Table of Content

17 January 2020, Volume 31 Issue 6

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A high-quality driver to accelerate the progress towards schistosomiasis elimination by science and technology-led innovation in Jiangsu Province

ZHOU Xiao-Nong

2019, 31(6):  573. 

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Schistosomiasis was once hyper?endemic in Jiangsu Province. During the past seven decades, the professionals working in schistosomiasis control from Jiangsu Province insisted on scientific and precision control all the time, created a series of replicable and generalizable “Jiangsu experiences”. These practices have developed a number of tools and approaches that have been employed in schistosomiasis control programs in main endemic foci of China. More importantly, the successful experiences from national schistosomiasis control programs of China have been firstly transferred to Africa by professionals from Jiangsu Province, and remarkable achievements have been obtained for the control of schistosomiasis haematobia in Zanzibar. 　

Endemic status of schistosomiasis in People's Republic of China in 2018

ZHANG Li-Juan, XU Zhi-Min, GUO Jing-Yi, DAI Si-Min, DANG Hui, Lü Shan, XU Jing, LI Shi-Zhu, ZHOU Xiao-Nong

2019, 31(6):  576. 

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This report presented the endemic status of schistosomiasis in the People’s Republic of China at a national level in 2018, and analyzed the data collected from the national schistosomiasis prevention and control system and 453 national schistosomiasis surveillance sites. Among the 12 provinces (municipality and autonomous region) endemic for schistosomiasis in China, 5 provinces (municipality and autonomous region), including Shanghai, Zhejiang, Fujian, Guangdong and Guangxi, continued to consolidate the achievements of schistosomiasis elimination, Sichuan Province achieved transmission interruption and 6 provinces of Yunnan, Jiangsu, Hubei, Anhui, Jiangxi and Hunan achieved transmission control by the end of 2018. There were 450 endemic counties (city, district) covering 260 million people, specifically including 28 456 endemic villages covering 70.059 7 million people at risk of infection. Among the 450 endemic counties (city, district), 58.44% (263/450), 27.56% (124/450) and 14.00% (63/450) reached the criteria of elimination, transmission interruption and transmission control, respectively. By the end of 2018, a total of 29 214 advanced schistosomiasis cases were documented in China. In 2018, a total of 11.127 6 million individuals received inquiry examinations and 2.062 9 million were positive; 7.191 4 million individuals received serological tests and 138.5 thousand of them were positive, 532.2 thousand individuals received stool examinations and 8 were positive in China. In 2018, snail survey was performed in 19 821 endemic villages and Oncomelania snails were found in 7 321 villages, accounting for 36.94% of all surveyed villages, with 3 newly detected villages with snails in China. Snail survey covered an area of 590 241.01 hm2 and 168 319.41 hm2 snail habitats were found, including emerging snail habitats of 61.28 hm2; however, no infected snails were identified. In 2018, a total of 646 823 bovines were raised in the schistosomiasis endemic areas of China, and 225 258 received serological examinations, with 2 638 positives detected, while 164 803 bovines received stool examinations, with 2 positives identified. In 2018, there were 90 388 patients with schistosomiasis receiving praziquantel chemotherapy, and expanded chemotherapy was given to 1 490 594 person?times; there were two bovines with schistosomiasis receiving praziquantel chemotherapy, and expanded chemotherapy was given to 352 577 bovine?times; chemical treatment was conducted in an area of 141 660.87 hm2, including an actual mollusciciding area of 75 308.26 hm2, and environmental improvements were performed in an area of 4 738.37 hm2 in China. Data from the 453 national schistosomiasis surveillance sites of China showed that the mean Schistosoma japonicum infection rates were 0.001 5% and zero in humans and bovines in 2018, respectively, and no infected snails were found. The results demonstrate that the endemic situation of schistosomiasis appears a tendency towards a continuous decline in China; however, there is still a risk of schistosomiasis transmission, and challenges remain in achieving the target set in the Thirteenth Five?Year National Plan for Schistosomiasis Control in 2020 in some regions.

Progress of interruption of schistosomiasis transmission in Jiangsu Province

2019, 31(6):  583. 

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Schistosomiasis was once heavily endemic in Jiangsu Province. Following the control efforts for several decades, schistosomiasis was almost eradicated in all endemic counties in Jiangsu Province in 1980, and transmission control was achieved in the province in 2011. According to the principle of “implementing the control measures with adaptation to local circumstances and guiding the control programs with classified interventions”, an integrated strategy with emphasis on the management of both infectious sources and snails has been recently employed for schitsosomiasis control in Jiangsu Province. In addition, a sensitive and highly effective surveillance system has been built and the application of novel techniques and information construction has been intensified to effectively interrupt the transmission of schistosomiasis in the Province. Transmission interruption of schistosomiasis was achieved in all endemic counties in Jiangsu Province. The paper summarizes the endemic situation of schistosomiasis, progress of schistosomiasis control, and major schistosomiasis control measures implemented during the stage of transmission interruption in Jiangsu Province.

Surveillance and control strategy of imported schistosomiasis mansoni: an expert consensus

ZHOU Xiao-Nong, LI Shi-Zhu, XU Jing, CHEN Jia-Xu, WEN Li-Yong, ZHANG Ren-Li, Lü Chao

2019, 31(6):  591. 

