High-throughput autoantibody profiling of different stages of Schistosomiasis japonica

Infection by the Schistosoma japonicum can result in acute, chronic and late-stage manifestations. The latter often presents with severe organ failures and premature death. Importantly, infection can also produce autoimmune phenomena reflected by the development of autoantibodies. We wished to explore and profile the presence of autoantibodies in sera of patients with different stages of S. japonicum infection with the added aim of providing a reference assisting diagnosis. Blood samples from 55 patients with chronic and 20 patients with late-stage schistosomiasis japonica together, with a control group of 50 healthy people were randomly investigated against a microarray of 121 different autoantigens. In addition, the frequency of antibodies against Schistosoma egg antigen (SEA) was examined. In the sera from patients with chronic schistosomiasis japonica, 14 different highly expressed autoantibodies were detected, while patients with late-stage schistosomiasis were found to express as many as 43 autoantibody specificities together with a significantly higher frequency of antibodies against SEA compared to the control group. The findings presented suggest that autoantibody-based classification of schistosomiasis japonica represents a promising approach for the elucidation of subtypes of the disease. This approach may reflect differential disease mechanisms, which could ultimately lead to better treatment.

Single-cell RNA sequencing reveals a peripheral landscape of immune cells in Schistosomiasis japonica

BACKGROUND

Schistosomiasis, also known as bilharzia, is a devastating parasitic disease. This progressive and debilitating helminth disease is often associated with poverty and can lead to chronic poor health. Despite ongoing research, there is currently no effective vaccine for schistosomiasis, and praziquantel remains the only available treatment option. According to the progression of schistosomiasis, infections caused by schistosomes are classified into three distinct clinical phases: acute, chronic and advanced schistosomiasis. However, the underlying immune mechanism involved in the progression of schistosomiasis remains poorly understood.

METHODS

We employed single-cell RNA sequencing (scRNA-seq) to profile the immune landscape of Schistosomiasis japonica infection based on peripheral blood mononuclear cells (PBMCs) from a healthy control group (n = 4), chronic schistosomiasis group (n = 4) and advanced schistosomiasis group (n = 2).

RESULTS

Of 89,896 cells, 24 major cell clusters were ultimately included in our analysis. Neutrophils and NK/T cells accounted for the major proportion in the chronic group and the healthy group, and monocytes dominated in the advanced group. A preliminary study showed that NKT cells were increased in patients with schistosomiasis and that CXCR2 + NKT cells were proinflammatory cells. Plasma cells also accounted for a large proportion of B cells in the advanced group. MHC molecules in monocytes were notably lower in the advanced group than in the chronic group or the healthy control group. However, monocytes in the advanced group exhibited high expression of FOLR3 and CCR2.

CONCLUSIONS

Overall, this study enhances our understanding of the immune mechanisms involved in schistosomiasis. It provides a transcriptional atlas of peripheral immune cells that may contribute to elimination of the disease. This preliminary study suggests that the increased presence of CCR2 + monocyte and CXCR2 + NKT cells might participate in the progression of schistosomiasis.

Trend of Human Schistosomiasis Japonica Prevalence in China from 1990 to 2019

Schistosomiasis (Schistosomiasis japonica) remains an important public health problem in China, and the Chinese government has set an ambitious goal of eliminating schistosomiasis by 2030. Based on the observational study of the Global Burden of Disease Study database in 2019 (GBD2019) and the World Bank database, this study aimed to analyze the prevalence trend of schistosomiasis in China from 1990 to 2019 by using the joinpoint regression model, and the relationship between economic and social development and schistosomiasis prevalence. The data of age-standardized infection rates (ASRs) from the Global Burden of Disease Study Global Health Data Exchange were collected, and Gross national product per capita (GDP) and people using safely managed sanitation services ((PPMS) % of population) were extracted from the World Bank database. Trends of ASR were analyzed using joinpoint regression analysis, the association of ASR with GDP, and PPMS using the Pearson correlation analysis. The results reveal that, from 1990 to 2019, the overall trend of ASR from schistosomiasis showed a decrease for both sexes, the decreases in men were relatively smaller compared with women. A larger decrease has been observed in the age groups from 15 to 49 years compared with other age groups. The ASR of schistosomiasis had a significant negative correlation with GDP and PPMS. This observational study identified decreasing prevalence rate of schistosomiasis in China since 1990. Continuous investment, optimization of control strategy, and economic development will help to achieve the goal of schistosomiasis elimination.

Three Gorges Dam: the changing trend of snail density in the Yangtze River basin between 1990 and 2019

BACKGROUND

The area of Oncomelania hupensis snail remains around 3.6 billion m², with newly emerging and reemergent habitats continuing to appear in recent years. This study aimed to explore the long-term dynamics of snail density before and after the operation of Three Gorges Dam (TGD).

METHODS

Data of snail survey between 1990 and 2019 were collected from electronic databases and national schistosomiasis surveillance. Meta-analysis was conducted to estimate the snail density. Joinpoint model was used to identify the changing trend and inflection point. Inverse distance weighted interpolation (IDW) was used to determine the spatial distribution of recent snail density.

RESULTS

A total of 3777 snail survey sites with a precise location of village or beach were identified. For the downstream area, snail density peaked in 1998 (1.635/0.11 m², 95% CI: 1.220, 2.189) and fluctuated at a relatively high level before 2003, then declined steadily from 2003 to 2012. Snail density maintained lower than 0.150/0.11 m² between 2012 and 2019. Joinpoint model identified the inflection of 2003, and a significant decreasing trend from 2003 to 2012 with an annual percentage change (APC) being - 20.56% (95% CI: - 24.15, - 16.80). For the upstream area, snail density peaked in 2005 (0.760/0.11 m², 95% CI: 0.479, 1.207) and was generally greater than 0.300/0.11 m² before 2005. Snail density was generally lower than 0.150/0.11 m² after 2011. Snail density showed a significant decreasing trend from 1990 to 2019 with an APC being - 6.05% (95% CI: - 7.97, - 7.09), and no inflection was identified. IDW showed the areas with a high snail density existed in Poyang Lake, Dongting Lake, Jianghan Plain, and the Anhui branch of the Yangtze River between 2015 and 2019.

CONCLUSIONS

Snail density exhibited a fluctuating downward trend in the Yangtze River basin. In the downstream area, the operation of TGD accelerated the decline of snail density during the first decade period, then snail density fluctuated at a relatively low level. There still exists local areas with a high snail density. Long-term control and monitoring of snails need to be insisted on and strengthened.

Single-cell RNA sequencing to dissect the immunological network of liver fibrosis in Schistosoma japonicum-infected mice

Introduction

Liver fibrosis is a poor outcome of patients with schistosomiasis, impacting the quality of life and even survival. Eggs deposited in the liver were the main pathogenic factors of hepatic fibrosis in Schistosomiasis japonica. However, the mechanism of hepatic fibrosis in schistosomiasis remains not well defined and there is no effective measure to prevent and treat schistosome-induced hepatic fibrosis.

Methods

In this study, we applied single-cell sequencing to primarily explore the mechanism of hepatic fibrosis in murine schistosomiasis japonica (n=1) and normal mouse was served as control (n=1).

