic of China (P.R. China), imported malaria predominates over all reported cases accounting for more than 90% of the total. On the way to eliminate malaria, prompt detection and rapid response to the imported cases are crucial for the prevention of secondary transmission in previous endemic areas. Through a comprehensive literature review, this chapter aims to identify risk determinants of potential local transmission caused by the imported malaria cases and discusses gaps to be addressed to reach the elimination goal by 2020. Current main gaps with respect to dealing with potential malaria resurgence in P.R. China include lack of cross-sectoral cooperation, lack of rapid response and risk assessment, poor public awareness, and inadequate research and development in the national malaria elimination programme.

Taeniasis, caused by Taenia species, is one of the common zoonoses in China, particularly in the western region of China. Up to now, not enough attention has been given in the high prevalence and high burden of the diseases. In order to study the endemic patterns and control strategies of taeniasis, a series of epidemiological investigations, molecular researches and pilot control activities have been conducted in recent years. This paper reviews the relevant publications in taeniasis research over the last 10 years.

To investigate the distribution features of Oncomelania hupensis infested areas in Gaoyou County so as to formulate surveillance and intervention strategies.A database was established through collecting data of the snail infested areas during 1970-2009 in the County. The data were input into SaTScan 9.2 software for spatial-temporal cluster analysis to determine the spatial and temporal cluster of the snail habitats. The results were displayed by ArcGIS 10.1 software.There were historically 720 snail habitats in the County in 1970-2009 including 521 in plain region with water networks and 199 in lakemarshland region. Those in water networks covered an area of 456.62 ha distributing mainly in the northern towns/townships of the County, and the latters distributed in the Xinmin Beach between Gaoyou Lake and Shaobo Lake, and Qiaojian Beach close to Tianchang County of Anhui Province with an area of 4 495.75 ha. The spatial-temporal cluster analysis revealed that among all the historical snail habitats, there were two prominent spatial-temporal clusters with a relative risk of3. One cluster appeared in Xinmin Beach in 1983-2002 and another one located in the north of Gaoyou in 1970-1973. Separate analysis was performed by the regions of water network or lakemarshland, indicating 2 clusters in each of the regions. During 1970-2009, 244 snail habitats were newly found in the County with 130 in water network region and 114 in lakemarshland region. Again, the spatial-temporal cluster analysis displayed 2 prominent clusters. By separate analysis, 2 clusters existed in each of the regions.The space-time scan statistics can be applied in detecting the cluster of snail infested areas in two dimensions, which will provide information for guiding specific measures of surveillance and control.

To set up a framework of indicators for schistosomiasis and malaria to guide the formulation and evaluation of vector-borne disease control policies focusing on adaptation to the negative impact of climate change.A 2-level indicator framework was set up on the basis of literature review, and Delphi method was applied to a total of 22 and 19 experts working on schistosomiasis and malaria, respectively. The result was analyzed to calculate the weight of various indicators.A total of 41 questionnaires was delivered, and 38 with valid response (92.7%). The system included 4 indicators at first level, i.e. surveillance, scientific research, disease control and intervention, and adaptation capacity building, with 25 indicators for schistosomiasis and 21 for malaria at the second level. Among indicators at the first level, disease surveillance ranked first with a weight of 0.32. Among the indicators at the second level, vector monitoring scored the highest in terms of both schistosomiasis and malaria.The indicators set up by Delphi method are practical,universal and effective ones using in the field, which is also useful to technically support the establishment of adaptation to climate change in the field of public health.

American trypanosomiasis, as one of the "neglected tropical diseases", is a zoonosis induced by Trypanosoma cruzi. It is endemic in 18 countries in the Central and South America, especially in rural areas. A rapid risk assessment was carried out to analyze the potential threat of imported cases to China, which would provide information to policy makers in health authorities.

