Integrating ecological approaches to interrupt schistosomiasis transmission: opportunities and challenges

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Abstract

Background

The development of agenda for global schistosomiasis elimination as a public health problem generates enthusiasms among global health communities, motivating great interests in both research and practice. Recent China-Africa schistosomiasis control initiatives, aiming to enhance collaboration on disease control in African countries, reflect in part that momentum. Yet there is a pressing need to know whether the Chinese experiences can be translated and applied in African settings.

Main body

China’s remarkable achievements in schistosomiasis control programme, associated experiences and lessons, have much to offer to those combating the disease. Central to the success of China’s control programmes is a strategy termed “integrated control” – integrating environmental approaches (e.g. improved sanitation, agricultural and hydrological development and management), which target different phases of the parasite transmission system, to chemical-based drug treatment and mollusciciding. Yet, despite significant measurable public health benefits, such integration is usually based on field experience and remains largely uncharacterized in an ecological context. This has limited our knowledge on relative contributions of varying components of the integrated control programme to the suppression of disease transmission, making it challenging to generalize the strategy elsewhere. In this opinion article, we have described and discussed these challenges, along with opportunities and research needs to move forward.

Conclusions

There is an urgent need to formalize an ecological framework for the integrated control programme that would allow research towards improved mechanistic understanding, quantification, and prediction of the control efforts.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0506-4) contains supplementary material, which is available to authorized users.

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Most cited references 11

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Schistosomiasis

Donald McManus, David Dunne, Moussa Sacko … (2018)

Schistosomiasis (bilharzia) is a neglected tropical disease caused by parasitic flatworms (blood flukes) of the genus Schistosoma, with considerable morbidity in parts of the Middle East, South America, Southeast Asia and, particularly, in sub-Saharan Africa. Infective larvae grow in an intermediate host (fresh-water snails) before penetrating the skin of the definitive human host. Mature adult worms reside in the mesenteric (Schistosoma mansoni and Schistosoma japonicum) or pelvic (Schistosoma haematobium) veins, where female worms lay eggs, which are secreted in stool or urine. Eggs trapped in the surrounding tissues and organs, such as the liver and bladder, cause inflammatory immune responses (including granulomas) that result in intestinal, hepato-splenic or urogenital disease. Diagnosis requires the detection of eggs in excreta or worm antigens in the serum, and sensitive, rapid, point-of-care tests for populations living in endemic areas are needed. The anti-schistosomal drug praziquantel is safe and efficacious against adult worms of all the six Schistosoma spp. infecting humans; however, it does not prevent reinfection and the emergence of drug resistance is a concern. Schistosomiasis elimination will require a multifaceted approach, including: treatment; snail control; information, education and communication; improved water, sanitation and hygiene; accurate diagnostics; and surveillance-response systems that are readily tailored to social-ecological settings.

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Schistosomiasis elimination: lessons from the past guide the future.

Robert Bergquist, J. Gray, Michelle Andrews … (2010)

Schistosomiasis is a major neglected tropical disease, with more than 200 million people infected and close to 800 million at risk. The disease burden is estimated to exceed 70 million disability-adjusted life-years. The anthelmintic drug praziquantel is highly effective in killing adult schistosome worms, but it is unable to kill developing schistosomes and so does not prevent reinfection. As a result, current praziquantel-based control programmes in Asia and sub-Saharan Africa are not effective or sustainable in the long term. The control of neglected tropical diseases, including schistosomiasis, is a funding priority for several donor agencies, with over US$350 million committed until 2013. Here we put forward an argument that donor funds would be more effectively spent on the development of a multi-faceted, integrated control programme, which would have a greater and longer lasting effect on disease transmission than the current chemotherapy-based programmes. The development of a transmission-blocking vaccine is also of great importance. A multi-faceted integrated control programme that incorporates a vaccine, even if only partly effective, has the potential to eliminate schistosomiasis. This integrated-approach model has the potential to improve the health of a billion of the world's poorest people and its effect cannot be underestimated. Copyright © 2010 Elsevier Ltd. All rights reserved.

