Table of Content

08 October 2018, Volume 30 Issue 4

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Severe Strongyloides stercoralis infection: a case report

HU Xin-Lan, CHEN Dong-Jie, WU Chang-Sheng, LI Ning, WU Shao-Lian, LI Zhen, CHEN Li-Qing, CHEN Fa-Lin

2018, 30(4):  179-480. 

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This paper reports a severe case of Strongyloides stercoralis infection during routine sputum smear examinations， due to cough and shortness of breath， so as to improve clinicians’ awareness of strongyloidiasis to avoid and reduce misdiagnosis and missed diagnosis.

Science and technology-led technical innovation provides a driving force to accelerate the progress of malaria elimination

TANG Lin-Hua

2018, 30(4):  361-363. 

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Since the malaria elimination program was launched， a series of scientific research programs have been conducted in Jiangsu Province, including epidemiology， pathogenic biology and vector biology， and some novel techniques and approaches have been established， which provides a strong safeguard for malaria elimination in Jiangsu Province and achieves the effective interruption of local malaria transmission. In addition， these tools provide new insights into and technical support for the national and global malaria elimination programs.

Progress of malaria elimination of Jiangsu Province, China

ZHOU Hua-Yun, CAO Jun, ZHU Guo-Ding, WANG Wei-Ming, CAO Yuan-Yuan, GU Ya-Ping, LI Ju-Lin, TANG Jian-Xia, LIU Yao-Bao, XU Sui, ZHANG Chao, GAO Qi

2018, 30(4):  364-368,395. 

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There were vivax malaria， falciparum malaria， and malariae malaria epidemic in Jiangsu Province， and vivax malaria was the dominant disease. Anopheles sinensis and An. anthropophagus were malaria?transmitted vectors. Since the founding of People’s Republic of China， there have been two major malaria outbreaks in Jiangsu Province， when the highest annual malaria incidence reached up to 24.95%. According to prevention and control principles of “adjusting measures to local conditions， giving different guidance to different categories and highlighting key points”， during the epidemic outbreak stage， the large?scale malaria prevention and control measures were implemented for all the residents who were target population in Jiangsu malaria?endemic areas. During the basic eradication stage， the targeted prevention and control measures had been carried out according to the different epidemic features to gradually consolidate the achievement of prevention and control in Jiangsu Province. In the malaria elimination stage， Jiangsu Province focused on controlling of the source of infection and malaria surveillance. According to the “1?3?7 targeted elimination” work model， the management of infectious sources and investigation and disposal of foci were carried out for each epidemic focus to block the malaria transmission. By the end of 2017， there had been no indigenous malaria cases for the six consecutive years in Jiangsu Province. All the 13 cities have passed the assessment of malaria elimination of Jiangsu Province. Although Jiangsu Province has achieved the goal of malaria elimination， it is urgent and necessary to maintain and improve malaria surveillance capabilities to prevent malaria reintroduction.

Quality analysis of malaria microscopic examinations in Jiangsu Province from 2011 to 2017

GU Ya-Ping, ZHU Guo-Ding, ZHANG Chao, XU Sui, YANG Meng-Meng, ZHOU Hua-Yun, CAO Jun

2018, 30(4):  369-373. 

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Objective To understand the quality of production of blood slides and laboratory personnel??s ability to microscopically examine Plasmodium at Jiangsu Province clinic inspection stations at all levels， so as to provide the evidence for the construction of malaria diagnostic laboratories and the evaluation of malaria elimination effect. Methods After the reexamination of the negative blood slides of the examination stations of the malaria center in each county （district）， the negative blood slides of the outpatient inspection station in the district and all the positive blood slides of the direct report of the network from 2011 to 2017， the staining and cleanliness of the blood smears， microscopic examination results and the coincidence rate of positive blood species were comprehensively analyzed. Results A total of 19 109 checked blood samples were examined. The qualified rates of blood preparation， dyeing and cleanliness were 87.5%， 89.3% and 87.6%， respectively. The quality of reexamined blood slides in different years showed statistically significant difference （all [P<0.05]）， by using chi?square trend test， and there was a trend of increasing year by year. There was a significant difference in the quality of the reexamined blood slides among the different cities with districts （[P<0.05]）. In addition， there were 1 860 blood samples from 2012 to 2017， and the total coincidence rate was 87.4% and the coincidence rate of positive blood smear examinations was 98.9%. The species coincidence rates of Plasmodium falciparum， Plasmodium vivax， Plasmodium malariae， Plasmodium ovale and mixed infection were 95.4%， 33.3%， 56.0%， 76.5% and 9.1%， respectively （[P<0.05]）. The total coincidence rates of blood smear reexaminations in different years were 85.0%， 90.1%， 86.0%， 85.3%， 90.0% and 87.6% from 2012 to 2017， respectively， and the difference was not statistically significant （[P>0.05]）. Conclusions The quality of blood slides at the primary clinic inspection stations in Jiangsu Province conforms to the standard established by the provincial malaria reference laboratory； however， the ability of Plasmodium species identification is insufficient and needs to be improved.

Analysis of blood smear examination results of fever patients in Jiangsu Province from 2010 to 2016

WANG Wei-Ming, ZHOU Hua-Yun, CAO Yuan-Yuan, ZHU Guo-Ding, GU Ya-Ping, XU Sui, CAO Jun

2018, 30(4):  374-377,389. 

