title: Interruption of schistosomiasis transmission in mountainous and hilly regions with an integrated strategy: a longitudinal case study in Sichuan, China.
abstract: BACKGROUND
  Schistosomiasis remains a major public health concern in China. Since 2004, an integrated strategy was developed to control the transmission of Schistosoma japonicum in China. However, the long-term effectiveness of this integrated strategy for the interruption of schistosomiasis transmission remains unknown in the mountainous and hilly regions of China until now. This longitudinal study aims to evaluate the effectiveness of the integrated strategy on transmission interruption of schistosomiasis in Sichuan Province from 2005 through 2014.
  
  
  METHODS
  The data regarding replacement of bovines with machines, improved sanitation, access to clean water, construction of public toilets and household latrines, snail control, chemotherapy, and health education were captured from the annual report of the schistosomiasis control programmes in Sichuan Province from 2005 to 2014, and S. japonicum infection in humans, bovines and snails were estimated to evaluate the effectiveness of the integrated strategy.
  
  
  RESULTS
  During the 10-year period from 2005 through 2014, a total of 536 568 machines were used to replace bovines, and 3 284 333 household lavatories and 15 523 public latrines were built. Tap water was supplied to 19 116 344 residents living in the endemic villages. A total of 230 098 hm2snail habitats were given molluscicide treatment, and 357 233 hm2snail habitats received environmental improvements. There were 7 268 138 humans and 840 845 bovines given praziquantel chemotherapy. During the 10-year study period, information, education and communication (IEC) materials were provided to village officers, teachers and schoolchildren. The 10-year implementation of the integrated strategy resulted in a great reduction in S. japonicum infection in humans, bovines and snails. Since 2007, no acute infection was detected, and no schistosomiasis cases or infected bovines were identified since 2012. In addition, the snail habitats reduced by 62.39% in 2014 as compared to that in 2005, and no S. japonicum infection was identified in snails since 2007. By 2014, 88.9% of the endemic counties achieved the transmission interruption of schistosomiasis and transmission control of schistosmiasis was achieved in the whole province in 2008.
  
  
  CONCLUSIONS
  The government-directed and multi-department integrated strategy is effective for interrupting the transmission of schistosomiasis in the mountainous and hilly regions of China.
authors.affiliation: Department of Health Education, West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, 610041, Sichuan Province, China.|Sichuan Provincial Center for Disease Control and Prevention, No. 6 Zhongxue Road, Chengdu, 610041, Sichuan Province, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Sichuan Provincial Center for Disease Control and Prevention, No. 6 Zhongxue Road, Chengdu, 610041, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zhong
authors.affiliation: Sichuan Provincial Center for Disease Control and Prevention, No. 6 Zhongxue Road, Chengdu, 610041, Sichuan Province, China.
authors.forename: Zi-Song
authors.initials: ZS
authors.lastname: Wu
authors.affiliation: Department of Environmental & Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Song
authors.initials: S
authors.lastname: Liang
authors.affiliation: Sichuan Provincial Center for Disease Control and Prevention, No. 6 Zhongxue Road, Chengdu, 610041, Sichuan Province, China.
authors.forename: Dong-Chuan
authors.initials: DC
authors.lastname: Qiu
authors.affiliation: Department of Health Education, West China School of Public Health, Sichuan University, No. 16 Renmin South Road, Chengdu, 610041, Sichuan Province, China. antiaids@163.com.
authors.forename: Xiao
authors.initials: X
authors.lastname: Ma
mesh_terms: D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008975:Molluscacides; D011223:Praziquantel / Q000494:pharmacology; D015995:Prevalence; D012499:Sanitation / Q000379:methods; D012549:Schistosoma japonicum / Q000187:drug effects / Q000302:isolation & purification*; D012554:Schistosomiasis japonica / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission* / Q000662:veterinary; D012908:Snails / Q000469:parasitology; D062066:Water Resources / Q000600:supply & distribution; D015047:Zoonoses / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control / Q000635:transmission
chemical_list: D008975:Molluscacides; D011223:Praziquantel
keywords: Integrated strategy; Longitudinal effectiveness; Mountainous and hilly region; Schistosomiasis japonica; Sichuan Province; Source of infection; Transmission interruption