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      Effectiveness of the new integrated strategy to control the transmission of Schistosoma japonicum in China: a systematic review and meta-analysis Translated title: Efficacité de la nouvelle stratégie intégrée de contrôle de la transmission de Schistosoma japonicum en Chine : revue systématique et méta-analyse

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          Since 2004, the national schistosomiasis control strategy in China has shifted from the morbidity control strategy (conventional strategy) to an integrated strategy (new strategy). We investigated the effectiveness of the new strategy and compared it against the conventional strategy. We retrieved from electronic databases the literature regarding the new strategy published from 2000 to 2017. The effect of the new or conventional strategy on infection by Schistosoma japonicum of humans and snails ( Oncomelania hupensis) was evaluated with pooled log relative risk (logRR). A total of only eight eligible publications were included in the final meta-analysis. The results showed that implementation of the new strategy reduced the infection risk by 3–4 times relative to the conventional strategy. More specifically, the conventional strategy caused a reduction in both human (logRR = 0.56, 95% CI: 0.12–0.99) and snail infections (logRR = 0.34, 95% CI: −0.69–1.37), while the new strategy also significantly reduced both human (logRR = 1.89, 95% CI: 1.33–2.46) and snail infections (logRR = 1.61, 95% CI: 1.06–2.15). In contrast to the conventional strategy, the new strategy appeared more effective to control both human (logRR difference = 1.32, 95% CI: 0.78–1.86) and snail infections (logRR difference = 1.53, 95% CI: 0.76–2.31). Our data demonstrate that the new integrated strategy is highly effective to control the transmission of S. japonicum in China, and this strategy is recommended for schistosomiasis elimination in other affected regions across the world, with adaptation to local conditions.

          Translated abstract

          Depuis 2004, la stratégie nationale de lutte contre la schistosomiase en Chine est passée d’une stratégie de contrôle de la morbidité (stratégie conventionnelle) à une stratégie intégrée (nouvelle stratégie). Nous avons examiné l’efficacité de la nouvelle stratégie et l’avons comparée à la stratégie conventionnelle. Nous avons extrait des bases de données électroniques la littérature concernant la nouvelle stratégie publiée de 2000 à 2017. L’effet de la stratégie nouvelle ou conventionnelle sur l’infection par Schistosoma japonicum des humains et des mollusques ( Oncomelania hupensis) a été évalué avec le risque relatif de log groupé (logRR). Au total, seulement 8 publications éligibles ont été incluses dans la méta-analyse finale. Les résultats ont montré que la mise en œuvre de la nouvelle stratégie réduisait de 3 à 4 fois le risque d’infection par rapport à la stratégie conventionnelle. Plus spécifiquement, la stratégie conventionnelle a entraîné une réduction des infections humaines (logRR = 0.56, IC à 95 % : 0.12–0.99) et des infections des mollusques (logRR = 0.34, IC à 95 % : −0.69–1.37), tandis que la nouvelle stratégie a aussi réduit les infections humaines (logRR = 1.89, IC à 95 % : 1.33 à 2.46) et des mollusques (logRR = 1.61, IC à 95 % : 1.06 à 2.15). Contrairement à la stratégie conventionnelle, la nouvelle stratégie a semblé plus efficace pour contrôler à la fois les infections humaines (différence de logRR = 1.32, IC à 95 % : 0.78–1.86) et les infections des mollusques (différence de logRR = 1.53, IC à 95 % : 0.76–2.31). Nos données démontrent que la nouvelle stratégie intégrée est très efficace pour contrôler la transmission de S. japonicum en Chine et que cette stratégie est recommandée pour l’élimination de la schistosomiase dans d’autres régions touchées du monde, avec une adaptation aux conditions locales.

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          Most cited references 59

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          Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk.

          An estimated 779 million people are at risk of schistosomiasis, of whom 106 million (13.6%) live in irrigation schemes or in close proximity to large dam reservoirs. We identified 58 studies that examined the relation between water resources development projects and schistosomiasis, primarily in African settings. We present a systematic literature review and meta-analysis with the following objectives: (1) to update at-risk populations of schistosomiasis and number of people infected in endemic countries, and (2) to quantify the risk of water resources development and management on schistosomiasis. Using 35 datasets from 24 African studies, our meta-analysis showed pooled random risk ratios of 2.4 and 2.6 for urinary and intestinal schistosomiasis, respectively, among people living adjacent to dam reservoirs. The risk ratio estimate for studies evaluating the effect of irrigation on urinary schistosomiasis was in the range 0.02-7.3 (summary estimate 1.1) and that on intestinal schistosomiasis in the range 0.49-23.0 (summary estimate 4.7). Geographic stratification showed important spatial differences, idiosyncratic to the type of water resources development. We conclude that the development and management of water resources is an important risk factor for schistosomiasis, and hence strategies to mitigate negative effects should become integral parts in the planning, implementation, and operation of future water projects.
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            The public health significance and control of schistosomiasis in China--then and now.

            The description of schistosomiasis in China dates back more than two millennia. The disease caused social and economic hardship, and the rates of morbidity and mortality were high. In the mid 1950s, when China's population was approximately 600 million, an estimated 11.6 million people were infected with Schistosoma japonicum. Hence, a national control programme was launched, with an emphasis on intermediate host snail control by means of environmental management. Over the past 50 years, the national control programme has made great progress and praziquantel-based morbidity control became the mainstay of control. In 2000, the number of infected people had been reduced to an estimated 694,788, the snail-infested area has been abridged by over 75%, and the disease had been eliminated in five of the 12 previously endemic provinces. Between the mid 1980s and 2003, the criteria of transmission interruption have been reached in 260 counties (60.0%), transmission control has been achieved in 63 counties (14.5%), but the disease was still endemic in the remaining 110 counties (25.4%). Comparison between the number of cases in 2000 and 2003 suggests that schistosomiasis has re-emerged; an estimated 843,011 people were infected with S. japonicum in 2003. Here, we provide a short historical account of the pubic health significance of schistosomiasis in China, highlight the progress made to date with the national control programme, and place particular emphasis on the most recent trends. Finally, we discuss remaining challenges for schistosomiasis control with the ultimate goal of disease elimination.
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              A strategy to control transmission of Schistosoma japonicum in China.

              Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China. We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice. After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001). A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China. 2009 Massachusetts Medical Society

                Author and article information

                EDP Sciences
                16 November 2018
                : 25
                : ( publisher-idID: parasite/2018/01 )
                [1 ] Yuhang Branch, The Second Affiliated Hospital of Zhejiang University Hangzhou 311100 Zhejiang Province PR China
                [2 ] School of Life Sciences, Fudan University Shanghai 200433 PR China
                [3 ] Department of Clinical Laboratory, The Obstetrics and Gynecology Hospital of Fudan University Shanghai 200001 PR China
                [4 ] Shanghai Skin Disease Hospital Shanghai 200443 PR China
                Author notes
                [* ]Corresponding authors: peachwang814@ 123456163.com

                These authors contributed equally to this work.

                parasite180109 10.1051/parasite/2018058
                © C. Qian et al., published by EDP Sciences, 2018

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 5, Tables: 1, Equations: 2, References: 67, Pages: 11
                Research Article


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