Spatial distribution of human Schistosoma japonicum infections in the Dongting Lake Region, China

Seropositive Rate and Associated Factors of Schistosomiasis in Hunan Province, China: A Three-Year Cross-Sectional Survey

INTRODUCTION

China's Hunan Province, known for its extensive lake and marshland areas, continues to face considerable challenges in eliminating schistosomiasis. This study aims to examine the epidemiological characteristics of schistosomiasis in the province, focusing on seropositive rates across various demographic groups, spatial distribution, and identifying key associated factors to inform targeted control measures.

METHODS

From 2020 to 2022, the number of people screened each year using the indirect hemagglutination assay (IHA) was 1,053,973, 682,921, and 729,782, respectively. The Cochran-Armitage test for trend and chi-square test were employed to assess differences in seropositive rates among different times, age groups, genders, educational levels, and occupations. Spatial autocorrelation analysis was conducted to identify clusters of seropositive rates at the village level. A multiple logistic model was used to identify associated factors and generalized estimating equation (GEE) was used to obtain the parameter estimates.

RESULTS

From 2020 to 2022, the seropositive rate of schistosomiasis in Hunan Province were 1.53% (95% CI: 1.51-1.55), 2.22% (95% CI: 2.19-2.26), and 2.06% (95% CI: 2.03-2.10), respectively. The seropositive rate in Hunan Province was spatially clustered in each year, with high-high clustering areas mainly distributed around the southern Dongting Lake region, the tributary areas of Dongting Lake, as well as along the Yangtze River. The seropositive rate increased with age, with individuals aged 60-69 showing the highest seropositive rate (adjusted odds ratio [OR] when compared to < 10 years old: 47.94; 95% CI: 30.04-76.52). Males had higher seropositive rate compared to females (adjusted OR: 1.72; 95% CI: 1.69-1.76). Compared to farmers, fishermen (adjusted OR: 2.54; 95% CI: 2.40-2.70) and business/service staff (adjusted OR: 1.63; 95% CI: 1.52-1.74) had higher seropositive rate. The seropositive rate decreased with increasing educational level. Individuals using tap water and sanitary toilets had lower seropositive rate compared to those who did not use (tap water: adjusted OR: 0.66; 95% CI: 0.64-0.68; sanitary toilets: adjusted OR: 0.95; 95% CI: 0.93-0.97). Additionally, those who raised sheep had a higher seropositive rate compared to those who did not (adjusted OR: 4.67; 95% CI: 4.04-5.39).

CONCLUSIONS

Schistosomiasis remains a significant public health issue in Hunan Province, with the seropositive rate remaining clustered in certain regions and high-risk populations. Achieving schistosomiasis elimination requires sustained targeted interventions, improved sanitation infrastructure, enhanced health education, and long-term monitoring and comprehensive control measures for high-risk areas and vulnerable populations to reduce transmission risk and ensure sustainable disease elimination.

Prevention and control of schistosomiasis in the Philippines from a health education perspective

Schistosomiasis, second only to malaria, poses a significant threat to many regions worldwide, particularly tropical and subtropical areas. The Philippines, located in a tropical region, has long suffered from the serious public health hazards of schistosomiasis. We recognize that, besides direct snail control and mass drug administration, education plays a crucial role, either directly or indirectly, in the prevention and control of schistosomiasis. Therefore, this paper delves into the current status of schistosomiasis in the Philippines, the evolving strategies for prevention and control, and the significance of these efforts, with a particular focus on analyzing the impact, achievements, and challenges of educational interventions in schistosomiasis control. This detailed analysis aims to provide a comprehensive perspective on the overall progress and challenges of schistosomiasis prevention and control in the Philippines.