Background Despite significant, steady progress in schistosomiasis control in the People's Republic of China over the past 50 years, available data suggest that the disease has re-emerged with several outbreaks of acute infections in the early new century. In response, a new integrated strategy was introduced. Methods This retrospective study was conducted between Jan 2005 and Dec 2012, to explore the effectiveness of a new integrated control strategy that was implemented by the national control program since 2004. Results A total of 1,047 acute cases were recorded between 2005 and 2012, with an annual reduction in prevalence of 97.7%. The proportion of imported cases of schistosomiasis was higher in 2011 and 2012. Nine clusters of acute infections were detected by spatio-temporal analysis between June and November, indicating that the high risk areas located in the lake and marshland regions. Conclusion This study shows that the new integrated strategy has played a key role in reducing the morbidity of schistosomiasis in the People's Republic of China., Author Summary A retrospective study on the incidence of acute schistosomiasis in the People's Republic of China (P.R. China) was performed, in order to assess the new integrated control strategy that was implemented through the national control program from 2005 to 2012. The lake and marshland regions have been identified as high risk areas as shown by the nine spatio-temporal clusters that we found in the transmission period between June and November each year. When a total of 1,047 reported cases of acute schistosomiasis were analyzed, a reduction in prevalence of 97.7% between 2005 and 2012 was found. In contrast, imported cases of acute schistosomiasis increased between 2011 and 2012. These findings support the approach and effectiveness of the new integrated strategy in the reduction of schistosomiasis morbidity.

With the shrinking of indigenous malaria cases and endemic areas in the People’s Republic of China (P.R. China), imported malaria predominates over all reported cases accounting for more than 90% of the total. On the way to eliminate malaria, prompt detection and rapid response to the imported cases are crucial for the prevention of secondary transmission in previous endemic areas. Through a comprehensive literature review, this chapter aims to identify risk determinants of potential local transmission caused by the imported malaria cases and discusses gaps to be addressed to reach the elimination goal by 2020. Current main gaps with respect to dealing with potential malaria resurgence in P.R. China include lack of cross-sectoral cooperation, lack of rapid response and risk assessment, poor public awareness, and inadequate research and development in the national malaria elimination programme.

Malaria has affected human health globally with a significant burden of disease, and also has impeded social and economic development in the areas where it is present. In Africa, many countries have faced serious challenges in controlling malaria, in part due to major limitations in public health systems and primary health care infrastructure. Although China is a developing country, a set of control strategies and measures in different local settings have been implemented successfully by the National Malaria Control Programme over the last 60 years, with a low cost of investment. It is expected that Chinese experience may benefit malaria control in Africa. This review will address the importance and possibility of China-Africa collaboration in control of malaria in targeted African countries, as well as how to proceed toward the goal of elimination where this is technically feasible.

The historical patterns of malaria transmission in the People’s Republic of China from 1949 to 2010 are presented in this chapter to illustrate the changes in epidemiological features and malaria burden during five decades. A significant reduction of malaria incidence has resulted in initiation of a national malaria elimination programme. However, challenges in malaria elimination have been identified. Foci (or hot spots) have occurred in unstable transmission areas, indicating an urgent need for strengthened surveillance and response in the transition stage from control to elimination.

To understand the current status of the malaria control programme at the county level in accordance with the criteria of the World Health Organisation, the gaps and feasibility of malaria elimination at the county and national levels were analysed based on three kinds of indicators: transmission capacity, capacity of the professional team, and the intensity of intervention. Finally, a roadmap for national malaria elimination in the People's Republic of China is proposed based on the results of a feasibility assessment at the national level.

Schistosomiasis japonica was endemic in 12 provinces (including municipalities and autonomous regions) in the People's Republic of China (PR China). Despite the tremendous decrease of schistosomiasis incidence after almost 60 years of control, the distribution of snail-breeding sites has not been reduced significantly. In order to verify current transmission risks and identify the potential establishment of new foci of schistosomiasis driven by environmental changes, we conducted surveillance in selected risk areas of three provinces: Jiangsu, Anhui and Shandong from 2008 to 2010 in addition to routine snail surveillance. We investigated populations and possible reservoirs in sentinel sites and report that the total number of new acute cases did not diminish further in spite of ongoing control activities. In Anhui Province the local count compared to the national count was 43% (19/44) in 2008, 33% (25/75) in 2009 and 40% (17/42) in 2010. In all, 31.58 km(2) areas of snail breeding sites were newly detected nationwide through the year 2008-2010, of which the proportion of Anhui was 42% (5.03/11.98) in 2008, 95% (8.39/8.79) in 2009 and 79% (8.52/10.81) in 2010. Sentinel surveillance showed eight, nine and five confirmed cases of acute schistosomiasis in mobile populations (fishermen, migrant workers) in 2008, 2009 and 2010, respectively. All these cases were detected in Chaohu County, which must therefore be deemed an area at risk. We conclude that continuous surveillance with an emphasis on snails must be enhanced in potential risk areas in PR China.

