A strategy to control transmission of Schistosoma japonicum in China.
BACKGROUND
Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China.


METHODS
We evaluated a comprehensive control strategy in two intervention villages and two control villages along Poyang Lake in the southeastern province of Jiangxi, where annual synchronous chemotherapy is routinely used. New interventions, implemented from 2005 through 2007, included removing cattle from snail-infested grasslands, providing farmers with mechanized farm equipment, improving sanitation by supplying tap water and building lavatories and latrines, providing boats with fecal-matter containers, and implementing an intensive health-education program. During the intervention period, we observed changes in S. japonicum infection in humans, measured the rate of infection in snails, and tested the infectivity of lake water in mice.


RESULTS
After three transmission seasons, the rate of infection in humans decreased to less than 1.0% in the intervention villages, from 11.3% to 0.7% in one village and from 4.0% to 0.9% in the other (P<0.001 for both comparisons). The rate of infection in humans in control villages fluctuated but remained at baseline levels. In intervention villages, the percentage of sampling sites with infected snails decreased from 2.2% to 0.1% in one grassland area and from 0.3% to no infection in the other (P<0.001 for both comparisons). The rate of infection in mice after exposure to lake water decreased from 79% to no infection (P<0.001).


CONCLUSIONS
A comprehensive control strategy based on interventions to reduce the rate of transmission of S. japonicum infection from cattle and humans to snails was highly effective. These interventions have been adopted as the national strategy to control schistosomiasis in China.
Wang
Long-De
LD
Ministry of Health, Beijing, China.
Chen
Hong-Gen
HG
Guo
Jia-Gang
JG
Zeng
Xiao-Jun
XJ
Hong
Xian-Lin
XL
Xiong
Ji-Jie
JJ
Wu
Xiao-Hua
XH
Wang
Xian-Hong
XH
Wang
Li-Ying
LY
Xia
Gang
G
Hao
Yang
Y
Chin
Daniel P
DP
Zhou
Xiao-Nong
XN
D000383:Agriculture; D000818:Animals; D002681:China / Q000453:epidemiology; D003140:Communicable Disease Control / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D004199:Disease Vectors; D005618:Fresh Water / Q000469:parasitology; D006266:Health Education; D006801:Humans; D012499:Sanitation; D012549:Schistosoma japonicum / Q000302:isolation & purification*; D012554:Schistosomiasis japonica / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission / Q000662:veterinary; D012908:Snails / Q000469:parasitology