Spatial Analysis of Schistosomiasis in Hunan and Jiangxi Provinces in the People's Republic of China

Understanding the spatial distribution of schistosome infection is critical for tailoring preventive measures to control and eliminate schistosomiasis. This study used spatial analysis to determine risk factors that may impact Schistosoma japonicum infection and predict risk in Hunan and Jiangxi Provinces in the People's Republic of China. The study employed survey data collected in Hunan and Jiangxi in 2016. Independent variable data were obtained from publicly available sources. Bayesian-based geostatistics was used to build models with covariate fixed effects and spatial random effects to identify factors associated with the spatial distribution of infection. Prevalence of schistosomiasis was higher in Hunan (12.8%) than Jiangxi (2.6%). Spatial distribution of schistosomiasis varied at pixel level (0.1 × 0.1 km), and was significantly associated with distance to nearest waterbody (km, β = -1.158; 95% credible interval [CrI]: -2.104, -0.116) in Hunan and temperature (°C, β = -4.359; 95% CrI: -9.641, -0.055) in Jiangxi. The spatial distribution of schistosomiasis in Hunan and Jiangxi varied substantially and was significantly associated with distance to nearest waterbody. Prevalence of schistosomiasis decreased with increasing distance to nearest waterbody in Hunan, indicating that schistosomiasis control should target individuals in close proximity to open water sources as they are at highest risk of infection.

Current Status of Schistosomiasis Control and Prospects for Elimination in the Dongting Lake Region of the People's Republic of China

Schistosomiasis japonica is an ancient parasitic disease that has severely impacted human health causing a substantial disease burden not only to the Chinese people but also residents of other countries such as the Philippines, Indonesia and, before the 1970s, Japan. Since the founding of the new People's Republic of China (P. R. China), effective control strategies have been implemented with the result that the prevalence of schistosomiasis japonica has decreased markedly in the past 70 years. Historically, the Dongting Lake region in Hunan province is recognised as one of the most highly endemic for schistosomiasis in the P.R. China. The area is characterized by vast marshlands outside the lake embankments and, until recently, the presence of large numbers of domestic animals such as bovines, goats and sheep that can act as reservoir hosts for Schistosoma japonicum. Considerable social, economic and environmental changes have expanded the Oncomelania hupensis hupensis intermediate snail host areas in the Dongting lake region increasing the potential for both the emergence of new hot spots for schistosomiasis transmission, and for its re-emergence in areas where infection is currently under control. In this paper, we review the history, the current endemic status of schistosomiasis and the control strategies in operation in the Dongting Lake region. We also explore epidemiological factors contributing to S. japonicum transmission and highlight key research findings from studies undertaken on schistosomiasis mainly in Hunan but also other endemic Chinese provinces over the past 10 years. We also consider the implications of these research findings on current and future approaches that can lead to the sustainable integrated control and final elimination of schistosomiasis from the P. R. China and other countries in the region where this unyielding disease persists.

Asian Schistosomiasis: Current Status and Prospects for Control Leading to Elimination

Schistosomiasis is an infectious disease caused by helminth parasites of the genus Schistosoma. Worldwide, an estimated 250 million people are infected with these parasites with the majority of cases occurring in sub-Saharan Africa. Within Asia, three species of Schistosoma cause disease. Schistosoma japonicum is the most prevalent, followed by S. mekongi and S. malayensis. All three species are zoonotic, which causes concern for their control, as successful elimination not only requires management of the human definitive host, but also the animal reservoir hosts. With regard to Asian schistosomiasis, most of the published research has focused on S. japonicum with comparatively little attention paid to S. mekongi and even less focus on S. malayensis. In this review, we examine the three Asian schistosomes and their current status in their endemic countries: Cambodia, Lao People's Democratic Republic, Myanmar, and Thailand (S. mekongi); Malaysia (S. malayensis); and Indonesia, People's Republic of China, and the Philippines (S. japonicum). Prospects for control that could potentially lead to elimination are highlighted as these can inform researchers and disease control managers in other schistosomiasis-endemic areas, particularly in Africa and the Americas.

Real-time PCR diagnosis of Schistosoma japonicum in low transmission areas of China

Background

Schistosomiasis in the People’s Republic of China (PRC) can be traced back to antiquity. In the past 60 years, the Chinese government has made great efforts to control this persistent disease with elimination slated by 2020 through the implementation of a comprehensive control strategy. This strategy aims to reduce the role of bovines and humans as sources of infection as a pre-requisite for elimination through transmission interruption. The goal of elimination will be achievable only by the implementation of a sustainable surveillance and control system, with sensitive diagnosis a key feature so that the true disease burden is not underestimated. Currently used diagnostics lack the necessary sensitivity to accurately determine the prevalence of Schistosoma japonicum infection in areas with low infection intensities. It is of critical importance to find and treat people and to identify animals with low-level infections if the National Control Programme for China is to achieve schistosomiasis elimination.