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Objective To analyze the working conditions and evaluate the effectiveness of blood smear examinations in fever patients after the start of national malaria elimination program （NMEP）， and explore the suitable strategy for malaria diagnosis and surveillance in NMEP， so as to provide the evidence for the development and adaptation of malaria elimination strategies and measures in Jiangsu Province. Methods The data of malaria epidemic situation reported by network， fever patients’ blood test tables， and epidemiological surveys of malaria cases were collected and statistically analyzed by SPSS 16.0 in Jiangsu Province from 2010 to 2016. Results A total of 2 367 cases of malaria cases were reported from 2010 to 2016. Among the 3 691 188 person?times of fever patients tested， there were 2 252 positives （0.06%）. The number of blood tests of fever patients decreased from 742 900 in 2010 to 277 000 in 2016. At the same time， the positive rate increased from 0.04% in 2010 to 0.16% in 2016. The positive rate of blood tests of fever patients in 2016 was significantly higher than that in 2010 （[χ2] = 161.61， P < 0.01）. From 2010 to 2016 in Jiangsu province， the centers for disease control and prevention of cities and counties， that completed the blood review within 3 days， deleted 273 negative cases. In 2010， the centers for disease control and prevention of cities and counties deleted 61 negative cases， but in 2016， the centers deleted only 14 negative cases， and the negative rate of blood review in 2010 was significantly higher than that in 2016 （[χ2] = 22.99， P < 0.01）. Conclusions A large number of blood smear examinations have been tested in fever patients in Jiangsu Province. It not only conforms to the strong monitoring system requirements issued by World Health Organization （WHO） in malaria elimination， but also provides the evidence for no local malaria case in Jiangsu since 2012.

nvestigation on malaria rapid diagnostic testing (RDT)-related knowledge, attitude and practice in primary healthcare professionals of Jiangsu Province

JIN Jia-Jie, WANG Wei-Ming, CAO Yuan-Yuan, ZHU Guo-Ding, ZHOU Hua-Yun, HUANG Jia-Yan, CAO Jun

2018, 30(4):  378-382,414. 

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Objective To investigate the malaria rapid diagnostic testing （RDT）?related knowledge， attitude， practice （KAP） of primary healthcare professionals in Jiangsu Province and analyze the corresponding influencing factors. Methods Four cities in Jiangsu Province were selected as the study sites by the typical sampling method to conduct a survey for the RDT?related KAP and work satisfaction of primary healthcare professionals， and the multiple logistic regression model was used to explore the relevant influencing factors. Results Totally 1 150 questionnaires were issued and 949 valid questionnaires were collected with the recovery rate of 82.52%. The valid questionnaires included 453 questionnaires from laboratory technicians， 466 from clinicians， and 30 from malaria prevention and control workers. Totally 83.98% of the surveyed professionals had a low mastering level of essential RDT?related knowledge. A total of 52.17% of the surveyed laboratory technicians recognized that the application of RDT technology could effectively improve the current primary?level microscopy work， and the degree of recognition of RDT technological advantage in the laboratory technicians was higher than that in the clinicians. Totally 79.25% of the surveyed laboratory technicians regarded themselves to be capable of conducting the standardized RDT operation， and 84.55% of the surveyed clinicians regarded themselves to be capable of conducting the qualified malaria clinical diagnostic practice. The key influencing factors of RDT?related KAP of primary healthcare professionals included the laboratory technicians’ gender， educational level， employer’s institutional level， professional title， and working years， and the employer’s institutional level of clinicians. Conclusions The primary healthcare professionals in Jiangsu Province exhibita good acceptability towards RDT technology. However， their essential knowledgeon RDT remains to be improved. Therefore， it is necessary to establish a specific training and educational system for primary healthcare professionals to better guarantee the advantageous impact of RDT technology on the consolidation of the malaria elimination work achievements.

Evaluation of an optimization strategy for use and management of malaria rapid diagnostic testing (RDT) in Jiangsu Province

QIAN Wen-Ji, JIN Jia-Jie, CAO Yuan-Yuan, WANG Wei-Ming, YANG Meng-Meng, CAO Jun, XIE Yu, HUANG Jia-Yan, ZHU Guo-Ding

2018, 30(4):  383-389. 

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Objective To evaluate the implementation effect of the optimization strategy for the use and management of malaria rapid diagnostic testing （RDT） technology in Jiangsu Province， so as to provide the empirical evidence and suggestions for promoting the standardized use of RDT technology. Methods Questionnaire surveys of primary?level health professionals’ RDT?related knowledge， attitude， and practice（KAP） and work satisfaction were conducted in 4 pilot cities in Jiangsu Province before and after the intervention. Results After the implementation of the intervention， 13.9% of surveyed laboratory technicians， 21.9% of surveyed clinicians and 4.1% of surveyed staff of the centers for disease control and prevention （CDCs） had significant improvements in RDT?related knowledge. About 10.9% of the surveyed laboratory technicians and 25.6% of the surveyed CDC staff improved their attitudes toward RDT technology. About 38.4% of the surveyed laboratory technicians and 10.0% of the surveyed clinicians improved the standardized use of RDT technology. All types of primary?level health professionals had high evaluation in the satisfaction and effectiveness of the optimization strategy. However， the evaluation of the surveyed clinicians was slightly lower than that of the laboratory technicians and CDC staff. Conclusion The optimization strategy in this project can effectively improve the knowledge， attitude and behavior of all types of primary?level health professionals and help to promote the standardized use of RDT technology.