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Schistosomiasis japonica control and research needs.

Xiao-Nong Zhou, Mohammad Sudomo, Remigio M. Olveda … (2009)

Schistosomiasis japonica, a chronic and debilitating disease caused by the blood fluke Schistosoma japonicum, is still of considerable economic and public health concern in the People's Republic of China, the Philippines, and Indonesia. Despite major progress made over the past several decades with the control of schistosomiasis japonica in the aforementioned countries, the disease is emerging in some areas. We review the epidemiological status and transmission patterns of schistosomiasis japonica, placing it into a historical context, and discuss experiences and lessons with national control efforts. Our analyses reveal that an integrated control approach, implemented through intersectoral collaboration, is essential to bring down the prevalence and intensity of Schistosoma japonicum infections and disease-related morbidity, and to sustain these parameters at low levels. The need for innovation and a sufficiently flexible control approach to adapt interventions in response to the changing nature and challenges of schistosomiasis control from the initial phase of morbidity control to the final state of elimination is emphasised. The aim of the presentation and the analyses is to inspire researchers and disease control managers elsewhere in Asia, Africa, and the Americas to harness the experiences gained and the lessons presented here to improve the control and eventual elimination of schistosomiasis and parasitic diseases.

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Author and article information

Contributors

Song Liang: ehs.liang@gmail.com

Eniola Michael Abe: abeeniola11@126.com

Xiao-Nong Zhou: xiaonongzhou1962@gmail.com

Journal

Journal ID (nlm-ta): Infect Dis Poverty

Journal ID (iso-abbrev): Infect Dis Poverty

Title: Infectious Diseases of Poverty

Publisher: BioMed Central (London )

ISSN (Print): 2095-5162

ISSN (Electronic): 2049-9957

Publication date (Electronic): 12 December 2018

Publication date PMC-release: 12 December 2018

Publication date Collection: 2018

Volume: 7

Electronic Location Identifier: 124

Affiliations

[1 ]ISNI 0000 0004 1936 8091, GRID grid.15276.37, Department of Environmental and Global Health, College of Public Health and Health Professions, and Emerging Pathogens Institute, , University of Florida, ; Gainesville, FL 32610 USA

[2 ]National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, 200025 China

[3 ]National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases, Shanghai, 200025 China

Article

Publisher ID: 506

DOI: 10.1186/s40249-018-0506-4

PMC ID: 6291957

PubMed ID: 30541611

SO-VID: d1838a1a-2511-498a-ae22-1632c8004808

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 October 2018

Date accepted : 16 November 2018

Funding

Funded by: National Key Research and Development Program of China

Award ID: 2016YFC1202001

Award Recipient : Xiao-Nong Zhou

Funded by: International Development Research Center (IDRC), Canada

Award ID: 108100-001

Award Recipient : Xiao-Nong Zhou

Funded by: China-UK Global Health Support Programme funded by UK DFID

Award ID: GHSP-CS-OP4-D02

Award Recipient : Xiao-Nong Zhou

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: R01AI125842

Award Recipient : Song Liang

Funded by: the Fourth Round of Three-Year Public Health Action Plan (2015-2017) in Shanghai

Award ID: GWTD2015S06

Award Recipient : Xiao-Nong Zhou

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Keywords: schistosomiasis,transmission interruption,ecological framework,integrated control

Data availability:

Keywords: schistosomiasis, transmission interruption, ecological framework, integrated control

Integrating ecological approaches to interrupt schistosomiasis transmission: opportunities and challenges

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Abstract

Background

Main body

Conclusions

Electronic supplementary material

Related collections

Chinese Journal of Schistosomiasis Control

Most cited references 11

Schistosomiasis

Schistosomiasis elimination: lessons from the past guide the future.

Schistosomiasis japonica control and research needs.

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Contributors

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