To identify the genetic structure of Oncomelania hupensis in the middle and lower reaches of Yangtze River by using microsatellite DNA molecular markers.O. hupensis snails were collected from the provinces of Anhui, Hunan, Hubei, Jiangxi, and Jiangsu, of which 6 polymorphic microsatellite DNA loci (P84, T5-13, T5-11, T4-22, T6-27 and P82) were amplified with fluorescence labeled universal primer. 20-50 snail samples were collected at each spot, adding up to 165 samples. The number of alleles (N(alpha)), inbreeding coefficient (F(IS)), heterozygosity (H), fixation index (F(ST)) of each group snails, genetic distance between/groups, and the polymorphic information content (PIC) were calculated. Cluster analysis was then carried out based on genetic distance, and hierarchical AMOVA calculation was done.The number of alleles in each population ranged from 3 to 33, and the inbreeding coefficient ranged from 0.143 to 0.539. The average expected heterozygosity and observed heterozygosity ranged from 0.600 to 0.883 and 0.308 to 0.759, respectively, being the highest in Hubei population and the lowest in Jiangsu population. The range of F(ST) value between paired populations was from 0.0006 to 0.0531. The small F(ST) value suggested that genetic differentiation did not occur among the populations. The average polymorphic information content in the populations ranged from 0.511 to 0.850, showing a high polymorphism except the Jiangsu population. Hierarchical AMOVA calculations showed that inter-individual variation of the snails occupied 95.2% of the total variations. Cluster analysis revealed that Anhui group clustered first to Jiangsu, followed with Hunan, Jiangxi and Hubei.There is a rich diversity in O. hupensis. Cluster analysis shows a consistency with the geographical distribution pattern. The genetic differences among the 5 snail populations are trivial with microsatellite DNA variation mostly present in individuals.

Schistosomiasis is one of the major public health problems in the People's Republic of China (and elsewhere), seri- ously threatening health as well as social and economic development. An integrated control strategy, emphasising transmis- sion control but also aimed at reducing greenhouse gases, was carried out in Jiangling county, Hubei province from 2007 to 2009. Three villages were chosen for a pilot study involving removal of cattle from neighbouring, snail-infested grasslands, improving sanitation and construction of units for household biogas production in addition to routine control measures. Both prevalence and intensity of infection in the snails in the neighbourhood were greatly reduced after two years of imple- mentation, while the prevalence of schistosomiasis in humans in the three villages had been reduced by 29%, 34% and 24%, respectively. The removal of cattle and construction of biogas production units had an additional positive effect in that the annual, average emission of greenhouse gases such as methane (CH4) and carbon dioxide (CO2) were reduced by an esti- mated 7.8 and 80.2 tons, respectively.

Oncomelania hupensis is the unique intermediate host of Schistosoma japonicum, which plays a key role during the transmission of schistosomiasis. It is mainly found in the Yangtze River valley and mountains or hills in southwest China. In this paper, we described 15 new microsatellite makers in O. hupensis. Polymorphism of each locus was assessed in 80 individuals from four wild populations (n = 20 per population). The number of alleles per locus ranged from 6 to 29, with an average of 15.8. The observed (H(O)) and expected (H(E)) heterozygosities varied from 0.397 to 0.851 and from 0.696 to 0.948, respectively. These microsatellite markers will be useful for population genetic studies and genome mapping in O. hupensis.

Background The clinical manifestations of neurocysticercosis (NCC) are poorly understood. This systematic review aims to estimate the frequencies of different manifestations, complications and disabilities associated with NCC. Methods A systematic search of the literature published from January 1, 1990, to June 1, 2008, in 24 different electronic databases and 8 languages was conducted. Meta-analyses were conducted when appropriate. Results A total of 1569 documents were identified, and 21 included in the analysis. Among patients seen in neurology clinics, seizures/epilepsy were the most common manifestations (78.8%, 95%CI: 65.1%–89.7%) followed by headaches (37.9%, 95%CI: 23.3%–53.7%), focal deficits (16.0%, 95%CI: 9.7%–23.6%) and signs of increased intracranial pressure (11.7%, 95%CI: 6.0%–18.9%). All other manifestations occurred in less than 10% of symptomatic NCC patients. Only four studies reported on the mortality rate of NCC. Conclusions NCC is a pleomorphic disease linked to a range of manifestations. Although definitions of manifestations were very rarely provided, and varied from study to study, the proportion of NCC cases with seizures/epilepsy and the proportion of headaches were consistent across studies. These estimates are only applicable to patients who are ill enough to seek care in neurology clinics and likely over estimate the frequency of manifestations among all NCC cases., Author Summary Neurocysticercosis is an infection of the brain with the flatworm Taenia solium which is normally transmitted between humans and pigs. Sometimes, humans can infect other humans and the larva of the parasite can go the brain, causing the disease neurocysticercosis. There has never been a systematic review of what clinical signs are found among people with neurocysticercosis. We conducted a thorough review of the literature to answer this question. We reviewed 1569 and 21 were of a sufficient quality to be included in the final analysis. Among neurocysticercosis patients who are seeking care in neurology clinics, about 79% have seizures/epilepsy, 38% severe headaches, 16% focal deficits and 12% signs of increased intracranial pressure. Several other symptoms were also reported in less than 10% of patients. People with neurocysticercosis who seek care in neurology clinics show a whole range of manifestations. Clinicians should be encouraged to consider neurocysticercosis in their differential diagnosis when a patient presented with one of the symptoms described in this review. This would ultimately improve the estimates of the frequency of symptoms associated with neurocysticercosis.