Results

A total of 10,403 cells were included in our analysis and grouped into 18 major cell clusters. Th2 cells and NKT cells were obviously increased and there was a close communication between NKT cells and FASLG signaling pathway. Flow cytometry analysis indicated that the expression of Fasl in NKT cells, CD8+ T cell and NK cell were higher in SJ groups. Arg1, Retnla and Chil3, marker genes of alternatively activated macrophages (M2), were mainly expressed in mononuclear phagocyte(1) (MP(1)), suggesting that Kupffer cells might undergo M2-like polarization in fibrotic liver of schistosomiasis. CXCL and CCL signaling pathway analysis with CellChat showed that Cxcl16-Cxcr6, Ccl6-Ccr2 and Ccl5-Ccr5 were the most dominant L-R and there were close interactions between T cells and MPs.

Conclusion

Our research profiled a preliminary immunological network of hepatic fibrosis in murine schistosomiasis japonica, which might contribute to a better understanding of the mechanisms of liver fibrosis in schistosomiasis. NKT cells and CXCL and CCL signaling pathway such as Cxcl16-Cxcr6, Ccl6-Ccr2 and Ccl5-Ccr5 might be potential targets to alleviate hepatic fibrosis of schistosomiasis.

[Conversion of serum anti-Schistosoma japonicum antibodies detected by immunological tests following treatment with praziquantel: a meta-analysis]

OBJECTIVE

To evaluate the conversion of serum antibodies against Schistosoma japonicum in humans and livestock detected by immunological tests following treatment with praziquantel.

METHODS

The studies pertaining to serological tests of schistosomiasis japonica published from 1991 to 2020 were retrieved in electronic databases, including Chinese National Knowledge Infrastructure, WanFang Data, PubMed and ScienceDirect. Data were extracted from included studies. The publication bias was assessed with funnel plots using the software RevMan version 5.3, and the conversion of antibodies against S. japonicum was evaluated through meta-analysis.

RESULTS

A total of 40 publications were included in the final meta-analysis, consisting of 33 Chinese publications and 7 English publications, and all immunological tests were performed with indirect hemagglutination test (IHA) and enzyme-linked immunosorbent assay (ELISA). Pooled analysis showed that the negative rates of serum anti-S. japonicum antibody were 45.36% [95% confidential interval (CI): (43.96%, 46.76%)] and 20.83% [95% CI: (19.69%, 21.97%)] detected by ELISA and IHA within 6 months post praziquantel treatment, 62.95% [95% CI: (61.59%, 64.31%)] and 55.61% [95% CI: (54.21%, 57.01%)] within 6 to 12 months after treatment and 85.92% [95% CI: (84.94%, 86.90%)] and 86.90% [95% CI: (85.95%, 87.85%)] over 12 months after treatment, respectively.

CONCLUSIONS

The negative rate of the serum anti-S. japonicum antibody by IHA and ELISA increased with the time of post-treatment with praziquantel. The overall negative rates of anti-S. japonicum antibody detected by IHA and ELISA are low within 12 months post praziquantel treatment. However, a high negative rate of anti-S. japonicum antibody is detected if there is no new contact with infested water after 12 months of praziquantel treatment.

Comparison of point-of-care test and enzyme-linked immunosorbent assay for detection of immunoglobulin G antibodies in the diagnosis of human schistosomiasis japonica

OBJECTIVE

Schistosomiasis japonica is an important helminthic disease in Asia. Sensitive and accurate diagnostic tools are indispensable for clinical diagnosis, screening infection and monitoring its control. In this study, we developed an immunochromatographic test (Sj-ICT) to detect anti-Schistosoma japonicum immunoglobulin G antibodies in human sera.

METHODS

Somatic extract from adult S. japonicum was used as an antigen. The Sj-ICT was developed and optimized as a point-of-care test. All 214 human serum samples were evaluated for diagnostic usefulness and comparison with an enzyme-linked immunosorbent assay (ELISA).

RESULTS

The diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy of the Sj-ICT were 90.8%, 87.9%, 86.4%, 91.9% and 89.3%, respectively. For ELISA the values were respectively 91.8%, 87.9%, 86.5%, 92.7% and 89.7%. The concordance between both methods was 86.4 % (Cohen's kappa value = 0.729).

CONCLUSIONS

The immunochromatographic test kit developed can support clinical diagnosis and large-scale surveys in endemic areas without requiring additional facilities or ancillary supplies.

Spatio-temporal variations of emerging sites infested with schistosome-transmitting Oncomelania hupensis in Hunan Province, China, 1949-2016

BACKGROUND

Constant emerging sites infested with Oncomelania hupensis (O. hupensis) impede the goal realization of eliminating schistosomiasis. The study assessed the spatial and temporal distributions of new Oncomelania snail habitats in Hunan Province from 1949 to 2016.

METHODS

We used the data from annual snail surveys throughout Hunan Province for the period from 1949 to 2016. Global Moran's I, Anselin local Moran's I statistics (LISA) and a retrospective space-time permutation model were applied to determine the spatial and temporal distributions of emerging snail-infested sites.

RESULTS

There were newly discovered snail-infested sites almost every year in 1949-2016, except for the years of 1993, 2009 and 2012. The number of emerging sites varied significantly in the five time periods (1949-1954, 1955-1976, 1977-1986, 1986-2003 and 2004-2016) (H = 25.35, p < 0.05). The emerging sites lasted 37.52 years in marshlands, 30.04 years in hills and 24.63 at inner embankments on average, with the values of Global Moran's I being 0.52, 0.49 and 0.44, respectively. High-value spatial clusters (HH) were mainly concentrated along the Lishui River and in Xiangyin County. There were four marshland clusters, two hill clusters and three inner embankment clusters after 1976.

CONCLUSIONS

Lower reaches of the Lishui River and the Dongting Lake estuary were the high-risk regions for new Oncomelania snail habitats with long durations. Snail surveillance should be strengthened at stubborn snail-infested sites at the inner embankments. Grazing prohibition in snail-infested grasslands should be a focus in marshlands. The management of bovines in Xiangyin County is of great importance.

The associations of hub gene polymorphisms in PI3K/AKT/mTOR pathway and Schistosomiasis Japonica infection and hepatic fibrosis

INTRODUCTION

Increasing evidence shows that the PI3K/AKT/mTOR pathway can be activated by a variety of stimulus in immune cells. Schistosomiasis Japonica is a serious threat to human health in some lakes of China.

METHODS

We analyzed the potential associations between the hub gene (PTEN, mTOR, AKT1 and AKT2) polymorphisms of PI3K/AKT/mTOR pathway and S. japonica risk, including infection risk, as well as immunological hepatic fibrosis risk. An immune database named Database of Immune Cell Expression, Expression quantitative trait loci and Epigenomics (DICE) was used to analyze the expression profiles of the hub genes in 15 types of immune cells.

RESULTS

Of them, two SNPs rs2295080 (mTOR) and rs7254617 (AKT2) were found associated with the risk of infection and fibrosis. We also performed a multivariant Cox regression analysis and found that HBV infection may increase hepatic fibrosis in chronic schistosomiasis patients, instead of genetic polymorphisms on PI3K/AKT/mTOR pathway or any other factors. We also found the expressions of mTOR (RICTOR) and AKT2 in T cells were higher than those in monocyte cells. And, the expressions of PTEN, mTOR (RICTOR) and AKT1 reduced both in activated CD4 T cells and activated CD8 T cells.

CONCLUSIONS

We concluded that rs2295080 may be an important marker in the diagnosis of susceptibility to schistosomiasis infection. But HBV infection not rs2295080 could promote immunological liver damage with fibrosis in patients with chronic schistosomiasis infection.