Vector surveillance in Jiangsu Province during the stage of malaria elimination

LI Ju-Lin, ZHU Guo-Ding, ZHOU Hua-Yun, TANG Jian-Xia, YANG Meng-Meng, WANG Wei-Ming, CAO Jun

2018, 30(4):  390-395. 

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Objective To analyze the vector surveillance results during the stage of malaria elimination， so as to provide the evidence for assessing the local transmission risk of imported malaria and carrying out the surveillance work after malaria elimination in Jiangsu Province. Methods From 2011 to 2017， the mosquito population was monitored and human biting rates were calculated by the half overnight human baiting trapping method and overnight lamp trapping method in 7 surveillance sites from June to October. The insecticide resistance level was tested by the force contact method recommended by WHO. Results A total of 5 106 Anopheles mosquitoes were captured by the half over?night human baiting trapping method in the 7 sites from 2011 to 2017， and all the mosquitoes were identified as Anopheles sinensis. The annual human biting rates were 1.075， 0.786， 1.057， 0.787， 0.790， 1.797 and 1.185 mosquitoes/（human·hour）， respectively. Totally 28 186 Anopheles mosquitoes were caught by the overnight lamp trapping method， and all the mosquitoes were An. sinensis. The densities of Anopheles mosquitoes were 57.950， 50.932， 14.800， 4.405， 58.070， 72.406， and 17.145 mosquitoes/（night·lamp）， respectively. In 2012， the resistance indexes of An. sinensis to deltamethrin， DDT and malathion were at R level in Jiangsu Province. Conclusions The major vector is An. sinensis and no An. anthropophagus is found in Jiangsu Province. An. sinensis has a high level of resistance to deltamethrin， DDT and malathion.

Study on distribution status of Oncomelania hupensis, the intermediate host of Schistosoma japonicum in Jiangxi Province Ⅱ Spatial-temporal distribution of snail?infested environments

LV Shang-Biao, LI Yi-Feng, CHEN Zhe, GU Xiao-Nan, YUAN Min, HU Fei, LI Zhao-Jun, LIN Dan-Dan

2018, 30(4):  396-403. 

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Objective To grasp the status of Oncomelania hupensis snail?infested environments in schistosomiasis endemic areas of Jiangxi Province， and establish the spatial database of snail?infested environments with the administrative village as the unit. Methods The spatial and temporal distributions of the historical snail environments， existing snail environments， and suspicious snail?infested environments were analyzed by the historical data review and field investigations. Results The distribution of snail?infested environments in Jiangxi Province included two popular types of lakeshore and hills. The O. hupensis snail?infested environments were mainly concentrated in the Poyang Lake area， which accounting for 66.97% of the total snail?infested areas. The potential snail?infested environment area was 204 745.48 hm2， among which the potential snail?infested environment areas in the lakeshore and hills were 146 548.58 hm2 and 58 196.90 hm2， accounting for 71.58% and 28.42%， respectively. The real existing snail area was 83 234.50 hm2， among which the real existing snail areas in the lakeshore and hills were 80 890.81 hm2 and 2 343.69 hm2， accounting for 97.18% and 2.82%， respectively. The compressed snail area was 114 253.30 hm2 with a compression rate of 57.85%， of which the compression rates in the lakeshore and hills were 46.51% and 94.97%， respectively. In the four types of snail?infested environments， the areas of Type Ⅰ， Type Ⅱ， Type Ⅲ and Type Ⅳ accounted for 55.77%， 25.75%， 13.91% and 4.57% of the total area， respectively. Conclusion The spatial database of O. hupensis snail?infested environments is established comprehensively and systematically， that will be conducive to tracking and performing the dynamic updates of the data of snails， so as to provide an important technical support for investigation and monitoring in the future.

Epidemiologic features and space-time clustering analysis of human schistosomiasis in Hubei Province from 2015 to 2016

ZHU Hong, WU Jia-Li, TU Zu-Wu, LI Bo, XIAO Ying, XIA Jing, TANG Li, ZHOU Xiao-Rong, TU Zhen

2018, 30(4):  404-409,459. 

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Objective To investigate the space?time patterns of schistosomiasis after the stage of transmission controlled in Hubei Province， so as to provide the reference for precise controlling. Methods The data of human schistosomiasis cases in Hubei Province from 2015 to 2016 and basic information of human schistosomiasis cases and serum antibody titer of human schistosomiasis cases in 2016 were collected and analyzed. The spatial clustering of human schistosomiasis was detected by the Flexible spatial scan statistics and Kulldorff circular scan statistic， respectively. Results Totally 64 819 serological positive cases from 51 counties and 1 504 stool hatching positive cases from 17 endemic counties were reported in Hubei Province in 2015， and 39 365 serological positive cases were reported from 48 counties in 2016. All of them were identified as the research objects. No stool hatching positive cases were reported from the routine work in the whole province in 2016. There were 1 603 cases of the highest antibody titer （1∶80 or more）， with the proportion of 4.07%. According to the results of Kulldorff spatial clustering analysis， there were eight and six spatial clustering areas in the distribution of serological positive cases and stool hatching positive cases in 2015， respectively. The numbers of spatial clustering areas in the distribution of serological positive cases and the cases of the highest antibody titer （1∶80 or more） were eight and five in 2016， respectively. According to the results of Flexible spatial clustering analysis， there were three and two spatial clustering areas in the distribution of serological positive cases and stool hatching positive cases in 2015， respectively. The numbers of spatial clustering areas in the distribution of serological positive cases and the cases of highest antibody titer （1∶80 or more） were two and one in 2016， respectively. Conclusions The distribution of human schistosomiasis cases is not balanced， and there is spatial clustering in Hubei Province. So the key area for prevention and control is on the middle and lower reaches of the Yangtze River in the future.