Background The objective of this study is to conduct a systematic review of studies reporting the frequency of neurocysticercosis (NCC) worldwide. Methods/Principal Findings PubMed, Commonwealth Agricultural Bureau (CAB) abstracts and 23 international databases were systematically searched for articles published from January 1, 1990 to June 1, 2008. Articles were evaluated for inclusion by at least two researchers focusing on study design and methods. Data were extracted independently using standardized forms. A random-effects binomial model was used to estimate the proportion of NCC among people with epilepsy (PWE). Overall, 565 articles were retrieved and 290 (51%) selected for further analysis. After a second analytic phase, only 4.5% of articles, all of which used neuroimaging for the diagnosis of NCC, were reviewed. Only two studies, both from the US, estimated an incidence rate of NCC using hospital discharge data. The prevalence of NCC in a random sample of village residents was reported from one study where 9.1% of the population harboured brain lesions of NCC. The proportion of NCC among different study populations varied widely. However, the proportion of NCC in PWE was a lot more consistent. The pooled estimate for this population was 29.0% (95%CI: 22.9%–35.5%). These results were not sensitive to the inclusion or exclusion of any particular study. Conclusion/Significance Only one study has estimated the prevalence of NCC in a random sample of all residents. Hence, the prevalence of NCC worldwide remains unknown. However, the pooled estimate for the proportion of NCC among PWE was very robust and could be used, in conjunction with estimates of the prevalence and incidence of epilepsy, to estimate this component of the burden of NCC in endemic areas. The previously recommended guidelines for the diagnostic process and for declaring NCC an international reportable disease would improve the knowledge on the global frequency of NCC., Author Summary Neurocysticercosis (NCC) is a parasitic infection of the brain caused by the tapeworm Taenia solium, which infects humans and pigs. There have been increasing case reports and epidemiological studies on this disease, but its global frequency has never been determined, partly due to the fact that blood tests are not very good for the diagnosis of NCC. We present here a systematic review of the literature on the frequency of NCC diagnosed with neuroimaging worldwide. Overall, 565 articles were retrieved and 290 (51%) selected for further review. Of those, only 26 had information valid enough to estimate the frequency of NCC in various populations. Only one study estimated the prevalence of NCC in the general population. The most striking finding was that the proportion of NCC among persons with epilepsy was very consistent and estimated at 29.6% (95%CI: 23.5%–36.1%) from 12 studies conducted in Latin America, Sub-Saharan Africa and Southeast Asia. A reinforcement of the suggested universal guidelines for the diagnostic process, declaring NCC an international reportable disease and standardizing procedures for data collection could improve our understanding of the frequency of NCC worldwide and hence its global burden.

Climate change-according to conventional wisdom-will result in an expansion of tropical parasitic diseases in terms of latitude and altitude, with vector-borne diseases particularly prone to change. However, although a significant rise in temperature occurred over the past century, there is little empirical evidence whether climate change has indeed favoured infectious diseases. This might be explained by the complex relationship between climate change and the frequency and the transmission dynamics of infectious diseases, which is characterised by nonlinear associations and countless other complex factors governing the distribution of infectious diseases. Here, we explore whether and how climate change might impact on diseases targeted by the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)). We start our review with a short summary of the current evidence-base how climate change affects the distribution of infectious diseases. Next, we introduce biology-based models for predicting the distribution of infectious diseases in a future, warmer world. Two case studies are presented: the classical RNAS(+) disease schistosomiasis and an emerging disease, angiostrongyliasis, focussing on their occurrences in the People's Republic of China. Strengths and limitations of current models for predicting the impact of climate change on infectious diseases are discussed, and we propose model extensions to include social and ecological factors. Finally, we recommend that mitigation and adaptation strategies to diminish potential negative effects of climate change need to be developed in concert with key stakeholders so that surveillance and early-warning systems can be strengthened and the most vulnerable population groups protected.