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In 1980s, Biomphalaria straminea, an intermediate host of Schistosoma mansoni, was found in Shenzhen City, Guangdong Province, China, and currently, this snail has colonized in Shenzhen City and spread to peripheral cities involving of Dongguan and Huizhou. Since imported cases infected with S. mansoni have been reported from time to time in China, Mainland China is facing the potential risk of transmission of schistosomiasis mansoni. With the deepening of the opening?up policy, notably the implementation of the Belt and Road Initiative, there is an increase in the risk of transmission of schistosomiasis mansoni in Mainland China. Increasing the understanding on schistosomiasis mansoni, improving the awareness toward schistosomiasis mansoni prevention and control, and identifying, reporting and managing imported cases with S. mansoni infection or pathogen carriers, are of particular importance to prevent the development of entire life cycle of S. mansoni and the resultant schistosomiasis mansoni transmission in China. To protect public health, a consensus has been reached pertaining to the surveillance and control strategy of imported schistosomiasis mansoni by Chinese infectious disease experts and parasitologists, with aims to improve the awareness and capability for the diagnosis, treatment and control of imported schistosomiasis mansoni among Chinese disease control and prevention institutions and medical institutions, and decrease and even eliminate the risk of schistosomiasis mansoni transmission in China.

Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination

LI Yi-Feng, LIN Dan-Dan

2019, 31(6):  596. 

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Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.

Endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018

ZHANG Jian-Feng, LI Wei, FENG Yun, YAO Yun-Yi, WANG Xin-Yao, XIONG Chun-Rong, LIU Lu, YANG Kun

2019, 31(6):  599. 

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bjective　To analyze and investigate the changing trend of the endemic situation of schistosomiasis in national surveillance sites of Jiangsu Province from 2011 to 2018, so as to provide scientific evidence for formulating strategies for schistosomiasis control. Methods　From 2011 to 2014, the national schistosomiasis surveillance sites were set in seven schistosomiasis?endemic counties (cities, districts) across Jiangsu Province as according to the National Schistosomiasis Surveillance Scheme (2011 version), and from 2015 to 2018, the national surveillance sites were assigned in all 64 counties (cities, districts) endemic for schistosomiasis in Jiangsu Province according to the National Schistosomiasis Surveillance Scheme (2014 version). Schistosoma japonicum infections in local populations, mobile populations and livestock, and snail status were monitored in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and the monitoring data were statistically analyzed. Results　The sero?prevalence of S. japonicum infections was 1.50% to 4.61% among local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and a higher sero?prevalence was seen in men than in women, with the sero?positives predominantly detected in local populations at ages of over 50 years. The positive rate of stool examinations was 0 to 0.14% among sero?positive local populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no acute case was found in local populations during the study period. The sero?prevalence of S. japonicum infections was 0.46% to 15.97% among mobile populations in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no egg?positives were identified. A total of 1 453 livestock were tested in the national schistosomiasis surveillance sites of Jiangsu Province from 2011 to 2018, and no S. japonicum infections were detected. During the period from 2011 through 2018, snail survey was conducted in an area of 216 million m2 in the national schistosomiasis surveillance sites of Jiangsu Province, and 1 291.01 hm2 snail habitats were identified, with snail densities ranging from 0.01 to 0.47 snails/0.1 m2; however, no S. japonicum infections were identified in snails. Conclusions　The overall endemic situation of schistosomiasis appears a tendency towards a decline in Jiangsu Province, and S. japonicum infection remains at a low level in both humans and livestock. No S. japonicum infection has been identified in local populations in Jiangsu Province since 2012. In the future, monitoring and management of imported sources of S. japonicum infections should be intensified in Jiangsu Province, and the capability building of passive surveillance of schistosomiasis should be improved in sentinel hospitals in national schistosomiasis surveillance sites of Jiangsu Province. In addition, the examination of schistosomiasis should be strengthened in mobile populations in Jiangsu Province, a sensitive and effective surveillance?response system for schistosomiasis is urgently needed.

Spatio-temporal analysis of Oncomelania hupensis along Jiangsu section of the Yangtze River from 2015 to 2017

LIU Lu, YANG Kun, ZHANG Jian-Feng, WU Feng, SHI Liang, ZHAO Song, HE Jian, LI Wei

2019, 31(6):  603. 

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Objective　To investigate the spatio?temporal characteristics of Oncomelania hupensis snails along the Jiangsu section of the Yangtze River, so as to provide evidence for eliminating schistosomiasis and formulating precision control measures in Jiangsu Province. Methods　A total of 75 marshlands were randomly sampled from Nanjing, Zhenjiang and Yangzhou cities along the Jiangsu section of the Yangtze River basin, and the spatio?temporal distribution and changing patterns of O. hupensis snails were investigated using the spatial autocorrelation analysis, kernel density analysis and hotspot analysis during the period from 2015 through 2017. Results　There was a spatial autocorrelation in the mean snail density along the Jiangsu section of the Yangtze River basin during the period from 2015 through 2017. The number of living snails and the density of living snails showed an overall decline in Yangzhou City; however, both showed a slight increase in 2016. Kernel density analysis and hotspot analysis showed that the hotspots of living snails were located in the regions neighboring the marshlands at the Yangzhou?Zhenjiang boundary areas along the Jiangsu section of the Yangtze River basin. Conclusion　There is a spatial autocorrelation in the snail distribution with hotspots along the Jiangsu section of the Yangtze River basin, and the surveillance of snails should not be neglected in the marshlands in Jiangsu Province.

