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      Epidemiology of Schistosomiasis in the People’s Republic of China, 2004

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          Abstract

          Although the number of human infections decreased, human prevalence increased from 4.9% in 1995 to 5.1% in 2004.

          Abstract

          Results from the third nationwide cluster sampling survey on the epidemiology of schistosomiasis in the People’s Republic of China, conducted by the Ministry of Health in 2004, are presented. A stratified cluster random sampling technique was used, and 239 villages were selected in 7 provinces where Schistosoma japonicum remains endemic. A total of 250,987 residents 6–65 years of age were included in the survey. Estimated prevalence rates in the provinces of Hunan, Hubei, Jiangxi, Anhui, Yunnan, Sichuan, and Jiangsu were 4.2%, 3.8%, 3.1%, 2.2%, 1.7%, 0.9%, and 0.3%, respectively. The highest prevalence rates were in the lake and marshland region (3.8%) and the lowest rates were in the plain region with waterway networks (0.06%). Extrapolation to all residents in schistosome-endemic areas indicated 726,112 infections. This indicates a reduction of 16.1% compared with a nationwide survey conducted in 1995. However, human infection rates increased by 3.9% in settings where transmission is ongoing.

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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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            Conquering schistosomiasis in China: the long march.

            The last half-century of schistosomiasis control activities in China have brought down the overall prevalence of human infection with Schistosoma japonicum to less than 10% of the level initially documented in the mid 1950s. Importantly, this reduction is not only, or even mainly, due to the advent of praziquantel in the 1970s and its subsequent dramatic fall in price. Instead, it is the result of a sustained, multifaceted national strategy, adapted to different eco-epidemiological settings, which has been versatile enough to permit subtle adjustments over time as the nature of the challenge changed. Consequently, prevalence has been falling relatively smoothly over the whole period rather than suddenly dropping when mass chemotherapy became feasible. Thus, early recognition of the huge public health and economic significance of the disease, and the corresponding political will to do something about it,underpinned this success. In addition, intersectoral collaboration and community participation played important roles in forming a sustained commitment to a working control strategy based on local resources. The unfolding story is presented from the early years' strong focus on snail control, by means of environmental management, to the last period of praziquantel-based morbidity control carried out under the 10-year World Bank Loan Project (WBLP). An important legacy of the WBLP is the understanding that a research component would sustain control measures and enable future progress. We are now witnessing the payoffs of this forward thinking in the form of a new promising class of drugs, improved diagnostics, and budding vaccine development in addition to novel ways of disease risk prediction and transmission control using satellite-based remote sensing. Different aspects of social and economic approaches are also covered and the importance of health promotion and education is emphasized. Issuing from the review is a set of recommendations, which might further consolidate current control activities, with the ultimate aim to eliminate schistosomiasis from the Chinese mainland.
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              Schistosomiasis in the People's Republic of China: prospects and challenges for the 21st century.

              Schistosomiasis japonica is a serious communicable disease and a major disease risk for more than 30 million people living in the tropical and subtropical zones of China. Infection remains a major public health concern despite 45 years of intensive control efforts. It is estimated that 865,000 people and 100,250 bovines are today infected in the provinces where the disease is endemic, and its transmission continues. Unlike the other schistosome species known to infect humans, the oriental schistosome, Schistosoma japonicum, is a true zoonotic organism, with a range of mammalian reservoirs, making control efforts extremely difficult. Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death. Infected children are stunted and have cognitive defects impairing memory and learning ability. Current control programs are heavily based on community chemotherapy with a single dose of the drug praziquantel, but vaccines (for use in bovines and humans) in combination with other control strategies are needed to make elimination of the disease possible. In this article, we provide an overview of the biology, epidemiology, clinical features, and prospects for control of oriental schistosomiasis in the People's Republic of China.
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                Author and article information

                Journal
                Emerg Infect Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                October 2007
                : 13
                : 10
                : 1470-1476
                Affiliations
                [* ]National Institute of Parasitic Diseases, Shanghai, People’s Republic of China
                []Fudan University, Shanghai, People’s Republic of China
                []Nanjing Medical University, Nanjing, People’s Republic of China
                [§ ]Hunan Institute of Parasitic Diseases, Yueyang, People’s Republic of China
                []Hubei Institute of Parasitic Diseases, Wuhan, People’s Republic of China
                [# ]Jiangxi Institute of Parasitic Diseases, Nanchang, People’s Republic of China
                [** ]Anhui Institute of Parasitic Diseases, Wuhu, People’s Republic of China
                [†† ]Jiangsu Institute of Parasitic Diseases, Wuxi, People’s Republic of China
                [‡‡ ]Sichuan Institute of Parasitic Diseases, Chengdu, People’s Republic of China
                [§§ ]Yunnan Institute of Endemic Diseases, Dali, People’s Republic of China
                [¶¶ ]Ministry of Health, Beijing, People’s Republic of China
                Author notes
                Address for correspondence: Xiao-Nong Zhou, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Rd, Shanghai 200025, People’s Republic of China; email: ipdzhouxn@ 123456sh163.net
                Article
                06-1423
                10.3201/eid1310.061423
                2851518
                18257989
                cc1ab75e-c5ea-453f-9571-dde0a2ef5370
                History
                Categories
                Research

                Infectious disease & Microbiology
                status,schistosomiasis,cluster sampling survey,epidemiology,research,schistosoma japonicum,china

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