Assessment of schistosomiasis transmission risk after flood damage in Wuhan City

WANG Hao, XIONG Yue-Lin, ZHANG Jia-Jing, LI Yang, ZUO Yu-Ting, XU Ming-Xing

2018, 30(4):  410-414. 

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Objective To assess the schistosomiasis transmission risk after flood damage in Wuhan City. Methods Schistosomiasis epidemic villages in Wuhan City were selected by using probability proportional to size sampling （PPS）. The field investigations of Oncomelania hupensis snails， the activity of people and cattle on marshland， water infectivity of schistosome， reservoir host infection and wild feces contamination were conducted. I-III levels of risk environments were assessed and treated with appropriate measures. Results A total of 90 schistosomiasis epidemic villages and 170 environments were monitored. Totally 9 811 snails were dissected but no Schistosoma japonicum infected snails were found. There were significant decreases in the density of snails and the survival rate of living snails after the flood （[χ2] = 102.517， t = 4.724， both P < 0.01）. Totally 289 pieces of wild feces were captured， and no eggs of S. japonicum were detected. A total of 11 surveillance and forecast sites were detected on water systems， and 221 sentinel mice were placed. After breeding， 219 sentinel mice survived （99.10%）， and no schistosome infection was detected. In addition， 1 720 mouse traps were placed in 3 survey sites， and 66 Apodemus agrarius were captured， and no schistosome?infected ones were found. All of the environments were assessed as Grade III. Meanwhile， 5 key schistosomiasis control areas were determined， and no emergency happened after the implementation of comprehensive control interventions. Conclusion The risk of schistosomiasis transmission remains low in Wuhan City after the flood， but the potential epidemic risk cannot be ignored.

Surveillance and risk assessment system of schistosomiasis epidemic focus in Hankou marshland of Wuhan City

KONG Shi-Bo, HUANG Ya-Dong, TAN Xiao-Dong, XIE Yao-Fei, ZHANG Yu-Peng

2018, 30(4):  415-419. 

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Objective To construct a monitoring and risk assessment system of schistosomiasis epidemic focus in marshland， so as to grasp the risk of schistosomiasis transmission， and to provide the technical support for targeted prevention and control measures. Methods The crowd and the risk source of schistosomiasis in Hankou marshland in Wuhan City were monitored to grasp the risk factors of schistosomiasis. The risk level was evaluated by the three?dimensional risk matrix and three?dimensional visualization method. Results The total numbers of people on holidays and working days were 59 582 and 36 382 person?times a day respectively in Hankou marshland. Fishing and swimming were the most common ways to contact the river water. The most majority of the people exposed to river water were male （73.9%）， retirees （36.1%）， local residents （69.7%） and people whose income was [1 000-3 000] yuan per month （52.1%）， and the awareness of protection of them was low. In spring， the average density of living Oncomelania hupensis snails was 0.993/0.1 m2， the rat density was 7.72%， and the density of wild feces was 0.78/hm2. In autumn， the average density of living snails was 0.596 /0.1 m2， the rat density was 5.22%， and the density of wild feces was 0.32/hm2. The average density of living snails， the rat density and the density of wild feces were reduced by 39.9%， 32.4% and 59.0% respectively in autumn compared with those in spring. The risk assessment results of three?dimensional matrix showed that part 1 and part 2 were medium risk， part 3 was high risk and part 4 was maximum risk. The risk assessment results of the visualization method showed that the risk level increased from part 1 to part 4， which were basically consistent with the results of the risk matrix. Conclusions There is a relatively large risk of schistosome infection in Hankou marshland in 2013. The surveillance and risk assessment system of epidemic focus is feasible and scientific.

Prevalence of Cryptosporidium spp. infections in large-scale pig farms in north of Yangtze River in Anhui Province

LI Wen-Chao, YANG Hui-Hui, KAN Zhen-Zhen, YANG Yun-Long, SUN Yue-Yang, GU You-Fang, CHEN Hui-Liang

2018, 30(4):  420-423,464. 

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Objective To characterize the prevalence and species/genotypes of Cryptosporidium spp. in farmed pigs in the north of the Yangtze River in Anhui Province. Methods A total of 500 samples of pig feces were obtained from seven large?scale pig farms in the north of the Yangtze River in Anhui Province. PCR and sequences analysis of the small subunit rDNA gene were used to detect and identify the Cryptosporidium species/genotypes. Results The overall prevalence of Cryptosporidium was 4.8% （24/500）. Additionally， Cryptosporidium prevalence was 40.0% in Qianshan and 6.3% in Chuzhou， respectively. No Cryptosporidium infection was found in other sampling areas. The DNA sequence analysis of the SSUrDNA gene revealed that all of the isolates represented C. scrofarum. The Cryptosporidium infection rate （9.1%） of pigs （> 60 days） was significantly higher than the rates of both pigs （< 30 days） and pigs （30-60 days） （both P < 0.01）. Conclusion C. scrofarum in the farmed pigs in the north of the Yangtze River in Anhui Province may be a source of Cryptosporidium infection and pose a potential public health threat to humans and other animals， and therefore， the status should be paid more attention to.