Methods

We evaluated a real-time polymerase chain reaction (qPCR) assay using 633 human stool samples collected from five villages in Hunan, Anhui, Hubei, and Jiangxi provinces, and 182 bovine (70 cattle and 112 buffalo) stool samples obtained from four villages in Hunan, Anhui, and Jiangxi provinces in the PRC. All stool samples were subjected to the miracidium hatching test (MHT, a diagnostic procedure used in the National Schistosomiasis Control Programme) and the qPCR assay. Samples positive by MHT were subjected to either the Kato-Katz technique for humans, or the formalin-ethyl acetate sedimentation-digestion (FEA-SD) procedure for bovines, to determine infection intensities.

Results

The qPCR assay exhibited a high level of sensitivity in the detection of S. japonicum infections. With both the human and bovine samples, a significantly higher prevalence was determined using the qPCR assay (11.06% humans, 24.73% bovines) than with the MHT (0.93% humans, 7.69% bovines). The animal contamination index (calculated using data obtained with the qPCR technique) for all positive bovines was 27 618 000 eggs per day, indicating a considerable amount of environmental egg contamination that would be underestimated using less sensitive diagnostic procedures.

Conclusions

The qPCR assay we have evaluated will be applicable as a future field diagnostic and surveillance tool in low-transmission zones where schistosomiasis elimination is targeted and for monitoring post-intervention areas to verify that elimination has been maintained.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0390-y) contains supplementary material, which is available to authorized users.

Schistosoma japonicum transmission risk maps at present and under climate change in mainland China

BACKGROUND

The South-to-North Water Diversion (SNWD) project is designed to channel fresh water from the Yangtze River north to more industrialized parts of China. An important question is whether future climate change and dispersal via the SNWD may synergistically favor a northward expansion of species involved in hosting and transmitting schistosomiasis in China, specifically the intermediate host, Oncomelania hupensis.

METHODOLOGY/ PRINCIPAL FINDINGS

In this study, climate spaces occupied by the four subspecies of O. hupensis (O. h. hupensis, O. h. robertsoni, O. h. guangxiensis and O. h. tangi) were estimated, and niche conservatism tested among each pair of subspecies. Fine-tuned Maxent (fMaxent) and ensemble models were used to anticipate potential distributions of O. hupensis under future climate change scenarios. We were largely unable to reject the null hypothesis that climatic niches are conserved among the four subspecies, so factors other than climate appear to account for the divergence of O. hupensis populations across mainland China. Both model approaches indicated increased suitability and range expansion in O. h. hupensis in the future; an eastward and northward shift in O. h. robertsioni and O. h. guangxiensis, respectively; and relative distributional stability in O. h. gangi.

CONCLUSIONS/SIGNIFICANCE

The southern parts of the Central Route of SNWD will coincide with suitable areas for O. h. hupensis in 2050-2060; its suitable areas will also expand northward along the southern parts of the Eastern Route by 2080-2090. Our results call for rigorous monitoring and surveillance of schistosomiasis along the southern Central Route and Eastern Route of the SNWD in a future, warmer China.

Spatio-temporal variations of typhoid and paratyphoid fevers in Zhejiang Province, China from 2005 to 2015

Typhoid and paratyphoid are two common enteric infectious diseases with serious gastrointestinal symptoms. Data was collected of the registered cases in Zhejiang Province from 2005 to 2015. The epidemiological characteristics were investigated and high-risk regions were detected with descriptive epidemiological methods and in-depth spatio-temporal statistics. A sharp decline in the incidences of both diseases was observed. The seasonal patterns were identified with typhoid and paratyphoid, one in summer from May to September was observed from 2005 to 2010 and the other lesser one in spring from January to March only observed from 2005 to 2007. The men were more susceptible and the adults aged 20 to 60 constituted the major infected population. The farmers were more likely to get infected, especially to typhoid. The Wilcoxon sum rank test proved that the incidences in the coastal counties were significantly higher than the inland. Besides, a positive autocorrelation was obtained with typhoid fever in global autocorrelation analysis but not with paratyphoid fever. Local autocorrelation analysis and spatio-temporal scan statistics revealed that high-risk clusters were located mainly in the coastal regions with typhoid fever but scattered across the province with paratyphoid fever. The spatial risks were evaluated quantitatively with hierarchical Bayesian models.