Assessing the efficiency of schistosomiasis control programs in Jiangsu Province from 2005 to 2015 using data envelopment analysis (Malmquist index method)

FENG Yun, SHI Liang, ZHANG Jian-Feng, ZHAO Song, XIONG Chun-Rong, YAO Yun-Yi, LIU Lu, HE Jian, WANG Xin-Yao, DONG Xuan, YANG Kun, LI Wei

2019, 31(6):  607. 

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Objective　To assess the total factor productivity (TFP) of schistosomiasis control programs in Jiangsu Province, so as to provide insights into sustainable schistosomiasis control. Methods　The data envelopment analysis?Malmquist index method was employed to analyze the human resources and financial investments in schistosomiasis control programs from health sectors in each schistosomiasis?endemic city of Jiangsu Province from 2005 to 2015, and assess the outputs of each schistosomiasis control project. Results　The overall productive efficiency of schistosomiasis control programs in Jiangsu Province showed an increasing tendency, and the mean fluctuation of annual TFP was 2.3%. The comprehensive technical efficiency, including pure efficiency and scale efficiency, appeared a steady increase with minor fluctuations, and the mean fluctuation of annual comprehensive technical efficiency was 3.8%. The growth rate of technical progress fluctuated greatly from 2005 to 2011, and showed a steady increase from 2012 to 2015, which became a major contributor to the growth of TFP. A higher growth rate of TFP was seen in Huai’an and Changzhou cities, which showed a greater comprehensive technical efficiency, and a large fluctuation was observed in the growth rate of technical progress in Yancheng, Nanjing, Huai’an and Yangzhou cities. Conclusions　There is a continuous improvement in the technical level of schistosomiasis control programs in Jiangsu Province, and technical application and supervision and management capacity also show a steady increase. In addition, the application of new techniques and new strategies contributes greatly to TFP growth. In the future, the investment into new techniques and new strategies should be increased to ensure the sustainable schistosomiasis control in Jiangsu Province.

Polysaccharide from Phellinus igniarius alleviates oxidative stress and hepatic fibrosis in Schistosoma japonicum?infected mice

ZHANG Jia-Ning, QU Hai-Yan, ZHANG Jin-Meng, FENG Jin-Mei, SONG Wen-Jian, YUAN Fa-Hu

2019, 31(6):  615. 

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Objective　To evaluate the role of polysaccharide from Phellinus igniarius (PPI) in the improvement of oxidative stress, hepatic granuloma and hepatic fibrosis in Schistosoma japonicum?infected in mice. Methods　The mouse model of schistosomiasis was established by S. japonicum cercariae infection via the abdomen. Balb/c mice were randomly assigned into 5 groups, including the healthy control group (Group A), infection control group (Group B), PPI treatment group (Group C), praziquantel treatment group (Group D) and PPI?praziquantel combination group (Group E), of 10 mice in each group. Each mouse in groups B, C, D and E was infected with (30 ± 2) S. japonicum cercariae. Then, mice in groups D and E were given praziquantel by gavage at a dose of 500 mg/kg for successive two days on day 42 post?infection, while mice in groups C and E were given PPI by gavage at a dose of 400 mg/kg for successive 30 days on day 42 post?infection. Histopathological changes of hepatic tissues were observed using hematoxylin?eosin (HE) staining, and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), laminin (LN) were determined, while the activities of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH?PX), glutathione reductase (GSH?R) and glutathione (GSH) were detected in Mouse liver homogenates. The expression of transforming growth factor?beta (TGF?β) and alpha?smooth muscle actin (α?SMA) was quantified in hepatic tissues using immunohistochemistry, and the Nrf2 and Gsta4 gene expression was quantified using quantitative real?time PCR (qPCR) assay. Results　Untreated mice presented typical pathological changes of schistosomal hepatic disorders, while PPI treatment effectively alleviated hepatic egg granulomas and collagen deposition. S. japonicum infection resulted in aggravation of hepatic lipid peroxidation, induction of oxidative stress, elevated serum MDA level and a reduction in the activity of GSH and antioxidant enzymes activities in mice. As compared to infected but untreated mice, PPI treatment suppressed hepatic lipid peroxidation, increased the GSH activity and restored the activity of antioxidant enzymes. In addition, PPI treatment inhibited the TGF?β signaling pathway and up?regulated the Nrf2 and Gsta4 gene expression. Conclusions　PPI plays a critical role in the treatment of schistosomiasis?induced hepatic fibrosis. It may improve oxidative stress damages through up?regulating Nrf2 and Gsta4 gene expression, thereby suppressing the development of hepatic egg granulomas and hepatic fibrosis.

Dynamic changes of myeloid?derived suppressor cells and regulatory T cells in livers of mice infected with Echinococcus granulosus

ZHANG Xiao-Fan, GONG Wen-Ci, CAO Sheng-Kui, XU Meng, CAO Jian-Ping, SHEN Yu-Juan

2019, 31(6):  622. 

