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Review
, 14 (2), 270-95

Schistosomiasis in the People's Republic of China: Prospects and Challenges for the 21st Century

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Review

Schistosomiasis in the People's Republic of China: Prospects and Challenges for the 21st Century

A G Ross et al. Clin Microbiol Rev.

Abstract

Schistosomiasis japonica is a serious communicable disease and a major disease risk for more than 30 million people living in the tropical and subtropical zones of China. Infection remains a major public health concern despite 45 years of intensive control efforts. It is estimated that 865,000 people and 100,250 bovines are today infected in the provinces where the disease is endemic, and its transmission continues. Unlike the other schistosome species known to infect humans, the oriental schistosome, Schistosoma japonicum, is a true zoonotic organism, with a range of mammalian reservoirs, making control efforts extremely difficult. Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death. Infected children are stunted and have cognitive defects impairing memory and learning ability. Current control programs are heavily based on community chemotherapy with a single dose of the drug praziquantel, but vaccines (for use in bovines and humans) in combination with other control strategies are needed to make elimination of the disease possible. In this article, we provide an overview of the biology, epidemiology, clinical features, and prospects for control of oriental schistosomiasis in the People's Republic of China.

Figures

FIG. 1
FIG. 1
Map illustrating the current and former areas of endemic schistosomiasis (shaded) in China. The disease has now been eradicated from three important zones: the whole Pearl River system (Guangxi and Guangdong), the isolated coastal focus (Fujian), and the Yangtze delta (Shanghai, Zhejang, and Jiangsu). Schistosomiasis distribution has been substantially reduced in the other provinces but remains a major problem in the marshland and lake areas of Hubei, Hunan, Anhui, and Jiangxi and in some mountainous areas of Sichuan and Yunnan.
FIG. 2
FIG. 2
Life cycle of S. japonicum.
FIG. 3
FIG. 3
Ultrasound B photographs depicting normal and schistosomiasis-diseased liver parenchyma. Normal image (top left) of the left and right lobe. Stage one fibrosis (top right; right lobe) with focal echodense areas scattered within the parenchyma and no definite borders. Stage two fibrosis (lower left; both lobes) with typical fish-scale pattern and a few echodense areas <20 mm in diameter. Stage three fibrosis (lower right; left lobe) with echodense bands forming contiguous network, multiple focal echodense areas >20 mm in diameter, and masses of central fibrosis.
FIG. 4
FIG. 4
Age-sex distribution of S. japonicum in China based on the 1989 and 1995 national parasitic surveys which comprised eight provinces. The data are from stratified random cluster samples and are derived from the same study populations using the same stool and serological methods. Results for each survey were pooled for all the populations included. Source: Office of Endemic Disease Control, China (1989 and 1997). n, number of subjects involved in the surveys.
FIG. 5
FIG. 5
Effect of schistosomiasis on human prevalence in China based on three treatment scenarios. Key assumptions are (A) mass human treatment with 50% coverage; (B) selected or targeted human treatment with 90% coverage; and (C) selected or targeted human treatment with 90% coverage plus mass bovine treatment with 50% coverage.

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