Study on diagnosis of atypical cerebral cysticercosis

YU Tao, XU Feng-Quan, WANG Yan, FU Yu-Guang, DAI Jun, FU Ting-Xia

2018, 30(4):  424-427. 

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Objective To analyze the characteristics of the results of serum immunological tests and brain CT image examinations of atypical cerebral cysticercosis patients， so as to provide the reference for improving the diagnosis of the disease. Methods Totally 446 suspected cerebral cysticercosis patients were chosen as the study objects， all of them were given experimental treatment with praziquantel， and then the patients with atypical cerebral cysticercosis were diagnosed according to the treatment effect and review results of brain CT or MRI. Meanwhile， all the 446 patients were tested for serum specific IgG and IgG4 antibodies and cysticercus circulating antigen （CAg） by ELISA， McAb ELISA and PEG?ELISA respectively， and the IHA test was also performed. All the patients received the brain CT examinations. The test results were analyzed statistically and the test performances of the methods above?mentioned were calculated. Results Among the 446 suspected cerebral cysticercosis patients， after the praziquantel treatment， there were 315 patients whose symptoms were alleviated， and they were diagnosed as atypical cerebral cysticercosis. Among the 446 suspected cerebral cysticercosis patients， the positive rates of specific IgG and IgG4 antibodies， and CAg were 15.47%， 15.02%， and 11.21% respectively， and the positive rate of IHA was 28.47% （[χ2] = 52.45， P ＜ 0.01）. The brain CT examinations showed that there were 79.14% （353/446） of patients with suspected cysticercus foci. The sensitivities of ELISA， McAb?ELISA， PEG?ELISA， IHA test and brain CT examination （suspected cysticercus foci） for the diagnosis of atypical cerebral cysticercosis were 15.36%-96.82%， the specificities were 63.36%-99.24%， the positive predictive values were 86.40%-98.52%， the negative predictive values were 32.83%-98.25%， the positive likelihood ratios were 2.64-27.86， the negative likelihood ratios were 0.05-0.81， and the OR values were 7.16-52.80. The consolidation of the five tests above?mentioned showed the OR value was 108.00， which was 2 times of the OR value of CT examination. Conclusion Atypical cerebral cysticercosis is definitely diagnosed mainly by means of evaluating the effect of the diagnostic therapy （anti?cysticercus）， and the serum immunological examinations and brain CT examination also have important reference values.

Transmission risk matrix assessment of imported leishmaniasis in China

HAO Yu-Wan, TIAN Tian, ZHU Ze-Lin, CAO Chun-Li, LI Shi-Zhu, ZHOU Xiao-Nong

2018, 30(4):  428-432. 

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Objective To assess the risk of imported leishmaniasis in China， offering scientific evidences for leishmaniasis prevention and control. Methods The expert consultation method was used to establish a risk index system， and the risk matrix was used to evaluate the risk scales of leishmaniasis. Results This risk assessment indicator system included 3 first?grade indexes and 13 second?grade indexes to the aspect of risk probability. Five indexes were also included on the aspect of the risk hazard severity in this system. The transmission risk matrix assessment showed that the risk of imported leishmaniasis transmission in China was in low risk level. Conclusion This risk matrix assessment is applied for the transmission of imported leishmaniasis in China in the first time， indicating the potential risk of imported leishmaniasis in China.

Detection effect of an automatic identification system of Schistosoma japonicum miracidia

YANG Pei-Cai, HE Yi-Sha, ZHANG Hong-Ying, GAO Yuan, ZHOU Wei, GONG Yun-Hua, ZHANG Ke

2018, 30(4):  433-435,439. 

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Objective To evaluate the effect of an automatic identification system of Schistosoma japonicum miracidia， and compare it with the traditional eye detection method in the simulation field. Methods A total of 260 fecal samples were collected from schistosomiasis non?endemic areas， and the test sample bottles containing schistosome miracidia were prepared according to different experimental needs. Thirty fecal samples for the sensitivity test were separately added with five fresh miracidia per sample， and then the mixed samples were detected by two experienced technicians （with more than 15 years’ traditional test experience） or the automatic system. The positive detection rates were compared between the two methods. Thirty fecal samples for repetition test were separately added with ten fresh miracidia per sample， and then the mixed samples were detected separately with the automatic identification system by two experienced technicians. The results were compared between two persons. The two methods including the automatic identification system and the traditional eye detection method were carried out blindly with totally 200 samples in the simulation field. There were three groups （each with 30 samples）： Group 1 with more than 21 fresh miracidia， Group 2 with 6 to 20 fresh miracidia， and Group 3 with 1 to 5 fresh miracidia. The other 110 samples were as a negative group. The detection time， accuracy， missed detection rate， and false detection rate of the two methods were statistically compared. Results The positive detection rates of the 30 positive samples were 43.33% and 33.33% by the two technicians with the traditional eye detection method， respectively， while the detection rate was 80.00% by the automatic identification system， and the difference was statistically significant （[χ2] = 7.05， [χ2] = 12.97， both P < 0.01）. Thirty positive samples were detected by the two technicians using the same automatic identification system， and the positive detection rates of the two were 96.67% and 86.67%， respectively， with no significant difference （[χ2] = 0.27， P > 0.05）. The experiments showed that the correct detection rate of the positive samples was 98.00% by the automatic identification system， which was higher than 79.75% by the traditional eye detection method. The detection time of the automatic identification system was shortened by half compared with that of the traditional eye detection method. The missed detection rate， and false detection rate of the automatic identification system were 2.22% and 1.82%， respectively， which were much lower than 35.56% and 7.73% of the traditional eye detection method. Conclusions Compared with the traditional eye detection method， the automatic identification system of S. japonicum miracidia has the advantages of high sensitivity， good repeatability， short detection time， high accuracy， low missed detection rate， and low false detection rate. It can be used in the field and clinical detection in replacement of the traditional eye detection method.