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Objective　To investigate the dynamics changes of the myeloid?derived suppressor cells (MDSCs) and regulatory T (Treg) cells in mice infected with Echinococcus granulosus and explore the possible biological significance. Methods　Thirty female BALB/c mice of 6 weeks old were randomly divided into the infection and control groups, of 15 mice in each group. Mice in the infection group were intraperitoneally injected with 2 000 E. granulosus protoscoleces, while those in the control group were injected with the same volume of physiological saline. Mouse liver white blood cells were harvested 3 (early stage), 6 (medium stage) and 12 months (late stage) post?infection, and the proportions of MDSCs, their subpopulations (M?MDSCs and PMN?MDSCs) and Treg cells were assessed by flow cytometry. Results　The proportions of MDSCs were (1.61 ± 0.36)%, (5.68 ± 0.69)% and (16.18 ± 0.69)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post?infection with E. granulosus, and (2.19 ± 0.42)%, (0.99 ± 0.07) % and (4.18 ± 0.84)% in the control group, and there were significant differences in the proportion of the MDSCs in mouse liver white blood cells between the infection and control groups 6 and 12 months post?infection (P < 0.01). The proportions of M?MDSCs were (0.69 ± 0.27)%, (5.30 ± 0.72)% and (10.75 ± 0.29)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post?infection, and (0.42 ± 0.24)%, (0.69 ± 0.02)% and (2.12 ± 0.13)% in the control group, and there were significant differences in the proportion of the M?MDSCs in the mouse liver white blood cells between the infection and control groups 6 and 12 months post?infection (P < 0.01). The proportions of PMN?MDSCs were (0.93 ± 0.23)%, (0.32 ± 0.02)% and (5.14 ± 1.03)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post?infection, and (1.77 ± 0.26)%, (0.28 ± 0.05)% and (1.99 ± 0.90)% in the control group, and there were significant differences in the proportion of PMN?MDSCs in mouse liver white blood cells between the infection and control groups 3 and 12 months post?infection (P < 0.05). The proportions of Treg cells were (3.35 ± 0.14)%, (6.24 ± 0.38)% and (3.41 ± 0.07)% in mouse liver white blood cells in the infection group 3, 6 and 12 months post?infection, and (3.48 ± 0.46)%, (3.65 ± 0.45)% and (3.12 ± 0.12)% in the control group, and there were significant differences in the proportion of Treg cells in mouse liver white blood cells between the infection and control groups 6 and 12 months post?infection (P < 0.01). Conclusions　The percentages of both MDSCs and Treg cells increase in mouse liver white blood cells 6 and 12 months post?infection with E. granulosus, and a more remarkable increase is seen in the percentage of MDSCs, which is mainly found in M?MDSCs. These findings suggest that M?MDSCs may play a major immunosuppressive role in the medium and late stages of E. granulosus infection in mice.

Study on the molecular phylogeny of Echinococcus multilocularis in Qinghai Province

ZHU Wen-Jun, HAN Xiu-Min, CAI Qi-Gang, SUN Yan-Qiu, GUO Ya-Min

2019, 31(6):  628. 

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Objective　To amplify and sequence Cox1 and Nad1 genes in Echinococcus multilocularis isolates from Qinghai Province, and to create phylogenetic trees and molecular clocks, so as to provide evidence for estimating the evolutionary relationships and origins of E. multilocularis in Qinghai Province. Methods　Twenty?two post?surgical specimens of patients with hepatic alveolar echinococcosis were sampled from Qinghai Provincial People’s Hospital in 2017. The Cox1 and Nad1 genes were amplified from E. multilocularis samples and sequenced. Then, the gene sequences were aligned to the Cox1 and Nad1 genes of Echinococcus species in GenBank database. The intra?species variation was observed, and the phylogenetic tree and molecular clock were created. Results　All E. multilocularis samples shared more than 99% genetic homology with the sequences of Cox1 and Nad1 genes from the E. multilocularis Asian strain in the GenBank database. A total of 6 genotypes were identified, including 2 isolates that had no 100% homology with the sequences of known genes in the GenBank database. Phylogenetic tree analysis revealed remarkable clustering of the E. multilocularis samples with the E. multilocularis Asian strain, and the E. multilocularis isolates from Qinghai Province were estimated to date back to 94 000 years ago by the molecular clock. Conclusions　The present study characterizes 6 E. multilocularis genotypes in Qinghai Province, including 2 novel genotypes. Asian strain is the predominant strain of E. multilocularis in Qinghai Province, and the E. multilocularis isolates from Qinghai Province date back to 94 000 years ago.

Endemic situation of schistosomiasis in Wuhu City from 2009 to 2018

ZHANG Rong, GAO Feng-Hua, CHEN Yong, HANG Qing-Qing, LI Lin-Lin

2019, 31(6):  635. 

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Objective　To analyze the endemic situation of schistosomiasis in Wuhu City from 2009 to 2018, so as to provide evidence for adjusting and developing the control strategy. Methods　The data regarding the endemic situation were retrospectively collected and analyzed in Wuhu City from 2009 to 2018. Results　The prevalence of human Schistosoma japonicum infections reduced from 0.450% in 2009 to 0.035% in 2018 in Wuhu City, and a reduction rate of 92.22% (χ2 = 1 6128.307, P < 0.01), and the prevalence of S. japonicum infections decreased from 0.483% in 2009 to 0 in 2018 (χ2 = 27.570, P < 0.01) in livestock. The area of snail habitats increased from 1 501.07 hm2 in 2009 to 4 408.62 hm2 in 2018, with an increase of 193.70%. No infected snails were found in Wuhu City since 2012, and no egg positives were detected in humans and livestock since 2016. Conclusions　Currently, the endemic situation of schistosomiasis is at a low level in Wuhu City; however, there are still factors affecting schistosomiasis transmission. In the future, the integrated strategy with emphasis on the control of infectious source and the surveillance?response system should be intensified to consolidate the achievements of schistosomiasis control.