Mapping Soil Transmitted Helminths and Schistosomiasis under Uncertainty: A Systematic Review and Critical Appraisal of Evidence

BACKGROUND

Spatial modelling of STH and schistosomiasis epidemiology is now commonplace. Spatial epidemiological studies help inform decisions regarding the number of people at risk as well as the geographic areas that need to be targeted with mass drug administration; however, limited attention has been given to propagated uncertainties, their interpretation, and consequences for the mapped values. Using currently published literature on the spatial epidemiology of helminth infections we identified: (1) the main uncertainty sources, their definition and quantification and (2) how uncertainty is informative for STH programme managers and scientists working in this domain.

METHODOLOGY/PRINCIPAL FINDINGS

We performed a systematic literature search using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. We searched Web of Knowledge and PubMed using a combination of uncertainty, geographic and disease terms. A total of 73 papers fulfilled the inclusion criteria for the systematic review. Only 9% of the studies did not address any element of uncertainty, while 91% of studies quantified uncertainty in the predicted morbidity indicators and 23% of studies mapped it. In addition, 57% of the studies quantified uncertainty in the regression coefficients but only 7% incorporated it in the regression response variable (morbidity indicator). Fifty percent of the studies discussed uncertainty in the covariates but did not quantify it. Uncertainty was mostly defined as precision, and quantified using credible intervals by means of Bayesian approaches.

CONCLUSION/SIGNIFICANCE

None of the studies considered adequately all sources of uncertainties. We highlighted the need for uncertainty in the morbidity indicator and predictor variable to be incorporated into the modelling framework. Study design and spatial support require further attention and uncertainty associated with Earth observation data should be quantified. Finally, more attention should be given to mapping and interpreting uncertainty, since they are relevant to inform decisions regarding the number of people at risk as well as the geographic areas that need to be targeted with mass drug administration.

Assessing the influence of water level on schistosomiasis in Dongting Lake region before and after the construction of Three Gorges Dam

Schistosomiasis is a severe public health problem in the Dongting Lake region, and its distribution, prevalence, and intensity of infection are particularly sensitive to environmental changes. In this study, the human and bovine schistosomiasis variations in the Dongting Lake region were studied from 1996 to 2010, and the relationships between schistosomiasis and water level were examined. Furthermore, based on these results, the potential effects of the Three Gorges Dam (TGD) on schistosomiasis were investigated. Results showed an increase in human schistosomiasis and in the scope of seriously affected regions, along with a decrease in bovine schistosomiasis. Human schistosomiasis was negatively correlated with water level during wet season (from May to October), particularly the average water level in October. This finding indicated that the decreasing water level may be highly related to the increasing of human schistosomiasis in the Dongting Lake region. Based on this result and the variation of schistosomiasis before and after the construction and operation of TGD, the impoundment of the Three Gorges reservoir is believed to decrease the water level and increase the contact between people and schistosomiasis. Therefore, the TGD, which is operated by regulating water and scheduling water operations, is not good for the control of human schistosomiasis in the Dongting Lake region. Although the extent of the influence of the TGD on schistosomiasis remains unclear, the influence of the TGD on preventing and controlling schistosomiasis should not be ignored.

Comparative Analysis of Transcriptional Profiles of Adult Schistosoma japonicum from Different Laboratory Animals and the Natural Host, Water Buffalo

Background

Schistosomiasis is one of the most widely distributed parasitic diseases in the world. Schistosoma japonicum, a zoonotic parasite with a wide range of mammalian hosts, is one of the major pathogens of this disease. Although numerous studies on schistosomiasis japonica have been performed using laboratory animal models, systematic comparative analysis of whole-genome expression profiles in parasites from different laboratory animals and nature mammalian hosts is lacking to date.