Relation between ICOS signaling and Th9 cell polarization in mice infected with Schistosoma japonicum

ZHAN Ting-Zheng, MA Hui-Hui, ZHANG Ting-Ting, HE Shan-Shan, XU Jing, XIA Chao-Ming

2018, 30(4):  436-439. 

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Objective To detect the expression level of ICOS on Th9 cells in mice infected with Schistosoma japonicum， and investigate the relation between ICOS signaling and Th9 cell polarization. Methods Twenty?five mice with S. japonicum infection were used as models. IL?9+cells in CD4+ T cells and ICOS+ cells in Th9 cells of the mice were detected by flow cytometry 0， 4， 7， 9 weeks and 12 weeks after the infection. Results Compared with that 0 week after the infection， the proportion of Th9 cells in CD4+ T cells of the mice significantly increased 4， 7， 9， 12 weeks after the infection （all P < 0.05）， and the proportion of ICOS+ cells in Th9 cells also markedly improved （P < 0.05）. Conclusion In S. japonicum infection， the ICOS signaling may have a regulatory effect on Th9 cell polarization.

Preparation and purification of polyclonal antibody against Toxoplasma gondii microneme protein 16 and its application in subcellular localization

WEI Dong-Dong, WANG Long-Jiang, LI Jin, CUI Yong, YIN Kun, HUANG Bing-Cheng, WEI Qing-Kuan, LEI Zhan, SUN Hui

2018, 30(4):  440-442. 

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Objective To prepare and purify the rabbit anti?TgMIC16 polyclonal antibody， so as to apply it in subcellular localization. Methods New Zealand white rabbits were immunized with purified recombinant TgMIC16 mixing with the same volume of Freund’s adjuvant for three times， respectively. The rabbit serum was collected on the 14th day after the last immunization. The polyclonal antibody in rabbit serum was purified with Protein A affinity purification column. ELISA and Western blotting were used to detect the antibody titer and specificity of polyclonal antibody. The polyclonal antibody was used to the localization of TgMIC16 by the immunofluorescence method. Results Indirect ELISA showed that the antibody titer was 1∶512 000. Western blotting showed that the recombinant TgMIC16 protein was recognized by the specific polyclonal antibody. IFA showed that TgMIC16 was located in the microneme of Toxoplasma gondii. Conclusion The rabbit anti?TgMIC16 is prepared and purified， and successfully applied to immunofluorescence localization of TgMIC16 in T. gondii.

Field molluscicidal effect of water-free formulations of niclosamide ethanolamine salt against Oncomelania hupensis snails in a marshland

ZHOU Qiang, WAN Li-Xin, YOU Qi-Hui, YOU Jun, HANG De-Rong, HUANG Yi-Xin

2018, 30(4):  443-445. 

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Objective To evaluate the molluscicidal effects of various water?free formulations of niclosamide ethanolamine salt against Oncomelania hupensis in the field of marshlands along the Yangtze River. Methods The river beach with O. hupensis snails were selected as the test field in the marshland along the Yangtze River in Pukou District， Nanjing City. A molluscicidal experiment was carried out by the mechanical dusting method with the dustable powder （DP）， powder?granule （PG）， granule （GR） of niclosamide ethanolamine salt respectively. The snail mortality， corrected mortality， and the reduced rate of snails’ density were parallel compared among DP， PG and GR. Results On the 3rd day after the dusting， the snail mortality rates were 66.67%， 67.24%， and 66.87% in the DP， PG， and GR groups respectively， on the 7th day after the dusting， the snail mortality rates were 75.36%， 79.73%， and 73.97% in the DP， PG， and GR groups respectively， and there was no significant difference among the groups （[χ2] = 0.006，0.895， both P > 0.05）. On the 15th day after the dusting， the snail mortality rates were 86.92%， 72.86%， and 71.43% in the DP， PG， and GR groups respectively， and there was a significant difference among the groups （[χ2] = 9.709， P < 0.01）. The snail mortality in the DP group was significantly higher than that in the PG， and GR groups. The curves of the snail corrected mortality and reduced rate of snails’ density presented steadily rising trends in the DP group， but presented falling trends in the PG and GR groups on the 15th day after the dusting. Conclusions The molluscicidal effect of DP is stable and effective in the marshland along the Yangtze River， but the drift of the powder is still not effectively controlled. It is necessary that the different dosage forms are perfected.

Current status of human hookworm infection in Jiangxi Province in 2014

XIE Shu-Ying, GONG Zhi-Hong, CHEN Zhe, HANG Chun-Qin, LAN Wei-Ming, JIANG Wei-Sheng, ZENG Xiao-Jun

2018, 30(4):  446-448,471. 