Surveillance of echinococcosis in Yixing City from 2011 to 2018

LIANG Jing, XUE Zhi-Qiang, LI Xue-Bing, SUN Xu-Feng

2019, 31(6):  638. 

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Objective　To analyze the results of echinococcosis surveillance in Yixing City from 2011 to 2018, so as to provide insights into echinococcosis control in the city. Methods　All echinococcosis cases reported in Yixing City since 2007 that were captured from the China National Notifiable Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention received a case study, and serological test and transabdominal B?mode ultrasound screening were performed among permanent residents and mutton market workers in Fangdong and Fangzhuang villages of Yixing City from 2011 to 2018. The cyst, mass and tubercle were detected in the liver and lung of the sheep from the mutton markets, and the Echinococcus coproantigen was detected in the canine stool samples from Fangdong and Fangzhuang villages. In addition, the awareness of echinococcosis prevention and control knowledge was investigated in the two villages using a questionnaire survey from 2011 to 2018. Results　A total of 7 cases with echinococcosis had been reported in Yixing City since 2007, with prevalence of 0.56/100 000, and all cases were E. granulosus?infected patients, including 2 cases with a history to travel to echinococcosis?endemic areas and 5 cases with a history of working in local mutton markets or dog contacts. From 2011 to 2018, a total of 1 861 residents received serological tests, with 0.54% seropositivity, and no seropositives were detected since 2016. Among the 1 807 individuals receiving transabdominal B?mode ultrasound screening, suspected cysts were found in 143 individuals (7.91%), and 1.40% (2/143) seropositivity was detected in these individuals. The mean positive rate of the Echinococcus coproantigen was 0.67% (3/446) in the canine stool samples. Among the 4 010 sheep liver and lung specimens sampled from the mutton markets, 7 specimens (0.17%) were detected with cysts or tubercles. In addition, the mean awareness rate of echinococcosis prevention and control knowledge was 76.95% among the 538 subjects receiving questionnaire surveys from 2011 to 2018, and the overall awareness appeared a tendency towards a rise year after year. Conclusions　Although the prevalence of echinococcosis and the seropositivity of anti?Echinococcus antibodies are low, there is still a risk of transmission of echinococcosis in Yixing City. The surveillance of echinococcosis should continue to be intensified and related control interventions are required.

Surveillance of human intestinal parasitic diseases in Nanping City from 2014 to 2018

CAI Chang-Huang, ZHANG Zhi-Ping, ZHUO Ming-Ying, LIU Yi-Ruo

2019, 31(6):  641. 

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Objective　To investigate the status of human intestinal parasitic diseases in Nanping City from 2014 to 2018, so as to provide reference for the development of the effective control measures. Methods　Administrative villages were selected using the two?stage cluster sampling in Nanping City from 2014 to 2018, and surveillance of human intestinal parasitic diseases was performed in 5 administrative villages in each county (district) of Nanping City. Intestinal parasitic infections were detected using a modified Kato?Katz thick smear method (two smears for a single stool sample) in villagers, and the hookworm species was differentiated. In addition, the eggs of Enterobius vermicularis were detected using the adhesive tape method in children aged 3 to 6 years. Results　A total of 6 317 villagers were detected in Nanping City from 2014 to 2018, and the overall prevalence of human intestinal parasitic infections was 2.15%. There was year? ([χ2] = 10.53, P < 0.05) and gender?specific prevalence of human intestinal parasitic infections in Nanping City during the study period ([χ2] = 17.00, P < 0.01). The prevalence of human intestinal parasitic infections increased with age, and there was age?specific prevalence of human intestinal parasitic infections in Nanping City ([χ2] = 102.62, P < 0.01). A total of 945 children at ages of 3 to 6 years were detected, and the prevalence of E. vermicularis infection was 3.28%. Conclusions　The prevalence of human intestinal parasitic infections is at a low level in Nanping City from 2014 to 2018, and the infection mainly occurs in villagers of advanced age and low education levels. Further comprehensive measures are required to control intestinal parasitic infections in key populations.

Surveillance of soil?borne nematodiasis in Danyang City from 2012 to 2018

JIANG Tao, FU Qin-Fang, ZHU Tao

2019, 31(6):  645. 