[Diagnostic value of nucleic acid detection in schistosomiasis japonica: a meta-analysis]

OBJECTIVE

To quantitatively evaluate the diagnostic value of variable-temperature and isothermal nucleic acid amplification techniques in the detection of schistosomiasis japonica using a meta-analysis.

METHODS

The publications pertaining to the nucleic acid detection of schistosomiasis japonica were searched in electronic databases, including Chinese National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed and ScienceDirect, and the compilations and proceedings of schistosomiasis were manually searched. In addition, the citations of publications associated with the nucleic acid detection of schistosomiasis japonica were traced using a document tracing method. The retrieved literatures were screened according to the inclusion and exclusion criteria, and data were extracted from the included literatures. The quality of the included literatures was assessed using the software RevMan version 5.3, and a meta-analysis was performed using the software MetaDiSc version 1.4.

RESULTS

A total of 19 publications covering 24 groups of studies were enrolled, including 5 Chinese publications and 14 English publications. There were 17 groups of studies reporting the comparison between the variable-temperature nucleic acid amplification technique and the golden standard, and 7 groups of studies showing the comparison between the isothermal nucleic acid amplification technique and the golden standard. Assessment of the literature quality indicated a minor overall bias of the included literatures, and the Deek funnel plot showed a possible publication bias in the documents reports variable-temperature nucleic acid amplification techniques. There was a heterogeneity caused by non-threshold effect among the studies associated with the variable-temperature amplification technique, and the random effects model was therefore used to combine the effects. The pooled sensitivity and specificity of the variable-temperature amplification technique were 0.81 (0.79 to 0.83) and 0.73 (0.71 to 0.74) for the diagnosis of schistosomiasis japonica, and area under the SROC curve was 0.944 3. There was no heterogeneity among the studies associated with the isothermal amplification technique, and the fixed effects model was therefore used to combine the effects. The pooled sensitivity and specificity of the isothermal amplification technique were 0.96 (0.94 to 0.98) and 0.95 (0.94 to 0.97) for the diagnosis of schistosomiasis japonica, and area under the SROC curve was 0.989 9.

CONCLUSIONS

Both variable-temperature and isothermal nucleic acid amplification techniques have a high efficiency for the diagnosis of schistosomiasis japonica, and the isothermal amplification technique shows a relatively higher accuracy than the variable-temperature amplification technique.

Co-parasitism of intestinal protozoa and Schistosoma japonicum in a rural community in the Philippines

Background

Co-parasitism is a frequent occurrence in impoverished communities in the tropics resulting in a considerable disease burden. While there are extensive reports of intestinal helminthiases, including schistosomiasis japonica, the occurrence and extent of diseases caused by intestinal protozoa (IP) have yet to be investigated in depth in the Philippines. We present a detailed analysis of polyparasitism in a rural community of Northern Samar, focusing on co-infections of IP with Schistosoma japonicum.

Methods

A descriptive cross sectional study was carried out in 2015 across 18 barangays (villages) endemic for S. japonicum in Northern Samar, the Philippines to assess the burden of human schistosomiasis and IP infections. Faecal samples collected from 412 participants from the 18 barangays were included in the final molecular analysis. A multiplex quantitative PCR assay was developed and used for the detection of Blastocystis spp., Entamoeba histolytica, Cryptosporidium spp. and Giardia duodenalis in stool samples. The findings were combined with previous results of droplet digital PCR diagnosis of individuals from the same 18 barangays infected with S. japonicum determined using the same stool samples for analysis.

Results

Mean age of the study participants was 40.3 years (95% CI: 38.8–41.8) with 53% (n = 218) being males. Prevalence of S. japonicum (74.5%) and Blastocystis spp. (58.7%) was significantly higher compared to other infections, with E. histolytica having the lowest prevalence (12.1%). A majority of individuals were infected with more than one parasite with two infections being most common (n = 175, 42.5%). The prevalence of individuals with two parasites was significantly higher than all others with 27.9% (n = 115) subjects harbouring a single parasite species. Of individuals with two infections, S. japonicum and Blastocystis spp. were the most common combination (n = 110, 62.9%). Examining age within the population, 58.5% (n = 38) of school-aged children and 60.1% (n = 14) of women of child bearing age harboured at least two parasite species.

Conclusions

The study revealed that polyparasitism with IP infections and schistosomiasis japonica is highly prevalent in individuals in Northern Samar which likely contributes to the significant public health and socio-economic burden suffered by this population. More generally, the findings are of relevance when considering implementation of integrated control strategies for intestinal parasites.

Electronic supplementary material

The online version of this article (10.1186/s40249-018-0504-6) contains supplementary material, which is available to authorized users.

[Challenges and strategies of health education and health promotion in stage of schistosomiasis elimination]

Health education and health promotion are important measures for comprehensive control of schistosomiasis in China, which can improve the compliance rate of residents involved in schistosomiasis control activities, reduce the water contact behavior of the target population, thus avoiding or decreasing the infection of schistosome in endemic areas. In recent years, the comprehensive control of schistosomiasis in China has achieved remarkable results. China has reached the goal of transmission control and is moving toward the transmission interruption or even elimination of schistosomiasis. This article analyzes the role of health education and health promotion in schistosomiasis control programme and the current challenges. Meanwhile, suggestions are also put forward on how to conduct health education and health promotionin the stage of schistosomiasis elimination.

[Role of goat in transmission of schistosomiasis japonica IV Goat breeding in endemic regions and role of goat in schistosomiasis transmission]

This review describes the major species, number, breeding pattern, ratio of fenced to freely grazed goat, susceptibility to Schistosoma japonicum, pattern of S. japonicum infection, infection rate, intensity of infection, fecal contamination of goat that were bred in 5 marshland and lake provinces of Hunan, Hubei, Jiangxi, Anhui and Jiangsu, and two mountainous provinces of Yunnan and Sichuan, and demonstrates the associations of infected goat distribution with the distribution of infected Oncomelania hupensis snails and humans. Considering the huge number of goat which were predominantly grazed freely in marshland and lake endemic regions of China, the high infection rate, numerous environmental pollution by goat feces, as well as the close correlation between the infected goat distribution and infected snail distribution, goat is considered as a major infectious source for schistosomiasis japonica in China, and to play a critical role in the transmission of the disease. Since the control of schistosomiasis in animals is critical to schistosomiasis interruption and elimination, it is suggested that the integrated management of goat schistosomiasis should be included in the national schistosomiasis control program of China.

Estimating the prevalence of schistosomiasis japonica in China: a serological approach

BACKGROUND

The prevalence of schistosomiasis japonica has decreased significantly, and the responses changing from control to elimination in Jiangsu Province, P.R. China. How to estimate the change in prevalence of schistosomiasis using only serological data will be important and useful.

METHODS

We collected serum samples from 2011 to 2015 to build a serum bank from Dantu County of Jiangsu, China. Serum samples were detected by enzyme-linked immunosorbent assay (ELISA), the positive rate and optical density (OD) value were obtained. The Bayesian model including the prior information of sensitivity and specificity of ELISA was established, and the estimated infection rates were obtained for different years, genders and age groups.

RESULTS

There was no significant difference in the mean OD between different years and genders, but there was a significant difference between the different age groups. There were statistically significant differences in the positive rate for different years and age groups, but no significant difference at different genders. The estimated infection rate for the five years was 1.288, 1.456, 1.032, 1.485 and 1.358%, respectively. There was no significant difference between different years and between genders, but a significant difference between different age groups.

CONCLUSIONS

The risk of schistosomiasis transmission in this area still exists, and risk monitoring of schistosomiasis should be strengthened.