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Objective To understand the status of human hookworm （Ancylostoma duodenale or Necator americanus） infection in Jiangxi Province. Methods A stratified cluster random sampling was conducted based on the geographical location and economic condition in 2014. Kato?Katz??s thick smear method was used for stool examinations， and filter paper cultivation was conducted for distinguishing the species of hookworms. Results A total of 21 615 persons were involved in the investigation， and there were 1 095 persons infected with hookworm with the prevalence of 5.07% （standardized rate of 4.05%）. The infection rate of hookworm in Nanfeng County was the highest （13.96%）. Most of the infected people had low worm burden （95.43%）. The infection rate of hookworm of the female was higher than that of the male （[χ2] = 28.03， P < 0.05）. The prevalence increased with the age， while the infection rate of hookworm in people at ages of 75 years and higher was the highest （14.79%）. Housewife was the highest risk occupation with the infection rate of 7.55%. The differences of infection rates among different educational level groups were significant （[χ2] = 135.88， P < 0.05）. The prevalence rates of hookworm in different landforms were significantly different （[χ2] = 34.37， P < 0.05）. The priority species was N. americanus（80.41%）in Jiangxi Province. Conclusions The infection rate of hookworm decreases obviously in Jiangxi Province. The high risk groups of hookworm infection are the people with low educational level， female and elder age?group.

Investigation of Enterobius vermicularis infection in children in Jiangxi Province in 2014

LAN Wei-Ming, LIU Hong-Yun, GAO Zu-Lu, XU Jing, JIANG Wei-Sheng, HUANG Cheng-Jian, XIE Shu-Ying, HANG Chun-Qin, ZENG Xiao-Jun

2018, 30(4):  449-451. 

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Objective To know the status of Enterobius vermicularis infection in children in Jiangxi Province in 2014， so as to provide the evidence for the formulation of prevention and control measures. Methods A survey was performed according to the scheme of the 3rd Principal Human Parasites of Jiangxi Province in 2014. Based on the ecological regions， a stratified cluster sampling method was applied by the economic and geographic situation. There were 84 survey sites from 28 counties， and the basic data were also collected in the different investigation sites， and the round?end tube adhesive cellophane anal swab was used to examine E. vermicularis eggs for the children aged 3-6 years. Results A total of 1 486 children aged 3-6 years were detected， the E. vermicularis infection rate was 13.73% （204/1 486）， and the infection rates were 13.89% （114/821） and 13.53% （90/665） in the male and female, respectively. The infection rate in the different age groups showed a gradual rise then fall trend， the lowest infection rate was 10.05% （38/378） in the 3?year age group， and the highest infection rate was 18.24%（[81/444]） in the 5?year age group. The infection rates in the high， medium and low?income survey sites were 13.79% （87/631）， 17.23% （51/296）， and 11.81% （66/559）， respectively. The E. vermicularis infection rates in the 4 ecological regions were from 12.34% to 17.74%， but there was no significant difference among the different ecological regions （[P>0.05]）. Conclusion The status of E. vermicularis infection in children in Jiangxi Province is relatively serious， and therefore， the parasitic disease control sectors should continue to strengthen the monitoring and control work of E. vermicularis infection in children.

Clinical analysis of 50 cases of serous cavity effusion related with paragonimiasis

HUANG Lan, WANG Song-Ping

2018, 30(4):  452-454. 

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Objective To analyze the clinical characteristics of serous cavity effusion related with paragonimiasis， so as to improve the physician’s ability of the clinical diagnosis and treatment. Methods The clinical data of 50 cases of serous cavity effusion related with paragonimiasis diagnosed in a hospital in recent 3 years were collected and retrospectively analyzed. Results Among the 50 patients， there were 35 males and 15 females， and 35 children and 15 adults. Eighteen patients had a clear history of exposure to the foci. Among the children， the respiratory symptoms accounted for 68.6% （24/35）， gastrointestinal symptoms for 22.9% （8/35）， and no apparent symptoms for 8.6% （3/35）； among the adults， the respiratory symptoms accounted for 93.3% （14/15） and the abdominal distention for 6.7% （1/15）. The paragonimus antibody was positive in all the patients. The chest radiography or CT showed pulmonary inflammatory exudation and serous cavity effusion. Eosinophilia in blood was found in 25 cases， a large number of eosinophils in serous cavity effusion were found under microscopy in 12 cases， and eosinophil infiltration of pleura was found in 7 cases. All were cured after the patients received chemotherapy （praziquantel） and drainage fluid. Conclusions The clinical manifestations of paragonimiasis are not very specific and paragonimiasis is often accompanied with serous cavity effusions. Clinically， paragonimiasis is easily misdiagnosed as tuberculosis or cancer. We should consider about the possibility of paragonimiasis when eosinophil is high in blood， serous cavity effusion and pleura.

Construction and application of malaria biobank

TANG Jian-Xia, XU Sui, LIU Yao-Bao, CAO Yuan-Yuan, ZHANG Mei-Hua, GU Ya-Ping, ZHANG Chao, ZHOU Hua-Yun, ZHU Guo-Ding, CAO Jun

2018, 30(4):  455-459. 

