title: A multi-component integrated approach for the elimination of schistosomiasis in the People's Republic of China: design and baseline results of a 4-year cluster-randomised intervention trial.
abstract: Despite major successes in its control over the past 50years, schistosomiasis japonica continues to be a public health problem in the People's Republic of China (P.R. China). Historically, the major endemic foci occur in the lakes and marshlands along the Yangtze River, areas where transmission interruption has proven difficult. The current endemic situation may alter due to the closure of the Three Gorges Dam. Considerable environmental and ecological changes are anticipated that may result in new habitats for the oncomelanid intermediate snail host of Schistosoma japonicum (Sj), thereby increasing the risk of transmission. The current national control program for P.R. China involves a multi-component integrated strategy but, despite targeting multiple transmission pathways, certain challenges remain. As the Chinese government pushes towards elimination, there is a requirement for additional tools, such as vaccination, for long-term prevention. Whereas the zoonotic nature of schistosomiasis japonica adds to the complexity of control, it provides a unique opportunity to develop a transmission blocking vaccine targeting bovines to assist in the prevention of human infection and disease. Mathematical modelling has shown that control options targeting the various transmission pathways of schistosomiasis japonica and incorporating bovine vaccination, mass human chemotherapy and mollusciciding could lead to its elimination from P.R. China. Here we present the study design and baseline results of a four-year cluster randomised intervention trial we are undertaking around the schistosomiasis-endemic Dongting Lake in Hunan Province aimed at determining the impact on schistosome transmission of the multi-component integrated control strategy, including bovine vaccination using a heterologous "prime-boost" delivery platform based on the previously tested SjCTPI vaccine.
authors.affiliation: Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Population Health, University of Queensland, Brisbane, Australia; Research School of Population Health, Australian National University, Canberra, Australia.
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Gray
authors.affiliation: Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Yue-Sheng
authors.initials: YS
authors.lastname: Li
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Williams
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Zheng-Yuan
authors.initials: ZY
authors.lastname: Zhao
authors.affiliation: Department of Infectious Diseases, College of Veterinary Medicine and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, USA.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Harn
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Sheng-Ming
authors.initials: SM
authors.lastname: Li
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Mao-Yuan
authors.initials: MY
authors.lastname: Ren
authors.affiliation: National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, People's Republic of China.
authors.forename: Zeng
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Feng-Ying
authors.initials: FY
authors.lastname: Guo
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Jia-Gang
authors.initials: JG
authors.lastname: Guo
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Hunan Institute of Parasitic Diseases, World Health Organisation Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, Hunan Province, People's Republic of China.
authors.forename: Yu-Lan
authors.initials: YL
authors.lastname: Dong
authors.affiliation: Central South University, Changsha, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Griffith Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Allen G
authors.initials: AG
authors.lastname: Ross
authors.affiliation: Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia. Electronic address: Don.McManus@qimrberghofer.edu.au.
authors.forename: Donald P
authors.initials: DP
authors.lastname: McManus
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology / Q000469:parasitology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008975:Molluscacides / Q000494:pharmacology; D009534:Niclosamide / Q000494:pharmacology*; D011223:Praziquantel / Q000008:administration & dosage / Q000627:therapeutic use*; D012554:Schistosomiasis japonica / Q000453:epidemiology / Q000517:prevention & control* / Q000662:veterinary*; D012556:Schistosomicides / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014612:Vaccines / Q000276:immunology; D055815:Young Adult
chemical_list: D008975:Molluscacides; D012556:Schistosomicides; D014612:Vaccines; D011223:Praziquantel; D009534:Niclosamide
keywords: China; Cluster-randomised intervention trial; Dongting Lake; Integrated control; Schistosoma japonicum; Schistosomiasis; Schistosomiasis japonica; Transmission blocking vaccine