Methodology/Principal Findings

Adult schistosomes were obtained from laboratory animals BALB/c mice, C57BL/6 mice, New Zealand white rabbits and the natural host, water buffaloes. The gene expression profiles of schistosomes from these animals were obtained and compared by genome-wide oligonucleotide microarray analysis. The results revealed that the gene expression profiles of schistosomes from different laboratory animals and buffaloes were highly consistent (r>0.98) genome-wide. Meanwhile, a total of 450 genes were identified to be differentially expressed in schistosomes which can be clustered into six groups. Pathway analysis revealed that these genes were mainly involved in multiple signal transduction pathways, amino acid, energy, nucleotide and lipid metabolism. We also identified a group of 1,540 abundantly and stably expressed gene products in adult worms, including a panel of 179 Schistosoma- or Platyhelminthes-specific genes that may be essential for parasitism and may be regarded as novel potential anti-parasite intervention targets for future research.

Conclusions/Significance

This study provides a comprehensive database of gene expression profiles of schistosomes derived from different laboratory animals and water buffaloes. An expanded number of genes potentially affecting the development of schistosomes in different animals were identified. These findings lay the foundation for schistosomiasis research in different laboratory animals and natural hosts at the transcriptional level and provide a valuable resource for screening anti-schistosomal intervention targets.

The zoonotic parasite Schistosoma japonicum is one of the major pathogens of schistosomiasis and can parasitize a wide range of mammals. Although numerous schistosome transcriptional profiling studies have been performed using laboratory animal models, the differences in the global gene expression profiles of worms from different laboratory animals and natural mammalian hosts have not been characterized. Therefore, we studied the gene expression profiles of adult worms from BALB/c mice, C57BL/6 mice, rabbits and buffaloes using a transcriptomics approach. Our results indicate that, although the expression profiles of adult worms from different mammals are generally similar, hundreds of genes are differentially expressed, which were mainly involved in various signal transduction pathways, amino acid, energy, nucleotide and lipid metabolism. Numerous abundantly and stably expressed genes in adults were identified, including some genes that are only found in blood flukes or expanded within the phylum Platyhelminthes and may be important for parasitism. Our data provide a basis for schistosomiasis research in different mammalian hosts at the transcriptional level as well as a valuable resource for the screening of anti-schistosomal intervention targets.

Spatial analysis of Schistosomiasis in Hubei Province, China: a GIS-based analysis of Schistosomiasis from 2009 to 2013

BACKGROUND

Schistosomiasis remains a major public health problem in China. The major endemic areas are located in the lake and marshland regions of southern China, particularly in areas along the middle and low reach of the Yangtze River. Spatial analytical techniques are often used in epidemiology to identify spatial clusters in disease regions. This study assesses the spatial distribution of schistosomiasis and explores high-risk regions in Hubei Province, China to provide guidance on schistosomiasis control in marshland regions.

METHODS

In this study, spatial autocorrelation methodologies, including global Moran's I and local Getis-Ord statistics, were utilized to describe and map spatial clusters and areas where human Schistosoma japonicum infection is prevalent at the county level in Hubei province. In addition, linear logistic regression model was used to determine the characteristics of spatial autocorrelation with time.

RESULTS

The infection rates of S. japonicum decreased from 2009 to 2013. The global autocorrelation analysis results on the infection rate of S. japonicum for five years showed statistical significance (Moran's I > 0, P < 0.01), which suggested that spatial clusters were present in the distribution of S. japonicum infection from 2009 to 2013. Local autocorrelation analysis results showed that the number of highly aggregated areas ranged from eight to eleven within the five-year analysis period. The highly aggregated areas were mainly distributed in eight counties.

CONCLUSIONS

The spatial distribution of human S. japonicum infections did not exhibit a temporal change at the county level in Hubei Province. The risk factors that influence human S. japonicum transmission may not have changed after achieving the national criterion of infection control. The findings indicated that spatial-temporal surveillance of S. japonicum transmission plays a significant role on schistosomiasis control. Timely and integrated prevention should be continued, especially in the Yangtze River Basin of Jianghan Plain area.