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Objective　To monitor the epidemic status of human soil?borne nematodiasis in Danyang City, so as to provide scientific evidence for formulating control measures. Methods　The soil?borne nematode infections were tested using a modified Kato?Katz technique among residents aged more than 3 years living in Danyang City from 2012 to 2018, and the Enterobius vermicularis eggs were detected using the transparent adhesive tape anal swab method among children at ages of 3 to 12 years. Results　A total of 13 540 residents were monitored for soil?borne nematode infections from 2012 to 2018, and the prevalence of human soil?borne nematode infections was 0.45%. The prevalence of Ascaris lumbricoides, Trichuris trichura and Enterobius vermicularis infections was 0.32%, 0.12% and 0.01%, respectively, and a single parasite infection was predominant. There were significant differences in the prevalence of soil?borne nematode (χ2 = 42.610, P < 0.05), A. lumbricoides (χ2 = 26.276, P < 0.05) and T. trichura (χ2 = 20.692, P < 0.05). The prevalence of human soil?borne nematode infections was 0.45% in males and 0.47% in females, and lower prevalence was found in local residents than in floating population (0.28% vs. 0.66%; χ2 = 10.561, P < 0.05). The highest infection was found in subjects at ages of 31 to 40 years (0.59%), followed by in subjects at ages of 41 to 50 years (0.56%), and the lowest infection was seen in children at ages of 3 to 5 years (0.27%). In addition, the prevalence of human soil?borne nematode infections varied significantly in occupation (χ2 = 75.692, P < 0.05), with the highest infection seen in boatmen. Among the 5 078 children monitored, the prevalence of E. vermicularis infection was 0.37%, and the prevalence of E. vermicularis infection varied significantly in year (χ2 = 15.466, P < 0.05). Conclusion　The human soil?borne nematode infection is at a low level in Danyang City; however, the surveillance of soil?borne nematodiasis remains to be intensified in children living in rural areas and immigrant populations.

Epidemic situation of malaria in Jiangsu Province in 2018

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

2019, 31(6):  649. 

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Objective　To analyze the epidemic situation of malaria in Jiangsu Province in 2018, so as to provide scientific evidence for formulating post?elimination malaria surveillance schemes and technical measures in Jiangsu Province. Methods　The malaria case report cards, epidemiological individual investigation forms of malaria cases and foci data were collected from Jiangsu Province in 2018, and the epidemic situation of malaria was descriptively analyzed. Results　A total of 243 malaria cases were reported in Jiangsu Province in 2018, which increased by 1.67% in relative to in 2017 (239 cases), and these cases included 171 cases with falciparum malaria, 14 cases with vivax malaria, 15 cases with quartan malaria, 42 cases with ovale malaria and a case with mixed infection of P. vivax and P. ovale. All cases were overseas imported, and no local secondary cases were found. The malaria cases were predominantly workers (76.54%). Nantong City (48 cases), Yangzhou City (33 cases) and Taizhou City (22 cases) were the most 3 cities with the largest number of malaria cases across Jiangsu Province. The malaria infections predominantly occurred in African areas (96.30%), and the other 9 cases had infections in Asia (8 cases) and Central America (1 case). There were 125 cases (51.44%) and 91 cases (37.45%) with definitive diagnosis at the day of admission and within 1 to 3 days post?admission, respectively. The percentages of definitive diagnosis at initial diagnosis were 48.27%, 88.76% and 97.30% at township?, county? and city?level medical institutions, respectively, and the percentage of definitive diagnosis at initial diagnosis was significantly lower in township?level medical institutions than in county? (χ2 = 21.47, P < 0.01) and city?level medical institutions (χ2 = 32.86, P < 0.01). Conclusions　There are no local malaria cases in Jiangsu Province; however, the number of overseas imported malaria cases remains high in China. In the future, improving the post?elimination malaria surveillance system, enhancing the awareness of malaria prevention and control knowledge among high?risk populations, increasing the diagnostic capability of malaria in medical institutions, and improving the management of imported malaria cases should be performed to consolidate the achievements of malaria elimination.

Application value of a dynamic automatic identification system in Schistosoma japonicum miracidium hatching test

YAO Yun-Yi, XIONG Chun-Rong, DONG Xuan, LI Wei, ZHANG Jian-Feng, YANG Kun

2019, 31(6):  652. 

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Objective　To evaluate the value of a dynamic automatic identification system in routine miracidium hatching test with nylon gauzes. Methods　Different quantities of fresh Schistosoma japonicum eggs were added to bovine fecal samples and divided into the low?infection group, medium?infection group and high?infection group, while the bovine feces without S. japonicum eggs served as negative controls. The detection efficiency and accuracy were compared between the identification system and manual detection in different groups. Results　The identification system can automatically identify S. japonicum miracidium. The detection rate and efficiency of S. japonicum miracidium in bovine fecal samples were both higher by using the identification system than by manual detection. Notably in the low?infection group, the identification system had a significantly higher rate of detection of S. japonicum miracidium than manual detection ([χ2] = 10.769，P = 0.002). The identification system completed the detection of bovine fecal samples in the field within 1 min. Conclusions　The dynamic automatic identification system may effectively improve the detection efficiency and accuracy of routine miracidium hatching test with nylon gauzes, and it may replace manual detection to be used in the field schisotsomiasis examinations and related researches. 　

Application value of Revolution CT combining three-dimensional visualization technique in precision resection of hepatic alveolar echinococcosis

WANG Yi-Jing, SUN Yan-Qiu, ZHANG Qiang, ZHANG Yong-Hai, TIAN Deng-Feng, HAN Xiu-Min, WANG Xue-Ling

2019, 31(6):  655. 