[Study on value of IHA in diagnosis of schistosomiasis japonica]

OBJECTIVE

To evaluate the value of indirect hemagglutination test (IHA) in schistosomiasis diagnosis.

METHODS

The literature concerned schistosomiasis diagnosis with IHA in the databases of Medline, CNKI, VIP and Wanfang Data from 1982 to 2014 was collected and evaluated.

RESULTS

Totally 21 articles which were satisfied with the research criteria were analyzed with the Meta-analysis method. The IHA method had high value in schistosomiasis diagnosis, the AUC_SROC of IHA in laboratory evaluation was 0.990 6, while in filed evaluation was 0.832 9, and the difference between them was significant (Z = 4.50, P < 0.05).

CONCLUSIONS

The diagnosis value of IHA in field evaluation is less than that in laboratory. In the process of the elimination of schistosomiasis, developing a new and higher sensitive reagent in schistosomiasis diagnosis is needed.

The Three Gorges Dam: Does the Flooding Time Determine the Distribution of Schistosome-Transmitting Snails in the Middle and Lower Reaches of the Yangtze River, China?

BACKGROUND

Schistosomiasis is one of the most devastating tropical diseases in the world. Oncomelania hupensis is the only intermediate host of Schistosoma japonicum, and its growth and development are sensitive to environmental factors. The Three Gorges Dam has substantially altered the water level in the Yangtze River. This study focused on the impact of the flooding time on the occurrence of Oncomelania snails in Hunan Province, China.

METHODS

The data regarding Oncomelania snails were collected from the Schistosomiasis Atlas of the People's Republic of China. Air temperature, hours of daylight and relative humidity from 1995 to 2002 were collected from the China Meteorological Data Sharing Service System. The data for rainfall and days inundated with water were collected from the Hunan flood control information system and hydrological stations in Hunan Province. A generalized additive model was used to estimate the impact of these factors on the presence or absence of snails.

RESULTS

The number of days inundated with water in the areas with snails ranged from 56 to 212 days. However, 82 percent of the areas without snails were inundated with water less than 60 days. The lowest air temperature in a year in the areas without snails ranges from -2.88 °C to -2.10 °C, and the range was from -2.88 °C to -2.34 °C for areas with snails. Annual rainfall in the areas with snails ranged from 989 to 1565 mm, and the range was from 1230 mm to 1647 mm for the areas without snails. The results from the generalized additive model showed that the number of days inundated with water, lowest air temperature in a year, annual rainfall, days of daily rainfall greater than 0.1 mm, and hours of daylight were the factors that significantly affect the occurrence of snails in Hunan Province, China.

CONCLUSIONS

The number of days inundated with water may be a key factor determining the geographical distribution of Oncomelania snails in Hunan Province and the favorable number of days inundated with water for the survival of snails ranges from about 2 to 7 months.

[Changes of serum anti-schistosome antibody levels in schistosomiasis japonica patients after treatment]

OBJECTIVE

To investigate the changes of serum anti-schistosome antibody titers in schistosomiasis japonica patients after treatment, in order to provide the evidence for formulating the schistosomiasis surveillance program in marshland and lake regions.

METHODS

Upon prospective cohort study, the stool examination positive schistosomiasis patients and blood examination positive suspected patients (the titer was more than 1:80, including 1:80) were selected as the research objects in Jiangling County in 2014, and they received the 2-day praziquantel therapy. Half year, one year and two years after the treatment, their blood samples and fecal samples were collected for IHA anti-schistosome antibody detections and schistosome egg and miracidium detections.

RESULTS

In 2014, the stool examination positives were 251, and the majority of them were over 41 years old, accounting for 93.23% (234/251) ; 581 cases of high antibody titers were detected by the IHA method, and the majority of them were over 41 years old, accounting for 89.16% (518/581) . Half year, one year and two years after the treatment, among the stool examination positives, the negative conversion rates of stool positives were 99.60% (250/251), 100% (239/239) and 100% (234/234) respectively and the negative conversion rates of antibody positives were 21.91% (55/251), 64.11% (156/239) and 76.89% (193/234) respectively. In the high antibody titer positives, the negative conversion rates were 38.04% (221/581), 64.11% (359/560), and 77.86% (429/551) respectively, Half year, one year and two years after the treatment. There were statistically significant differences among the antibody negative conversion rates by χ² test (χ² = 77.538, 183.412, 25.469 respectively, all P < 0.001) . The geometric mean values of antibody titers of different durations between 2 groups were analyzed by 2-independent-samples T test, and the geometric mean values of antibody titers between the 2 groups were different before the treatment (t = 23.576, P < 0.01), but the geometric mean values of antibody titers between the 2 groups were not different 6 months, 1 year and 2 years after the treatment (t = -0.046, 1.165, -0.132, P = 0.964, 0.245, 0.895 respectively).

CONCLUSIONS

The levels of serum anti-schistosome antibody degrade slowly in schistosomiasis japonica patients after the treatment, and the results of IHA tests cannot distinguish the current schistosome infection from previous schistosome infection. Therefore, it is necessary to develop the specific diagnostic technology for schistosome infection in order to meet the need of monitoring.

Interruption of schistosomiasis transmission in mountainous and hilly regions with an integrated strategy: a longitudinal case study in Sichuan, China

Background

Schistosomiasis remains a major public health concern in China. Since 2004, an integrated strategy was developed to control the transmission of Schistosoma japonicum in China. However, the long-term effectiveness of this integrated strategy for the interruption of schistosomiasis transmission remains unknown in the mountainous and hilly regions of China until now. This longitudinal study aims to evaluate the effectiveness of the integrated strategy on transmission interruption of schistosomiasis in Sichuan Province from 2005 through 2014.

Methods

The data regarding replacement of bovines with machines, improved sanitation, access to clean water, construction of public toilets and household latrines, snail control, chemotherapy, and health education were captured from the annual report of the schistosomiasis control programmes in Sichuan Province from 2005 to 2014, and S. japonicum infection in humans, bovines and snails were estimated to evaluate the effectiveness of the integrated strategy.

Results

During the 10-year period from 2005 through 2014, a total of 536 568 machines were used to replace bovines, and 3 284 333 household lavatories and 15 523 public latrines were built. Tap water was supplied to 19 116 344 residents living in the endemic villages. A total of 230 098 hm² snail habitats were given molluscicide treatment, and 357 233 hm² snail habitats received environmental improvements. There were 7 268 138 humans and 840 845 bovines given praziquantel chemotherapy. During the 10-year study period, information, education and communication (IEC) materials were provided to village officers, teachers and schoolchildren. The 10-year implementation of the integrated strategy resulted in a great reduction in S. japonicum infection in humans, bovines and snails. Since 2007, no acute infection was detected, and no schistosomiasis cases or infected bovines were identified since 2012. In addition, the snail habitats reduced by 62.39% in 2014 as compared to that in 2005, and no S. japonicum infection was identified in snails since 2007. By 2014, 88.9% of the endemic counties achieved the transmission interruption of schistosomiasis and transmission control of schistosmiasis was achieved in the whole province in 2008.

Conclusion

The government-directed and multi-department integrated strategy is effective for interrupting the transmission of schistosomiasis in the mountainous and hilly regions of China.

Approaches being used in the national schistosomiasis elimination programme in China: a review

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.