Climate change-according to conventional wisdom-will result in an expansion of tropical parasitic diseases in terms of latitude and altitude, with vector-borne diseases particularly prone to change. However, although a significant rise in temperature occurred over the past century, there is little empirical evidence whether climate change has indeed favoured infectious diseases. This might be explained by the complex relationship between climate change and the frequency and the transmission dynamics of infectious diseases, which is characterised by nonlinear associations and countless other complex factors governing the distribution of infectious diseases. Here, we explore whether and how climate change might impact on diseases targeted by the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)). We start our review with a short summary of the current evidence-base how climate change affects the distribution of infectious diseases. Next, we introduce biology-based models for predicting the distribution of infectious diseases in a future, warmer world. Two case studies are presented: the classical RNAS(+) disease schistosomiasis and an emerging disease, angiostrongyliasis, focussing on their occurrences in the People's Republic of China. Strengths and limitations of current models for predicting the impact of climate change on infectious diseases are discussed, and we propose model extensions to include social and ecological factors. Finally, we recommend that mitigation and adaptation strategies to diminish potential negative effects of climate change need to be developed in concert with key stakeholders so that surveillance and early-warning systems can be strengthened and the most vulnerable population groups protected.

Significant progress has taken place over the past 50 years in the control of schistosomiasis japonica in China. However, the available data suggested that schistosomiasis has re-emerged shortly after the World Bank Loan Project which was conducted from 1992 to 2001. The national control program with a revised strategy to control schistosomiasis by using integrated measures has been implemented since 2005. In this study, we aimed to evaluate the effect of the national program on schistosomiasis control from 2005 to 2008.A retrospective study was carried out to analyze the epidemic patterns of acute infections with Schistosoma japonicum (S. japonicum), based on the number of acute cases annually collected from the web-based national communicable diseases reporting system from 2005 to 2008.A total of 564, 207, 83 and 57 acute cases infected with S. japonicum were reported nationwide in 2005, 2006, 2007 and 2008, respectively, with an average annual reduction rate of 46.35% during last four years. Six outbreaks of acute infection with S. japonicum were reported in 2005 but none in the period of 2006 to 2008. All acute cases that were reported mainly came from the lake regions and became infected during the higher risk periods from the 27th to 43rd weeks of the year. Most of these cases are students (44.87%), farmers (31.51%) and fishermen (7.79%) who got the infection by water contact mainly through swimming (41.49%) and production activities (40.25%). With time, the proportion of imported cases among all acute cases increased due to more frequent movement of people that has occurred with a more mobile population.The national control program on schistosomiasis aliened with the revised control strategy has been effectively brought into effect. However, there is still a significant risk of infection among students, farmers and fishermen living in the lake regions. Therefore, it is important to strengthen control measures among risk populations in the high risk areas of transmission, or the lake regions.

Data of visceral leishmaniasis cases since 2005 were collected through the National Infectious Disease Monitoring System. Number of reported cases in 2005, 2006, 2007 and January to June in 2008 was 59, 49, 77 and 30 in Sichuan Province, and 92, 106, 162 and 83 respectively in Gansu Province. With an increase of the number of stray dogs and susceptible human population, damage of the medical services including diagnosis and treatment capacity after the earthquake, there might be a strengthened transmission potential and possible spread of the disease.

To compare the schizontocidal activity of recrystallized or crude daphnetin against malaria parasites in vivo.Schizontocidal activity of recrystallized or crude daphnetin at various dosages was assessed in mice infected with Plasmodium berghei ANKA using a "4-day suppress assay".The comparison of the reduction rate of parasitemia caused by either recrystallized or crude dephnetin showed that ED(50) of crude daphnetin was 18.36 mg/kg, with 95% confidence limit of 5.96-56.54 mg/kg while ED50 of recrystallized daphnetin was 11.46 mg/kg, with 95% confidence limit of 8.63-15.22 mg/kg.The results indicate that the efficacy of recrystallized daphnetin is 37.6% higher than that of crude daphnetin.