Approaches being used in the national schistosomiasis elimination programme in China: a review
© The Author(s). 2017
Received: 17 January 2017
Accepted: 27 February 2017
Published: 15 March 2017
Schistosomiasis japonica, caused by the human blood fluke Schistosoma japonicum, remains a major public health problem in China, although great success has been achieved. The control efforts during the past half-decade, notably the wide implementation of the new integrated strategy with emphasis on control of the source of S. japonicum infection across the country since 2004, has greatly reduced S. japonicum in humans, livestock, and intermediate host Oncomelania hupensis snails, and transmission control of schistosomiasis was achieved in China in 2015. A two-stage roadmap was therefore proposed for schistosomiasis elimination in 2015, with aims to achieve transmission interruption by 2020 and achieve disease elimination by 2025 in the country. During the last two decades, a variety of approaches, which target the epidemiological factors of schistosomiasis japonica have been developed, in order to block the transmission cycle of the parasite. These approaches have been employed in the national or local schistosomiasis control activities, and facilitated, at least in part, the progress of the schistosomiasis elimination programs. Here, we present an approach to control the source of S. japonicum infection, three new tools for snail control, three approaches for detecting and monitoring S. japonicum infection, and a novel model for health education. These approaches are considered to play a great role in the stage moving towards transmission interruption and elimination of schistosomiasis in China.
KeywordsSchistosomiasis japonica Schistosoma japonicum Oncomelania hupensis Elimination Snail control Source of infection Health education China
Please see Additional file 1 for translations of the abstract into the six official working languages of the United Nations.
Schistosomiasis japonica, caused by the human blood fluke Schistosoma japonicum, remains endemic in China, the Philippines and parts of Indonesia [1–3]. In China, the description of schistosomiasis dates back more than two millennia [4, 5]. After the founding of the People’s Republic of China, schistosomiasis was once recognized as “God of plague”, since the disease caused huge social, economic and disease burdens in the country . At the initial stage of the national schistosomiasis control programme in 1950s, over 11 million people were estimated to have the disease in China [7, 8]. Then, the integrated control activities [9–15], together with strong political will and sufficient financial support [16, 17], had resulted in a remarkable decline in both the prevalence and intensity of S. japonicum infection [18–23].
However, there was a resurgence of schistosomiasis in China at the early 2000s [24–28], due to the termination of the World Bank Loan Project (WBLP) for Chinese Schistosomiasis Control Program [29, 30], the continuous flooding along the Yangtze River basin , and changes of other natural, social and economic factors [32, 33]. Since 2004, schistosomiasis has been defined as one of the top four priorities for communicable disease control by the central government , and a new national strategy was proposed aiming to control the transmission of S. japonicum in China . The new strategy integrates management of the sources of S. japonicum infection, chemotherapy, snail control, health education, and improved sanitation and access to safe water [35–37]. The implementation of this integrated strategy has achieved great success in controlling the transmission of S. japonicum in the country [38–44]. By 2015, only 77.2 thousand people were estimated to have the disease in China , which reduced by 90.8% as compared to that in 2004 when the new integrated strategy was initiated , and no S. japonicum infection was identified in Oncomelania hupensis snails since 2014 . Based on the control achievements, a two-stage roadmap was therefore proposed for schistosomiasis elimination in China in 2015, with aims to achieve transmission interruption by 2020 and disease elimination by 2025 [48, 49].
During the past two decades, a variety of approaches, which target the epidemiological factors of schistosomiasis japonica, have been developed, in order to block the transmission cycle of the disease. These approaches have been employed in national or local schistosomiasis control activities, and facilitated, at least in part, the progress of the schistosomiasis elimination programs. Here, we present some approaches that have shown effective to control the transmission of S. japonicum in China, so as to provide choice of interventions for the national schistosomiasis elimination program.
An approach to control the source of S. japonicum infection
The public toilets have two types, 2-seat with an area of 6 m2 and 4-seat with an area of 13 m2 . A total of 53 public toilets had been built in the anchor sites along the Yangtze River basin and an estimated 79.62% rate of use was observed . Currently, this approach has been widely employed in the major schistosomiasis-endemic foci of China, and has become an effective tool for the management of the feces excreted from boatman and fishermen . Such an approach provides a novel measure for schistosomiasis elimination in the country.