The basic reproductive ratio of Barbour's two-host schistosomiasis model with seasonal fluctuations

Background

Motivated by the first mathematical model for schistosomiasis proposed by Macdonald and Barbour’s classical schistosomiasis model tracking the dynamics of infected human population and infected snail hosts in a community, in our previous study, we incorporated seasonal fluctuations into Barbour’s model, but ignored the effect of bovine reservoir host in the transmission of schistosomiasis. Inspired by the findings from our previous work, the model was further improved by integrating two definitive hosts (human and bovine) and seasonal fluctuations, so as to understand the transmission dynamics of schistosomiasis japonica and evaluate the ongoing control measures in Liaonan village, Xingzi County, Jiangxi Province.

Methods

The basic reproductive ratio R₀ and its computation formulae were derived by using the operator theory in functional analysis and the monodromy matrix theory. The mathematical methods for global dynamics of periodic systems were used in order to show that R₀ serves as a threshold value that determines whether there was disease outbreak or not. The parameter fitting and the ratio calculation were performed with surveillance data obtained from the village of Liaonan using numerical simulation. Sensitivity analysis was carried out in order to understand the impact of R₀ on seasonal fluctuations and snail host control. The modified basic reproductive ratios were compared with known results to illustrate the infection risk.

Results

The Barbour’s two-host model with seasonal fluctuations was proposed. The implicit expression of R₀ for the model was given by the spectral radius of next infection operator. The R₀s for the model ranged between 1.030 and 1.097 from 2003 to 2010 in the village of Liaonan, Xingzi County, China, with 1.097 recorded as the maximum value in 2005 but declined dramatically afterwards. In addition, we proved that the disease goes into extinction when R₀ is less than one and persists when R₀ is greater than one. Comparisons of the different improved models were also made.

Conclusions

Based on the mechanism and characteristics of schistosomiasis transmission, Barbour’s model was improved by considering seasonality. The implicit formula of R₀ for the model and its calculation were given. Theoretical results showed that R₀ gave a sharp threshold that determines whether the disease dies out or not. Simulations concluded that: (i) ignoring seasonality would overestimate the transmission risk of schistosomiasis, and (ii) mollusiciding is an effective control measure to curtail schistosomiasis transmission in Xingzi County when the removal rate of infected snails is small.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-017-1983-1) contains supplementary material, which is available to authorized users.

The influence of natural factors on the spatio-temporal distribution of Oncomelania hupensis

BACKGROUND

We analyzed the influence of natural factors, such as temperature, rainfall, vegetation and hydrology, on the spatio-temporal distribution of Oncomelania hupensis and explored the leading factors influencing these parameters. The results will provide reference methods and theoretical a basis for the schistosomiasis control.

METHODS

GIS (Geographic Information System) spatial display and analysis were used to describe the spatio-temporal distribution of Oncomelania hupensis in the study area (Dongting Lake in Hunan Province) from 2004 to 2011. Correlation analysis was used to detect the natural factors associated with the spatio-temporal distribution of O. hupensis. Spatial regression analysis was used to quantitatively analyze the effects of related natural factors on the spatio-temporal distribution of snails and explore the dominant factors influencing this parameter.

RESULTS

(1) Overall, the spatio-temporal distribution of O. hupensis was governed by the comprehensive effects of natural factors. In the study area, the average density of living snails showed a downward trend, with the exception of a slight rebound in 2009. The density of living snails showed significant spatial clustering, and the degree of aggregation was initially weak but enhanced later. Regions with high snail density and towns with an HH distribution pattern were mostly distributed in the plain areas in the northwestern and inlet and outlet of the lake. (2) There were space-time differences in the influence of natural factors on the spatio-temporal distribution of O. hupensis. Temporally, the comprehensive influence of natural factors on snail distribution increased first and then decreased. Natural factors played an important role in snail distribution in 2005, 2006, 2010 and 2011. Spatially, it decreased from the northeast to the southwest. Snail distributions in more than 20 towns located along the Yuanshui River and on the west side of the Lishui River were less affected by natural factors, whereas relatively larger in areas around the outlet of the lake (Chenglingji) were more affected. (3) The effects of natural factors on the spatio-temporal distribution of O. hupensis were spatio-temporally heterogeneous. Rainfall, land surface temperature, NDVI, and distance from water sources all played an important role in the spatio-temporal distribution of O. hupensis. In addition, due to the effects of the local geographical environment, the direction of the influences the average annual rainfall, land surface temperature, and NDVI had on the spatio-temporal distribution of O. hupensis were all spatio-temporally heterogeneous, and both the distance from water sources and the history of snail distribution always had positive effects on the distribution O. hupensis, but the direction of the influence was spatio-temporally heterogeneous. (4) Of all the natural factors, the leading factors influencing the spatio-temporal distribution of O. hupensis were rainfall and vegetation (NDVI), and the primary factor alternated between these two. The leading role of rainfall decreased year by year, while that of vegetation (NDVI) increased from 2004 to 2011.

CONCLUSIONS

The spatio-temporal distribution of O. hupensis was significantly influenced by natural factors, and the influences were heterogeneous across space and time. Additionally, the variation in the spatial-temporal distribution of O. hupensis was mainly affected by rainfall and vegetation.

[Study on cut-off value of IHA method for schistosomiasis diagnosis in different endemic areas]

OBJECTIVE

To explore the cut-off value of the indirect haemagglutination test (IHA) method for schistosomiasis japonica diagnosis in different endemic areas.

METHODS

Totally 55 nature villages of the lake-type endemic counties, Yugan and Xinzi, in Poyang Lake Region of Jiangxi Province were chosen as the study fields, and all the villagers over 5 years old were parallelly examined by Kato-Katz method + miracidial hatching test and IHA method. The detection data were analyzed by the correlation analysis, and the threshold values of the IHA method in different endemic areas were decided by the receiver operating characteristic (ROC) curve.

RESULTS

The positive rate of stool examinations of the villagers was correlated with the distribution trend of the antibody level of whole population (r = 0.588, P ＜ 0.05), but no correlation with the antibody level of the positive population (r = 0.221, P ＞ 0.05). The antibody level of stool-negative population during the period of 2008 to 2011 detected by IHA method dropped year by year, and the annual difference was statistically significant (F = 3.650, P ＜ 0.05). While the antibody level of stool-positive population found during the period of 2008 to 2011 maintained a certain high level in the 4 years, and there was no statistically significant difference among them (F = 2.461, P ＞ 0.05). When the positive rates were <1%, 1%-5% or >5%, the specificity of diagnosis could be improved when 1∶80, 1∶20 and 1∶10 were used as the cut-off values of IHA correspondingly.

CONCLUSIONS

The different threshold values for diagnosis of schistosomiasis japonica should be considered while using IHA method to screen out patients in different endemic areas.