Schistosomiasis japonica: modelling as a tool to explore transmission patterns

Modelling is an important tool for the exploration of Schistosoma japonicum transmission patterns. It provides a general theoretical framework for decision-makers and lends itself specifically to assessing the progress of the national control programme by following the outcome of surveys. The challenge of keeping up with the many changes of social, ecological and environmental factors involved in control activities is greatly facilitated by modelling that can also indicate which activities are critical and which are less important. This review examines the application of modelling tools in the epidemiological study of schistosomiasis japonica during the last 20 years and explores the application of enhanced models for surveillance and response. Updated and timely information for decision-makers in the national elimination programme is provided but, in spite of the new modelling techniques introduced, many questions remain. Issues on application of modelling are discussed with the view to improve the current situation with respect to schistosomiasis japonica.

Geographical distribution of human Schistosoma japonicum infection in The Philippines: tools to support disease control and further elimination

Schistosoma japonicum infection is believed to be endemic in 28 of the 80 provinces of The Philippines and the most recent data on schistosomiasis prevalence have shown considerable variability between provinces. In order to increase the efficient allocation of parasitic disease control resources in the country, we aimed to describe the small-scale spatial variation in S. japonicum prevalence across The Philippines, quantify the role of the physical environment in driving the spatial variation of S. japonicum, and develop a predictive risk map of S. japonicum infection. Data on S. japonicum infection from 35,754 individuals across the country were geo-located at the barangay level and included in the analysis. The analysis was then stratified geographically for the regions of Luzon, the Visayas and Mindanao. Zero-inflated binomial Bayesian geostatistical models of S. japonicum prevalence were developed and diagnostic uncertainty was incorporated. Results of the analysis show that in the three regions, males and individuals aged ⩾20years had significantly higher prevalence of S. japonicum compared with females and children <5years. The role of the environmental variables differed between regions of The Philippines. Schistosoma japonicum infection was widespread in the Visayas whereas it was much more focal in Luzon and Mindanao. This analysis revealed significant spatial variation in the prevalence of S. japonicum infection in The Philippines. This suggests that a spatially targeted approach to schistosomiasis interventions, including mass drug administration, is warranted. When financially possible, additional schistosomiasis surveys should be prioritised for areas identified to be at high risk but which were under-represented in our dataset.

Schistosomiasis research in the dongting lake region and its impact on local and national treatment and control in China

Schistosomiasis is a chronic and debilitating parasitic disease that has often been neglected because it is a disease of poverty, affecting poor rural communities in the developing world. This is not the case in the People's Republic of China (PRC), where the disease, caused by Schistosoma japonicum, has long captured the attention of the Chinese authorities who have, over the past 50–60 years, undertaken remarkably successful control programs that have substantially reduced the schistosomiasis disease burden. The Dongting Lake region in Hunan province is one of the major schistosome-endemic areas in the PRC due to its vast marshland habitats for the Oncomelania snail intermediate hosts of S. japonicum. Along with social, demographic, and other environmental factors, the recent completion and closure of the Three Gorges dam will most likely increase the range of these snail habitats, with the potential for re-emergence of schistosomiasis and increased transmission in Hunan and other schistosome-endemic provinces being a particular concern. In this paper, we review the history and the current status of schistosomiasis control in the Dongting Lake region. We explore the epidemiological factors contributing to S. japonicum transmission there, and summarise some of the key research findings from studies undertaken on schistosomiasis in Hunan province over the past 10 years. The impact of this research on current and future approaches for sustainable integrated control of schistosomiasis in this and other endemic areas in the PRC is emphasised.