Approaches for snail control
A machine simultaneously integrating mechanized environmental cleaning and automatic molluscicide treatment
A rapid niclosamide detector
Snail control with black plastic film coverage
Tools for detection and monitoring of S. japonicum infection
An intelligent device for detecting S. japonicum-infested water
A kit for detecting S. japonicum DNA in O. hupensis snails
Web- and Google Earth-based surveillance-response system
A novel model for health education
As described above, boatman and fisherman have a high likelihood and a high prevalence of S. japonicum infection [50–52], and they are recognized as the key target population of health education for schistosomiasis control . However, the health education materials are usually not reached to the boatman and fisherman due to their high motility. A new model was therefore developed of schistosomiasis control health education. Firstly, a group of active, respected boatman and fishermen with high education levels are selected as health education volunteers. Then, the volunteers receive training pertaining to schistosomiasis prevention and control by professional staff from local CDC, and the volunteers are ensured to seize the techniques of health education regarding schistosomiasis prevention and control knowledge. Subsequently, the volunteers transmit the schistosomiasis prevention and control knowledge to the massive boatman and fishermen (one volunteer is responsible for boatmen and fishermen living in 10 boats), and participate in the health education interventions targeting the boatman and fishermen. In addition, the volunteers help professional staff to alter the incorrect behaviors, remind the implementation of self-protective measures and prohibit the pouring of the contaminated feces into water. They also help to record the use of feces container in boats and the use of harmless public toilets at the anchor sites. To evaluate the effectiveness of this health education model on schistosomiasis control, a questionnaire survey was conducted among the boatmen and fishermen. The results showed that the 3-year (2005 to 2007) implementation of this health education model increased the awareness of schistosomiasis control knowledge from 23.85 to 95.7% and percentage of correct schistosomiasis control behavior from 6.59 to 53.42%, the use of public toilets from 0 to 80.21% and the use of on-boat fecal container from 0 to 54.52%, respectively, and the sero-prevalence of S. japonicum infection decreased from 27.95% in 2004 to 19.24% in 2005, 12.27% in 2006 and 8.15% in 2007, respectively . The results demonstrate that this new health education model improves the awareness of schistosomiasis prevention and control knowledge and may correct the incorrect health behaviors, which play an active role in the prevention and control of schistosomiasis among the boatman and fishermen.
In this study, we present several approaches that had been developed during the past 2 decades, and they have been proved to effectively facilitate the progress towards the elimination of schistosomiasis in China. Actually, there are many other diagnostics, therapeutics, information, education and communication (IEC) materials, and snail control interventions developed in China, which are not presented in this review. Further systematic reviews to describe the role of all approaches in the national schistosomisis elimination program of China are required.
With the agenda set for global schistosomiasis elimination , Africa, the most severely afflicted regions due to schistosomiasis [86, 87], is also striving to eliminate this neglected tropical disease . However, it is almost impossible to achieve schistosomiasis elimination depending on mass drug administration (MDA) with praziquantel alone, which remains the primary strategy for schistosomiasis control until now [89–91]. Currently, China is aiding the elimination of schistosomiasis from mainland Africa [92, 93]. The approaches, which have been proved to be effective to block the transmission cycle of S. japonicum in China, may be effective to control the transmission of other Schistosoma species, with adaption to local epidemiological profiles. Further studies to assess the feasibility and effectiveness of these approaches in regions endemic for S. mansoni and S. haematobium seem justified.
Center for disease control and prevention
Information, education and communication
Loop-mediated isothermal amplification
Mass drug administration
World bank loan project.
We would like to express our sincere thanks to anonymous reviewers for their kind comments to improve our manuscript.
This study was supported by the grants from the China UK Global Health Support Programme (grant no. GHSP-OP202), National S & T Major Program (grant no. 2012ZX10004-220), National Science & Technology Pillar Program of China (grant no. 2009BAI78B06), Shanghai Public Health 3-Year Action Plan (grant no. 15GWZK0101), Jiangsu Provincial Science & Technology Project (grant no. BL2014021), Jiangsu Provincial Young Talents in Medical Sciences (grant no. QNRC2016621) and Jiangsu Department of Health (grant nos. Q201404 and X201410).
Availability of data and materials
The data supporting the findings in this paper can be found in Jiangsu Institute of Parasitic Diseases.
LPS, WW and XNZ conceived and designed the study. LPS collected publications. WW prepared the first version of the manuscript. QBH, SZL, YSL and HTY provided suggestive comments on the revision of the manuscript. XNZ revised and finalized the manuscript. All authors read and approved the final version of the manuscript.
Part of the materials described in the manuscript was reported in the Third Symposium on Surveillance Response System Leading to Tropical Diseases Elimination. The corresponding author, Xiao-Nong Zhou, is the Editor-in-Chief of Infectious Diseases of Poverty.
Consent for publication
All authors provided consent for publication.
Ethics approval and consent to participate
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