Conquering the God of Plague in China: A Tale of Over 60 Years

Abstract

Schistosomiasis, caused by the blood fluke (trematodes) of the genus Schistosoma, is a neglected tropical disease that affects over 280 million people in the tropical and subtropical regions, with a further 800 million at risk of infection. S. mansoni, S. japonicum, and S. haematobium are the most significant species that infect humans causing schistosomiasis. China is only endemic for S. japonicum. The control campaign for schistosomiasis japonica in China was launched by Chairman Mao Zedong in 1950s after the People's Republic of China was founded in 1949, and the control efforts have achieved great success in controlling the transmission of schistosomiasis japonica in China. Historically, there are three shifts of national schistosomiasis control strategy in China, including snail control-based integrated control strategy, morbidity control-based integrated control strategy, and the currently implemented integrated control strategy with emphasis on control of source of S. japonicum infections. Many immunodiagnostics have been developed, which facilitates the identification of infections and plays an important role for accelerating the progress toward the elimination of schistosomiasis japonica in China. Since the introduction of praziquantel in the early 1980s, the agent has replaced other schistosomicides to become the only drug of choice for the treatment of S. japonicum infections in both humans and bovines. Although there is concern about emergence of praziquantel resistance in the parasite following long-term, repeated, and extensive application, the efficacy of praziquantel remains satisfactory, and there is no evidence of reduced susceptibility detected in main endemic foci of China. In addition, a national schistosomiasis surveillance network has been established in China, which provides valuable data to develop and adjust the national schistosomiasis control strategy. Novel tools, such as the geographic information system/remote sensing (GIS/RS), Google Earth, and intelligent device to detect S. japonicum-infested water, have been introduced for schistosomiasis control in China. Since both the prevalence and intensity of S. japonicum infection have been reduced to an extremely low level in China, a highly sensitive surveillance-response system is therefore required, which would facilitate the elimination of this neglected tropical disease in China. Currently, China is transferring the successful experiences from schistosomiasis control to foreign countries endemic for schistosomiasis. Let's expect the coming of the miracle "Farewell to God of Plague" as soon as possible in both China and across the world.