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Objective　To explore the application value of Revolution CT combining three?dimensional visualization technique in the precision resection of hepatic alveolar echinococcosis. Methods　Totally 12 patients with surgical treatment and pathologically confirmed hepatic alveolar echinococcosis in Qinghai Provincial People’s Hospital were retrospectively analyzed. All the patients underwent the Revolution CT plain and enhancement scan before surgery, and the 0.625 millimeter scan data were obtained. The DICOM format data were imported into MI?3DVS for three?dimensional reconstruction, simulated cutting, volume measurement, and surgical planning. Results　 The data of 12 patients were reconstructed successfully, and the sizes and locations of the lesions as well as the hepatic vascular systems were clearly displayed. The liver volume, hydatid volume, simulated resection volume, and residual liver ratio were measured accurately. The average whole liver volume and the lesion volume of the 11 surgical treated patients were (2 429.8 ± 335.9) mL and (919.6 ± 262.8) mL respectively. The average actually removed volume was highly associated with the average simulated resection volume (r = 0.979, P < 0.01). Conclusion　Revolution CT combining three?dimensional visualization technique can achieve accurate diagnosis as well as optimal surgical planning before operation, which is of great value for the precision resection of difficult hepatic alveolar echinococcosis.

Study on prevalence and vertical transmission rate of Toxoplasma gondii infections among parturient women in Wuhu City

XI Xu-Xia, JIANG Feng

2019, 31(6):  658. 

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Objective　To investigate the prevalence and vertical transmission rate of Toxoplasma gondii infections among in parturient women in Wuhu City, so as to provide reference for the prevention and control of toxoplasmosis among pregnant women in the city. Methods　Parturient women’s venous blood samples and neonatal heel blood samples were collected in Wuhu City and prepared into filter?paper blood samples. The prevalence and vertical transmission rate of T. gondii infections were detected using the loop?mediated isothermal amplification (LAMP) assay among the parturient women. Results　There were three positive samples detected in the 475 filter?paper blood samples from the parturient women, with a mean positive rate of 0.63%. The prevalence of T. gondii infection was 0 in pregnant women at ages of < 20 years (0/5) and at an advanced maternal age (0/24), while the prevalence was 0.67% (3/446) in pregnant women at an appropriate maternal age. T. gondii infection was detected in 2 filter?paper blood samples from newborns, with a vertical transmission rate of 66.67%. Conclusions　There is T. gondii infection in the parturient women and a high vertical transmission rate of T. gondii infection is detected in Wuhu City. The awareness of the potential risk factors of toxoplasmosis should be improved among pregnant women to prevent the damages of toxoplasmosis to humans.

Survey on Toxoplasma gondii infections among three types of populations in Wuxi City

XIAO Xin-Zhi, ZHOU Zhi-Min, LI Yang, Xu Guo-Xin, SHEN Guo-Qiang

2019, 31(6):  662. 

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Objective　To investigate the seroprevalence of Toxoplasma gondii infections among patients with rheumatoid arthritis, malignant tumors and schizophrenia in Wuxi City, so as to provide data support for the control of toxoplasmosis in these patients. Methods　A total of 205 cases with definitive diagnosis of rheumatoid arthritis, 257 cases with definitive diagnosis of malignant tumors and 235 cases with definitive diagnosis of schizophrenia were recruited, while 250 healthy volunteers served as controls. The demographic features were captured from the study subjects and serum samples were collected. The serum IgG and IgM antibodies against T. gondii were detected using an enzyme?linked immunosorbent assay (ELISA) in all study subjects, and the positive rates of anti?T. gondii IgG and IgM antibodies were compared between the patients and controls. Results　The seroprevalence of the anti?T. gondii IgG antibody was 20.98%, 24.12% and 24.68% in patients with rheumatoid arthritis, malignant tumors and schizophrenia, which were all significantly greater than in healthy controls (χ2 = 31.54, 42.12 and 42.98, all P values < 0.01), and the seroprevalence of the anti?T. gondii IgM antibody was 1.46%, 2.72% and 1.70% among patients with rheumatoid arthritis, malignant tumors and schizophrenia, which were all significantly higher than in healthy controls (χ2 = 0.06, 1.52 and 0.21, all P values > 0.05). Conclusions　The patients with rheumatoid arthritis, malignant tumors and schizophrenia present with higher seroprevalence of the anti?T. gondii IgG antibody than healthy controls in Wuxi regions. Screening of T. gondii infections among the patients with rheumatoid arthritis, malignant tumors and schizophrenia should be intensified to prevent the damages caused by T. gondii infections.

Status of grass-roots schistosomiasis control professionals in Jiangsu Province: a cross-sectional study

HE Jian, ZHANG Jian-Feng, WANG Xin-Yao, LIU Lu, SHI Liang, LI Wei, YANG Kun

2019, 31(6):  665. 

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Objective　To understand the status of grass?roots schistosomiasis control professionals in Jiangsu Province, so as to provide scientific evidence for the rational resource allocation and the improvement of capability building. Methods　A cross?sectional survey was conducted by telephone interview and e?mail among city? and county?level disease prevention and control institutions that undertook schistosomiasis control activities in Jiangsu Province, and the age, educational background, major, duration of working, professional title and professional capability were descriptively analyzed. Results　There were totally 274 full?time schistosomiasis control professionals working at grass?roots institutions in Jiangsu Province, with a mean age of (43.19 ± 9.47) years. The least professionals were below 30 years of age (12.77%，35/274), and the most professionals were aged from 41 to 50 years (36.86%，101/274). Among the 274 professionals, 43.07% (118/274) had duration of working of less than 10 years, 62.04% (170/274) had a bachelor degree, and 40.88% (112/274) had the medium?level professional title. Conclusions　A schistosomiasis control team with a relatively high academic degree and professional title has been built at the grassroot level in Jiangsu Province. However, capability building remains to be improved through the participation of more young professionals and professional training with adaptation to local conditions.