Long-term effectiveness of the integrated schistosomiasis control strategy with emphasis on infectious source control in China: a 10-year evaluation from 2005 to 2014

Schistosomiasis is a neglected tropical parasitic disease of great public health significance worldwide. Currently, mass drug administration with praziquantel remains the major strategy for global schistosomiasis control programs. Since 2005, an integrated strategy with emphasis on infectious source control was implemented for the control of schistosomiasis japonica, a major public health concern in China, and pilot studies have demonstrated that such a strategy is effective to reduce the prevalence of Schistosoma japonicum infection in both humans and bovines. However, there is little knowledge on the long-term effectiveness of this integrated strategy for controlling schistosomiasis japonica. The aim of this study was to evaluate the long-term effectiveness of the integrated strategy for schistosomiasis control following the 10-year implementation, based on the data from the national schistosomiasis control program released by the Ministry of Health, People's Republic of China. In 2014, there were 5 counties in which the transmission of schistosomiasis japonica had not been interrupted, which reduced by 95.2% as compared to that in 2005 (105 counties). The number of schistosomiasis patients and acute cases reduced by 85.5 and 99.7% in 2014 (115,614 cases and 2 cases) as compared to that in 2005 (798,762 cases and 564 cases), and the number of bovines and S. japonicum-infected bovines reduced by 47.9 and 98% in 2014 (919,579 bovines and 666 infected bovines) as compared to that in 2005 (1,764,472 bovines and 33,736 infected bovines), respectively. During the 10-year implementation of the integrated strategy, however, there was a minor fluctuation in the area of Oncomelania hupensis snail habitats, and there was only a 5.6% reduction in the area of snail habitats in 2014 relative to in 2005. The results of the current study demonstrate that the 10-year implementation of the integrated strategy with emphasis on infectious source has greatly reduced schistosomiasis-related morbidity in humans and bovines. It is concluded that the new integrated strategy has remarkable long-term effectiveness on the transmission of schistosomiasis japonica in China, which facilitates the shift of the national schistosomiasis control program from transmission control to transmission interruption and elimination. However, such a strategy seems to have little effect on the shrinking of areas of snail habitats.

[Role of goat in transmission of schistosomiasis japonica III Development of goat feces collector and optimization of fecal hatching technique]

OBJECTIVE

To develop a simple, feasible goat feces collector to improve the collection accuracy and integrity of goat fecal samples without pollution, and to modify the miracidium hatching test with a plastic tube to achieve simple, standard and comparative procedures, so as to provide technical support for pathogenic diagnosis and scientific research of goat schistosomiasis japonica.

METHODS

According to the body features of goat in marshland regions, a goat fecal collector, which was made of coarse fabric cottons, was devised, which was able to be fixed onto the goat buttocks and avoid urine pollution. Prior to miracidium hatching test, the goat fecal samples were pieced by using a mechanical method instead of the conventional artificial piecing method, and the effect of mechanical piecing treatment on miracidium hatching was evaluated. A filter membrane was added between the tube and rubbery ring to block the floater in fecal residues into the tube. The effects on miracidium hatching by using thin fat-free cotton, thick fat-free cotton, nylon gauze at 100 pores/25.4 mm² and 150 pores/25.4 mm² were compared.

RESULTS

The goat feces collector was composed of foreleg fixing garment, hindleg fixing garment and stool bag. The functions of the fixing garment were as a fixed collector to allow non-shift and tolerance of weight during goat activity, while the major function of stool bag was in storage of stool. The goat activity did not affect by the use of collector, and all fecal samples were excreted to the bag. This collector was easy to perform and could avoid urine pollution, which was reusable after cleaning. Prior to miracidium hatching, the goat fecal samples, together with water, were pieced at 18000 to 23000 r/min for successive three times in a cooking machine, of 10 s each time at an interval of 5 s. Mechanical piecing had no clear-cut effect on miracidium hatching of eggs in fecal samples. A total of 541, 620, 344 and 211 miracidia were detected by using the miracidium hatching test with nylon gauze at 100 pores/25.4 mm² and 150 pores/25.4 mm², thin fat-free cotton and thick fat-free cotton respectively, indicating a better detection efficacy by using nylon gauze at 100 pores/25.4 mm² and 150 pores/25.4 mm².

CONCLUSIONS

The goat fecal collector is a easy-to-perform, accurate, unpolluted and reusable device to collect goat feces, which is suitable for pathogenic diagnosis of goat schistosomiasis. Mechanical piecing and use of nylon gauze at 150 pores/25.4 mm² allow a simple, accurate and stable technique for parasitological diagnosis of schistosomiasis japonica, which provides a reliable tool for schistosomiasis control and research.

[Role of goat in transmission of schistosomiasis japonica III Effect of temperature and humidity on survival of eggs in goat feces and egg survival in natural environments]

OBJECTIVE

To investigate the survival of Schistosoma japonicum eggs in goat feces in natural marshlands and the factors affecting its survival, so as to provide evidences for understanding of the role of eggs in goat feces in the transmission of schistosomiasis and the development of the interventions pertaining to disease control and elimination.

METHODS

The goat animals of schistosomiasis japonica were modeled in laboratory, and the feces of infected goat were collected. In laboratory, the effects of environmental temperature and water content in goat feces on egg hatching were evaluated, and in the field, the effect of duration of goat feces on marshland on egg hatching and the effect of direct sunshine on egg survival were evaluated.

RESULTS

At 25°C in laboratory, the hatching rate of eggs in goat feces washigh-positively correlated with the water content in goat feces (r = 0.87). If the water content reduced to 7.6% in goat feces, the eggs in goat feces lost the ability to hatch. Under the same water content in goat feces, the hatching rate of eggs gradually decreased with the extension of the duration of exposure of goat feces to -5 °C, which reduced to 0 following 5 h exposure. At 5, 15 and 25 °C, the hatching rates of eggs gradually decreased with the extension of the duration of exposure of goat feces, and themiracidium hatching ratesof eggs were 2.3%, 5% and 0.9% respectively following the exposure for 52 d. At 35°C, the hatching rate of eggs gradually decreased with the extension of the duration of exposure, which reduced to 0 following 13 d exposure. In winter (-2-10 °C), the hatching rate of eggs gradually decreased with the extension of the duration of exposure of goat feces on marshlands, which reduced to 0 after 21 d of exposure, and in spring (16-19 °C), the hatching rate of eggs gradually decreased with the extension of the duration of exposure of goat feces on marshlands, which reduced to 0.9% after 5 d of exposure. At the same time point on the same marshland, the hatching rate of eggs in goat feces exposed to marshlands with direct sunshine was lower than that without direct sunshine.

CONCLUSIONS

The survival of S. japonicum eggs in goat feces is associated with environmental temperature and water content (humidity) in goat feces, and the temperature and humidity are major natural factors affecting egg hatching.

[Role of goat in transmission of schistosomiasis japonica Ⅳ Schistosome development in goat and egg count and distribution in goat feces]

OBJECTIVE

To describe the growth and development of Schistosoma japonicum in goat and the intensity and temporal distribution of eggs excreted by goat feces, so as to provide baseline data for the control and elimination of the role of goat in the transmission of schistosomiasis.

METHODS

The goat animal models of schistosomiasis were established, and stool samples were collected for parasitological examinations. The number of adult worms recovered, variation of schistosomes in goat at different time points post-infection, number of eggs in schistosomes, variation in number and temporal profiles of eggs excreted from goat feces were observed.

RESULTS

Of the 6 schistosome-infected goat, 415 adult worms were recovered, with a mean adult worm recovery of 34.58% (range, 23.00% to 45.50%). Among the 5 goat infected with 200 cercariae each, 47, 93, 77, 74 and 73 adult worms were recovered 2, 5, 8, 11 and 14 months post-infection, respectively. There were (200.00±42.33), (226.20±45.88), (168.20±25.85), (183.80±55.13) and (190.80±53.53) eggs detected in female schistosomes. The mean prepatent period of eggs excreted by 10 infected goat was (37.7±3.02) d. From 2 to 14 months post-infection, 7 batches of goat feces were hatched, and there were 30, 23, 14, 1 and 2 times for miracidium intensity of "++++", "+++", "++", "+" and "-", respectively, with 42.86%, 32.86%, 20.00%, 1.43% and 2.86% constituent ratios of miracidium intensity.