The applications of model-based geostatistics in helminth epidemiology and control

Funding agencies are dedicating substantial resources to tackle helminth infections. Reliable maps of the distribution of helminth infection can assist these efforts by targeting control resources to areas of greatest need. The ability to define the distribution of infection at regional, national and subnational levels has been enhanced greatly by the increased availability of good quality survey data and the use of model-based geostatistics (MBG), enabling spatial prediction in unsampled locations. A major advantage of MBG risk mapping approaches is that they provide a flexible statistical platform for handling and representing different sources of uncertainty, providing plausible and robust information on the spatial distribution of infections to inform the design and implementation of control programmes. Focussing on schistosomiasis and soil-transmitted helminthiasis, with additional examples for lymphatic filariasis and onchocerciasis, we review the progress made to date with the application of MBG tools in large-scale, real-world control programmes and propose a general framework for their application to inform integrative spatial planning of helminth disease control programmes.

Moderate and high endemicity of schistosomiasis is a predictor of the endemicity of soil-transmitted helminthiasis: a systematic review

The authors conducted a systematic literature review with the following aims: to investigate how frequently soil-transmitted helminthiasis (STH) infections are endemic where schistosomiasis is present; and to assess the correlation between the risk level of schistosomiasis and that of STH. Among 155 sites on which data were collected and analyzed, schistosomiasis was present in 130, all of which were also co-endemic for STH, whereas 25 sites were endemic only for STH. Ninety percent (117 out of 130) of the areas eligible for preventive chemotherapy (PC) against schistosomiasis are also eligible for PC against STH. This fact provides managers of control programmes with the operationally important indication that use of available information on endemicity of schistosomiasis is a valid tool to predict the presence of STH in the same geographical area and to estimate the need of PC for STH. The implementation of this tool is expected to save financial and human resources and help accelerate the scale-up of PC throughout the world.

Coordinating research on neglected parasitic diseases in Southeast Asia through networking

The new dialogue between stakeholders, that is, scientists, research administrators and donors as well as the populations victimized by endemic infections, is initiating a virtuous circle leading to lower disease-burdens, improved public health and the mitigation of poverty. There is now general agreement that control activities need research collaboration to advance, while surveillance plays an increasingly important role in sustaining long-term relief. On the part of the Regional Network on Asian Schistosomiasis and Other Helminth Zoonoses (RNAS(+)), this has led to a new vision not only focused on general strengthening of research capabilities but also on furthering efforts to close the gap between research and control and bridge different branches of science. From its original, exclusive focus on schistosomiasis, RNAS(+) has expanded to include food-borne and soil-transmitted helminth infections as well. Its current repository of data on the distribution, prevalence and severity of these diseases is increasingly utilised by decision makers charged with epidemiological control in the endemic countries. Thanks to a more rapid translation of research results into control applications and the dissemination of data and new technology through networking, the overall situation is improving. Working as a virtual organisation of researchers and control officers in the endemic countries of Southeast Asia, RNAS(+) is playing an important role in this conversion. Its responsibilities are divided along disease lines into five main areas, but no serious, endemic disease is considered to be outside the network's sphere of interest. This chapter recounts some of the more important RNAS(+) accomplishments, pinpoints potential directions for future operations and highlights areas where research is most needed.

Identifying high-risk areas of schistosomiasis and associated risk factors in the Poyang Lake region, China

The epidemiology of schistosomiasis japonicum over small areas remains poorly understood, and this is particularly true in China. We aimed to identify high-risk areas for schistosomiasis and associated risk factors in the Poyang Lake region, China. A cross-sectional study was conducted and 60 of 920 persons (6.5%) were found to be infected with Schistosoma japonicum. Locations of households and snail habitats were determined using a hand-held global positioning system. We mapped the data in a geographical information system and used spatial scan statistics to explore clustering of infection, logistic regression and Bayesian geostatistical models to identify risk factors for each individual's infection status and multinomial logistic regression to identify risk factors for living in a cluster area. The risk of schistosomiasis was spatially clustered and higher in fishermen and males, not in persons who lived in close proximity to snail habitats and infected water sources. This study has demonstrated significant spatial variation in the prevalence of schistosomiasis at a small spatial scale. The results suggest that demographic factors (gender, occupation) rather than the distance to infected water are driving human transmission at small-scale spatial levels. Such information can be used to plan locally targeted interventions based on anthelminthic drug administration, snail control and sanitation improvement.