Establishment and operation of schistosomiasis diagnostic reference laboratory in Jiangsu Province

HANG De-Rong, ZHANG Jian-Feng, LI Wei, HUANG Yi-Xin, ZHAO Song, GAO Qi, TANG Feng, XIONG Chun-Rong, YAO Yun-Yi, YANG Kun

2019, 31(6):  669. 

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Objective　To construct the schistosomiasis diagnostic reference laboratory in Jiangsu Province, and to examine the role and diagnostic efficiency of the reference laboratory. Methods　A schistosomiasis diagnostic reference laboratory was built in Jiangsu Province according to the requirements of the construction of the national schistosomiasis diagnostic reference laboratory in China. Inter?laboratory comparisons were conducted and the diagnostic capability of grassroots laboratories was evaluated in Jiangsu Province. Results　The organization structure, environmental conditions, administration and quality systems of the schistosomiasis diagnostic reference laboratory in Jiangsu Province all met the requirements for construction of the national schistosomiasis diagnostic reference laboratory in China, and the schistosomiasis diagnostic reference laboratory in Jiangsu Province was issued a certificate of a province?level schistosomiasis diagnostic reference laboratory. During the 6 inter?laboratory comparisons performed by national schistosomiasis diagnostic reference centers of China, the qualitative and quantitative results of each detection item were all in agreement with the reference samples (Kappa = 1), and the diagnostic capability was identified excellent. The results of indirect hemagglutination assay of 426 serum samples from 4 grassroots laboratories were re?examined, and the mean coincidence rate was 94.13% (range, 92.08% to 96.25%) with the grassroots laboratories, with a mean Kappa value of 0.85 (range, 0.83 to 0.86) and a mean missing rate of 10.19% (range, 0 to 17.65%). Conclusions　The schistosomiasis diagnostic reference laboratory has been successfully established and effectively operated in Jiangsu Province, which plays an active role in improving the capability of schistosomiasis diagnostic equality in the province.

Current status of chronic filariasis in Huai’an City

JIA Cong-Ying, YANG Wen-Zhou, TANG Yong

2019, 31(6):  673. 

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Objective　To understand the current status of chronic filariasis patients in Huai’an City, so as to provide insights into the future care of chronic filariasis patients. Methods　According to the data pertaining to the historically registered chronic filariasis patients in Huai’an City, each case was followed up and the baseline data of chronic filariasis patients were captured using questionnaire survey. The demographic and clinical features of the patients, and the distribution and coverage of the care sites were analyzed. Results　There were still 616 chronic filariasis patients in Huai’an City, including 229 men (37.2%) and 387 women (62.8%), and 93.2% were aged 60 years and older. The chronic filariasis patients were found across the 8 counties (districts) across the city, and the cases were predominantly detected in Lianshui (40.3%), Huaiyin (30.8%) and Yuyi (8.0%). There were 49.0% of the patients with lymphedema or elephantiasis alone, 10.2% with chyluria alone, 1.0% with hydrocele of tunica vaginalis alone, 2.4% with lymphatic inflammation or lymphadenitis alone, and 37.3% with two or more types of symptoms, respectively, and all cases with lymphedema or elephantiasis alone had the sites of edema in the lower limbs, with over 90% at stages I to III. Currently, there are 81 care sites in the city covering 567 patients. The mean number of care activities was 3.2 times in 2018, and the mean cumulative duration of caring activities was 18.4 years in the care sites. Conclusions　Although the number of chronic filariasis patients has remarkably decreased, the number remains high in Jiangsu Province, and the cases are characterized by high age and long course of disease. Further caring activities are required to improve the quality of life in chronic filariasis patients.

Present situation and progress of comprehensive treatments for hepatic alveolar echinococcosis

ZHAO Shun-Yun, ZHU Hai-Hong, WANG Xiang-Qian, A Ji-De, LU Xiao-Long, TIAN Qing-Shan, PAN Hong-Shuai, LIU Lin-Xun, WU Shi-Le, HAN Xiu-Min, GUO Ya-Min

2019, 31(6):  676. 

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Alveolar echinococcosis is a parasitic zoonosis that severely damages human health. Currently, radical surgical resection is the first choice for hepatic alveolar echinococcosis. For the advanced hepatic echinococcosis patients with refractory radical resection, the palliative surgery combined with chemotherapy, liver transplantation, drug therapy, and radiofrequency microwave ablation may provide comprehensive tools. This article reviews the current situation and progress of comprehensive treatments for hepatic alveolar echinococcosis.

Research and field application of molluscicides in China

HUANG Yi-Xin

2019, 31(6):  679. 

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Oncomelania hupensis, the only intermediate host of Schistosoma japonicum, is an indispensable part in the transmission of schistosomiasis, and snail control play a critical role in schistosomiasis prevention and control in China. This paper reviews the major molluscicides used currently and in the past and their application techniques in China. It is suggested that the research and development of molluscicides and their operational studies remain to be emphasized; notably, the novel molluscicides and new snail control techniques that meet the environmental protection requirements should be intensified. In addition, attentions should also be paid to the monitoring and evaluation of the field efficacy of molluscicides and snail control approaches, and it is necessary to evaluate the effect of molluscicides on environment and ecological security.