CONCLUSIONS

Approximately 1/3 S. japonicum cercariae may develop to adults in goats post-infection, and the prepatent period of eggs is (37.7±3.02) d. There is no remarkable decrease seen in the number of adult worms, eggs in female schistosomes and eggs in goat feces within 14 months post-infection. Our findings suggest a long duration for infected goat in the transmission of schistosomiasis, and there is no evidence to prove the "self-cure" phenomenon in goat, indicating that goat is an important source of infection for schistosomiasis japonica.

[Role of goat in transmission of schistosomiasis japonica III Environmental contamination by goat feces and prediction of environments at high risk of S. japonicum infection]

OBJECTIVE

To quantitatively estimate the range and area of environmental contamination by the feces of Schistosoma japonicum-infected that were freely grazed, so as to provide the theoretical evidence for the scientific assessment of the role of the freely grazed goat in the transmission of schistosomiasis japonica and development of control strategy.

METHODS

All the fecal samples excreted by the infected goat at daytime (12 h) were collected by using a self-made goat fecal collector, weighed and counted. The quantity and dispersal of the feces excreted by the freely grazed goat at daytime under a natural condition were investigated, and the walking route and speed of the freely grazed goat at daytime were recorded with a multifunction GPS data logger. The maximum range and area of the environment contaminated by the feces of the freely grazed goat at daytime were estimated, and the maximum range and area of the Oncomelania hupensis snails that may be infected by the schistosome miracidium released from the eggs in the fecal samples of the freely graze goat at daytime were calculated.

RESULTS

During the walking along the marshland at daytime (12 h), the quantity of the feces execrated by the freely grazed infected goat was (232.8 ± 39.8) g per goat, and the fecal samples were composed of (819.2 ± 152.1) pellets. The goat had a mean walking speed of (0.522 7 ± 0.099 7) km/h, and the longest distance, largest radius and largest range of walking activity were (6.272 4 ± 1.195 8) km, 3.136 2 km and (3 191.113 0 ± 1 189.709 4) hm² at daytime, respectively. The area of the snails that may be infected by the miracidium released from the eggs in the fecal samples of the freely graze goat (range of key regions for infected snails detection and control) at daytime was estimated to be (3 210.717 5 ± 1 190.907 3) hm².

CONCLUSIONS

The intensity of environmental contamination by the eggs in the fecal samples of the freely grazed goat is linked to the number of infected goat. The contamination range caused by the feces of the freely grazed goat with fixed fences is relatively stably kept within the walking range at day-time, and the range and area of goat fecal contamination is associated with the number of households that breed goat and the distribution of goat fence. The area of the snails that may be infected by the miracidium released from the eggs in the fecal samples of the freely graze goat is larger than the area of setting contaminated by the eggs in the goat feces, indicating that the range of infected snail examination and control is larger than the range of goat feces detected.

[Effect and mechanism of CD4+CD25+ regulatory T cells on protective efficacy of protein vaccine against Schistosoma japonicum in mice]

OBJECTIVE

To explore the effect and mechanism of CD4⁺CD25⁺ Tregs (Tregs) on the protective efficacy of gluthatione-S-transferase (GST) against Schistosoma japonicum in mice.

METHODS

Female BALB/c mice were divided randomly into five groups：a normal control group, an infected control group, an anti-CD25mAb group, a GST immunization group and a combination group with GST immunization and anti-CD25 mAb. The GST group and combination group were injected percutaneously with GST 50 μg each mouse, the other two groups were injected with equal volume PBS. The immunization was performed for 3 times for two-week interval, and 2 weeks after the last immunization, each mouse was challenged with 40 S. japonicum cercaria. Two weeks post-infection, the combination group and anti-CD25 mAb group were injected intraperitoneally with 300 μg antiCD25 mAb each mouse. The mice were succumbed 2 weeks, 3 weeks, 4 weeks and 5 weeks post-infection respectively. The percentages of CD4⁺CD25⁺ Tregs in splenocytes of mice were measured with flow cytometer. The levels of IFN-γ, IL-2, IL-4, IL-5 and TGF-β in cell cultural supernatants were determined by sandwich-ELISA after stimulation with Con A. The liver sections were stained with hematoxylin and eosin.

RESULTS

The worm burden in the combination group (15.80±2.74) was significantly lower than those of the infected control group (27.78±3.15), anti-CD25 mAb group (21.50±4.21), and GST group (20.84± 6.46). Compared to those of the infected control group, the percentages of CD4⁺CD25⁺ Tregs were significantly higher in the GST group, while the percentages of CD4⁺CD25⁺ Tregs were significantly lower post-anti-CD25 mAb-administration. Regardless of GST administration, the levels of IFN-γ, IL-2, IL-4 and IL-5 after anti-CD25 mAb were significantly higher than those of the infected control groups. There were no significant differences of egg granuloma and the level of TGF-β between each group.

CONCLUSIONS

CD4⁺CD25⁺ Tregs could be partially blocked by anti-CD25 mAb while Th1 and Th2 type immunization response could be enhanced, which plays a role in improving the protective efficacy of GST against of S. japonicum.

Evolution of the National Schistosomiasis Control Programmes in The People's Republic of China

Schistosomiasis japonica is caused by the parasitic trematode Schistosoma japonicum. It is endemic in The People's Republic of China and has significant impact on human health and socioeconomic development in certain regions. Over the last six decades, the national control programmes evolved in remarkable ways and brought schistosomiasis japonica largely under control. We describe the history and evolution of schistosomiasis control in The People's Republic of China, with an emphasis on shifts in control strategies that evolved with new insights into the biology of the parasite and its intermediate hosts, and the epidemiology of the disease in the country. We also highlight the achievements in controlling the disease in different socioecological settings, and identify persisting challenges to fully eliminate schistosomiasis japonica from the country. To reach the goal of schistosomiasis elimination, further integration of interventions, multisector collaboration, sensitive and effective surveillance are needed to strengthen.

Reaching the Surveillance-Response Stage of Schistosomiasis Control in The People's Republic of China: A Modelling Approach

With the goal set to eliminate schistosomiasis nationwide by 2020, The People's Republic of China has initiated the surveillance-response stage to identify remaining sources of infection and potential pockets from where the disease could reemerge. Shifting the focus from classical monitoring and evaluation to rapid detection and immediate response, this approach requires modelling to bridge the surveillance and response components. We review here studies relevant to schistosomiasis modelling in a Chinese surveillance-response system with the expectation to achieve a practically useful understanding of the current situation and potential future study directions. We also present useful experience that could tentatively be applied in other endemic regions in the world. Modelling is discussed at length as it plays an essential role, both with regard to the intermediate snail host and in the definitive, mammal hosts. Research gaps with respect to snail infection, animal hosts and sectoral research cooperation are identified and examined against the prevailing background of ecosystem and socioeconomic changes with a focus on coexisting challenges and opportunities in a situation with increasing financial constraints.