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Objective To establish a systemized malaria biobank with well?rounded epidemiologic data and a computer?aid management system， thus to provide qualified sources for malaria elimination and human malaria research. Methods The malaria biobank was based on the platform of Jiangsu Institute of Parasitic Diseases. The blood smear samples， dried blood samples， whole blood samples and parasite strains isolated from patients （from both local and imported cases） were collected since 2011 according to a standardized operational procedure. The biobank management software was applied to input of the epidemiological data and samples， and the quality of samples was monitored regularly. Results A standard malaria biobank was established. The Information Management System was applied to input， storage and output of samples. Totally 99.42% （2 223/2 236） of the blood smear samples， 92.58% （2 070/2 236）of the dried blood samples， 94.50% （2 113/2 236） of whole blood， and 2.06%（46/2 236） of the isolated stains in 2 236 reported cases were included in the malaria biobank in Jiangsu Province from 2011 to 2017. Based on the malaria biobank， 99.42%（2 223/2 236） of the blood smears and 82.74% （1 850/2 236）of DNA （from dried blood and whole blood samples） from malaria patients in Jiangsu Province were re?checked. Moreover， the samples in the malaria biobank were used in the studies of the mechanism of parasite drug resistance， malaria molecular epidemiology， and diagnosis technology development and evaluation. Conclusion The establishment of malaria biobank provides a guarantee for malaria elimination in Jiangsu Province and also provides a qualified resource for malaria research.

Challenges for maintaining achievements of malaria elimination in Jiangsu Province, China

CAO Yuan-Yuan, ZHOU Hua-Yun, ZHU Guo-Ding, WANG Wei-Ming, JIN Jia-Jie, QIAN Wen-Ji, HUANG Jia-Yan, CAO Jun

2018, 30(4):  460-464. 

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Objective To analyze the situation of malaria elimination， identify the current main challenges and difficulties of maintaining the achievements of malaria elimination， and find out feasible solutions in Jiangsu Province. Methods Through randomized grouping， the subject discussion and questionnaires were conducted by malaria control staffs from centers for diseases control and prevention of 13 cities of Jiangsu Province and Jiangsu Institute of Parasitic Diseases. The basic characteristics of participants and the effect of the discussion were analyzed through questionnaires. Results Twenty?seven professional participants were randomly divided into 3 groups. Totally 27 questionnaires were released and 24 valid questionnaires were retrieved. Among the 24 participants， 79.1% （19/24） of them were with mid?level and senior professional titles， and 66.7% （16/24） of them had worked for more than 10 years. Before the group discussion， only 16.7% （4/24） of the participants were aware of the current main challenges and difficulties in Jiangsu Province. After the discussion， 87.5% （21/24） of them thought the discussion increased their understanding of the challenges and difficulties. Through the subject discussion， the expert group summarized the current challenges and difficulties as well as the solutions in malaria prevention in Jiangsu Province in 4 aspects， namely the management guarantee of prevention work， diagnosis and treatment of the cases， field epidemiological investigation and others. Finally， a framework about these discussion results was established. Conclusions During the post?stage of malaria elimination， Jiangsu Province still faced many challenges and difficulties， such as management guarantee， case diagnosis and treatment， epidemiology survey and focus disposals， and malaria surveillance sustainability. The feasible solutions of these challenges may provide examples for other provinces and regions which are undergoing malaria elimination or in post?stage of malaria elimination.

Progress in researches on molecular markers of non-Plasmodium falciparum drug resistance

CHEN Jing, ZHANG Mei-Hua, TANG Jian-Xia, LIU Yao-Bao, CAO Jun

2018, 30(4):  465-471. 

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With the long?term and widespread application of antimalarial drugs， Plasmodium falciparum has gradually produced resistance to antimalarial drugs. At present， there are more researches on the molecular markers of P. falciparum drug resistance， while less attention has been paid to the molecular markers of non?P. falciparum drug resistance. In order to provide the reference for rational drug use in clinical treatment and reference for molecular monitoring of antimalarial drug sensitivity of non?P. falciparum， this paper reviews the researches on the common molecular markers related to non?P. falciparum drug resistance.

Discussion on strategy of development of forestry schistosomiasis control programs of China in new period

YANG Xiao, SUN Qi-Xiang, ZENG Zhu, GUO Wei, ZHOU Jin-Xing

2018, 30(4):  472-475,478. 

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Based on the literature research, this paper states the mechanism and measures of the Oncomelania snail control by the schistosomiasis prevention forests, reviews the development process of forestry schistosomiasis control programs, analyzes the new situation and problems, and then puts forward some countermeasures and suggestions about the national forestry program for schistosomiasis control in order to provide new ideas for the goal of schistosomiasis elimination in China in 2025 and the construction of national forestry program for schistosomiasis control.

Human skin infestation caused by Haemolaelaps casalis: a case report

TAO Xiang-Lin, WANG Yi-Xiao, YE Chang-Jiang, ZHENG Ling-Xiao, LIU Xiao, WANG Shu-Ran, SUN En-Tao

2018, 30(4):  476-478. 

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Our study reports a case of acarodermatitis caused by Haemolaelaps casalis. By morphological observations， the mites seized were identified as Haemolaelaps casalis （deutonymph） which could attack humans resulting in acarodermatitis characterized with the symptoms of papules and blisters in different degrees. The patient was treated with 15% calamine lotion and anti?inflammatory and antipruritic drugs. Meanwhile， the mites were eliminated in the bedroom. After the treatment for one week， the patient was cured. Haemolaelaps casalis， which had been found in the indoor mattress， could attack humans and cause acarodermatitis. We should strengthen the work of anti?mite in domestic environment.