Towards the Elimination of Schistosomiasis japonica through Control of the Disease in Domestic Animals in The People's Republic of China: A Tale of over 60Years

Schistosomiasis japonica, an endemic, zoonotic tropical parasitic disease caused by Schistosoma japonicum, remains an important public health concern in The People's Republic of China. Unlike other species of Schistosoma, over 40 species of wild and domestic animals can act as reservoir hosts of S. japonicum, which increases the difficulty for the control of this tropical disease. It is widely recognized that domestic animals, particularly water buffaloes and cattle, play an important role in the transmission of S. japonicum. Hence, since the 1950s when The People's Republic of China commenced fight against the disease, the control of animal schistosomiasis has been carried out almost synchronously with that of human schistosomiasis, such that great strides have been made over the past six decades. In this chapter, we review the history and current status of schistosomiasis control in domestic animals in The People's Republic of China. We thoroughly analyse the prevalence of domestic animal schistosomiasis at different stages of schistosomiasis control and the role of different species of domestic animals in transmission of the disease, summarize the control strategies and assess their effectiveness. Furthermore, the challenges ahead are discussed and recommendations for future direction are provided.

Schistosomiasis in a migrating population in the lake region of China and its potential impact on control operation

Coverage of migrating people in schistosomiasis control program is a growing concern in China. Schistosomiasis caused by Schistosoma japonicum is still one of the major infectious diseases of public health importance in China though tremendous efforts have been made to control the transmission over the past decades. Along with the rapid social-economic development, migrant population has been remarkably increasing across the country. The infected migrants may introduce a new souse of infection to endemic areas or the areas where the transmission had been controlled or interrupted but the intermediate host Oncomelania snail is still present. Preliminary studies for surveillance on schistosomiasis prevalence in migrants were reported, but there is little basic information provided. We carried out an investigation on the prevalence in immigrants, emigrants and permanent residents in three villages of Hunan province located in the main endemic area of lake region, and analyzed the potential impact of migration on control practice. In the study villages, the migrant population accounts for 53.6% of the total. Schistosoma infection was detected by modified Kato-Katz method and miracidium hatching test. Questionnaire survey was conducted comprising knowledge of disease and its transmission, water contact, personal protective measures, and whether examined and treated after water contact. The survey indicated that the migrants and permanent residents had similar life style, and the majority of them experienced water contact in agricultural work or routine life activities. However, the infection rate in immigrants was significantly higher than that in permanent residents. It was also found that the migrants had significantly less knowledge about the disease than the permanent residents, and took no personal protective measures. This is due to that the control program could not cover the migrants when they were absent at the time the program being implemented. The present study suggested that the surveillance and intervention for migrants, immigrants in particular, should be included and strengthened in schistosomiasis control program and a feasible scheme be developed.

Detection of active schistosome infection by cell-free circulating DNA of Schistosoma japonicum in highly endemic areas in Sorsogon Province, the Philippines

The current status of schistosomiasis in highly endemic areas is difficult to determine by ovum detection because of the superficially low parasite load after mass drug administration, whereas the parasite transmission rates are still high. Cell-free parasite DNA is fragments of parasite-derived DNA existing in the host's body fluids. We conducted population-based studies to test the presence of cell-free schistosome DNA in endemic areas of Sorsogon Province, the Philippines. Schistosome DNA in the serum and urine of Kato-Katz (KK)-positive subjects was detected by PCR (100% sensitivity). Schistosome DNA was also detected from KK-negative subjects (9/22 serum and 10/41 urine samples). Schistosome DNA was found to be network echogenic pattern (NW)-positive (serum 53.3%, urine 42.9%) or NW-negative (serum 25.5%, urine 20.8%) and enzyme-linked immunosorbent assay (ELISA)-positive (serum 47.1%, urine 40%) or ELISA-negative (serum 33.3%, urine 13.3%). These results indicate that cell-free schistosome DNA is a promising diagnostic marker for active schistosome infection in the case of light infection.

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.

A multi-component integrated approach for the elimination of schistosomiasis in the People's Republic of China: design and baseline results of a 4-year cluster-randomised intervention trial

Despite major successes in its control over the past 50years, schistosomiasis japonica continues to be a public health problem in the People's Republic of China (P.R. China). Historically, the major endemic foci occur in the lakes and marshlands along the Yangtze River, areas where transmission interruption has proven difficult. The current endemic situation may alter due to the closure of the Three Gorges Dam. Considerable environmental and ecological changes are anticipated that may result in new habitats for the oncomelanid intermediate snail host of Schistosoma japonicum (Sj), thereby increasing the risk of transmission. The current national control program for P.R. China involves a multi-component integrated strategy but, despite targeting multiple transmission pathways, certain challenges remain. As the Chinese government pushes towards elimination, there is a requirement for additional tools, such as vaccination, for long-term prevention. Whereas the zoonotic nature of schistosomiasis japonica adds to the complexity of control, it provides a unique opportunity to develop a transmission blocking vaccine targeting bovines to assist in the prevention of human infection and disease. Mathematical modelling has shown that control options targeting the various transmission pathways of schistosomiasis japonica and incorporating bovine vaccination, mass human chemotherapy and mollusciciding could lead to its elimination from P.R. China. Here we present the study design and baseline results of a four-year cluster randomised intervention trial we are undertaking around the schistosomiasis-endemic Dongting Lake in Hunan Province aimed at determining the impact on schistosome transmission of the multi-component integrated control strategy, including bovine vaccination using a heterologous "prime-boost" delivery platform based on the previously tested SjCTPI vaccine.

The effect of recombinant sTGFβ1RII and sIL13Rα2 receptor proteins on schistosomiasis japonica, hepatic fibrosis and signal transduction in a mouse model of schistosome disease

This study was designed to investigate the effect of recombinant sTGFβ1RII and sIL13Rα2 receptor proteins on schistosomiasis japonica, hepatic fibrosis and the expression of SMAD3 and STAT6. The proteins sTGFβ1RII and sIL13Rα2 were expressed in Escherichiacoli, purified using affinity chromatography and characterized by Western blotting. Female BALB/C mice (48) were randomly divided into eight groups and infected with Schistosoma japonicum. Five weeks after infection, test groups were injected with the recombinant proteins at different doses. Eight weeks after infection, lung and hepatic tissue samples were obtained and stained with hematoxylin and eosin (HE) and Masson's trichrome. Immunohistochemical staining was used to detect the expression of SMAD3 and STAT6. The recombinant proteins sTGFβ1RII and sIL13Rα2 were successfully expressed, purified, and characterized. The granuloma area, hepatic hydroxyproline (HYP) level and hepatic fibrosis of the protein therapeutic groups were significantly smaller than those of the positive control group (P<0.01). Treatment with sTGFβ1RII was more effective when the protein was administered for 4weeks rather than 2 (P<0.01). Hepatic fibrosis in the groups using a low dose of protein sTGFβ1 was lower that of the combination group (P<0.05). The expression level of STAT6 was significantly lower in groups treated with sIL13Rα2 than in groups not treated with the protein (P<0.01). The recombinant proteins TGFβ1RII and sIL13Rα2 were able to decrease granuloma area and hepatic fibrosis in schistosomiasis japonica, and also reduced the expression of the signal transduction proteins SMAD3 and STAT6. The proteins were more effective when used in combination than when applied singly.

Sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum: A case report

We report a case of sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloody stools. She had a significant past medical history of asymptomatic schistosomiasis japonica and constipation. A colonoscopy showed an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon. During the radical operative procedure, we noted the partially encircling tumor was located in the distal sigmoid colon, and extended into the serosa. Succedent pathological analysis demonstrated the diagnosis of sigmoid colonic ulcerative tubular adenocarcinoma, and showed deposited ova of Schistosoma japonicum in both tumor lesions and mesenteric lymph nodes. Three days after surgery the patient returned to the normal bowel function with one defecation per day. These findings reveal that deposited schistosome ova play a possible role in the carcinogenesis of colorectal cancer.