Analysis of risk factors and changing trends the infection rate of intestinal schistosomiasis caused by S. japonicum from 2005 to 2014 in Lushan city

Intestinal schistosomiasis caused by S. japonicum has long been a threat to the health of residents within endemic areas, especially along the mid-tier of the Yangtze River basin as well as the Dongting and Poyang lakes. Therefore, we collected monitoring data from 2005 to 2014 in Lushan City, Jiujiang City, Jiangxi Province, which is located downstream of Poyang Lake. We conducted a logistic regression analysis in 2005 and in 2008 and then conducted a time series analysis from 2005 to 2014 in Lushan city. The results of the logistic regression analysis showed that after integrated measures were implemented in Lushan city in 2004, the infection rate of intestinal schistosomiasis decreased sharply in different populations, but fishermen had a greater risk of contracting intestinal schistosomiasis in both 2005 and 2008. From the time series analysis, we found that the infection rate decreased sharply from 2005 to 2009 and then increased slowly from 2009 to 2011 before finally becoming relatively stable and the predicated infection rates in HES, SM2, and SM3 are ?1.14%, 0.35%, 0.29%, respectively, compared with 0.41% of schistosomiasis infection in 2014, showing a downward trend. Our study indicated that the integrated measures initiated in 2004 in Lushan city had a positive effect on controlling intestinal schistosomiasis, but we should still emphasize special treatment of particular populations, such as fishermen, and should consider environmental changes, such as changes in the water level of Poyang Lake, in the future.     

Spatio-temporal Transmission and Environmental Determinants of Schistosomiasis Japonica in Anhui Province,China

Background

Schistosomiasis japonica still remains of public health and economic significance in China, especially in the lake and marshland areas along the Yangtze River Basin, where the control of transmission has proven difficult. In the study, we investigated spatio-temporal variations of S. japonicum infection risk in Anhui Province and assessed the associations of the disease with key environmental factors with the aim of understanding the mechanism of the disease and seeking clues to effective and sustainable schistosomiasis control.

Methodology/Principal Findings

Infection data of schistosomiasis from annual conventional surveys were obtained at the village level in Anhui Province, China, from 2000 to 2010 and used in combination with environmental data. The spatio-temporal kriging model was used to assess how these environmental factors affected the spatio-temporal pattern of schistosomiasis risk. Our results suggested that seasonal variation of the normalized difference vegetation index (NDVI), seasonal variation of land surface temperature at daytime (LSTD), and distance to the Yangtze River were negatively significantly associated with risk of schistosomiasis. Predictive maps showed that schistosomiasis prevalence remained at a low level and schistosomiasis risk mainly evolved along the Yangtze River. Schistosomiasis risk also followed a focal spatial pattern, fluctuating temporally with a peak (the largest spatial extent) in 2005 and then contracting gradually but with a scattered distribution until 2010.

Conclusion

The fitted spatio-temporal kriging model can capture variations of schistosomiasis risk over space and time. Combined with techniques of geographic information system (GIS) and remote sensing (RS), this approach facilitates and enriches risk modeling of schistosomiasis, which in turn helps to identify prior areas for effective and sustainable control of schistosomiasis in Anhui Province and perhaps elsewhere in China.     

Elimination of schistosomiasis in China: Current status and future prospects

Elimination of schistosomiasis as a public health problem among all disease-endemic countries in 2030 is an ambitious goal. Recent achievements resulting from mass drug administration (MDA) with praziquantel is promising but may need to be complemented with also other means. Schistosomiasis was highly prevalent in China before the initiation of the national schistosomiasis control program in the mid-1950s, and, at that time, the country bore the world’s highest burden of schistosomiasis. The concerted control efforts, upheld without interruption for more than a half century, have resulted in elimination of the disease as a public health problem in China as of 2015. Here, we describe the current status of schistosomiasis in China, analyze the potential challenges affecting schistosomiasis elimination, and propose the future research needs and priorities for the country, aiming to provide more universal insights into the structures needed for a global schistosomiasis elimination encompassing also other endemic regions.     

Dynamical behavior of a hepatitis B virus transmission model with vaccination

Hepatitis B virus (HBV) infection is a globally health problem. In 2005, the WHO Western Pacific Regional Office set a goal of reducing chronic HBV infection rate to less than 2% among children five years of age by 2012, as an interim milestone towards the final goal of less than 1%. Many countries made some plans (such as free HBV vaccination program for all neonates in China now) to control the transmission HBV. We develop a model to explore the impact of vaccination and other controlling measures of HBV infection. The model has simple dynamical behavior which has a globally asymptotically stable disease-free equilibrium when the basic reproduction number R₀≤1, and a globally asymptotically stable endemic equilibrium when R₀>1. Numerical simulation results show that the vaccination is a very effective measure to control the infection and they also give some useful comments on controlling the transmission of HBV.     

华北平原农区土地利用变化对生态系统服务的影响——以河南省商丘市为例

快速城市化背景下,定量评估土地利用/覆被变化对生态系统服务的影响对区域生态环境建设具有重大意义.本文以典型华北平原农区商丘市1990—2015年3期土地利用分类图为基础,对商丘市土地利用和生态系统服务进行时空动态变化分析,并通过构建影响程度评估模型将各类型土地利用变化对生态系统服务的影响进行定量研究.结果表明: 1990—2015年,耕地和建设用地面积占研究区总面积的95%以上,变化量最大,分别为-104.38和201.59 km²;林地、草地和水域面积变化幅度最大,分别是79.3%、-73.7%和-24.2%;生态系统服务总价值持续下降10.05亿元,其中,水文调节服务价值下降最多,生态系统服务价值(ESV)在空间上呈现出“西增东减”的趋势和以市区为中心东西向延伸的“高-低-高”分布格局;耕地和水域对生态系统服务总价值贡献率达95%以上,对生态系统服务的影响最大;商丘市土地利用和ESV变化的主要驱动力是人口压力、经济增长、区域政策和城市规划.在未来的城乡发展规划中,需更加重视自然资源保护,合理调整土地利用结构,实现经济社会与生态环境的可持续发展.     

沈阳市城区绿地生态系统服务价值的时空变化

城市绿地是城市自然生态系统的组成部分,具有十分重要的生态服务功能.基于沈阳市城区2005、2010和2015年3期土地利用数据,参照中国生态系统单位面积生态服务价值当量,计算沈阳市绿地系统生态服务价值,分析其时空变化特征及变化速率.结果表明: 研究期间,沈阳市耕地面积降低最明显,2005—2010和2010—2015年的降幅分别达3.5%、10.9%;林地面积增加幅度较小,草地面积的增幅达17.2%.2005—2010年,沈阳绿地生态系统服务价值从2005年的11.76亿元增加至2010年的23.48亿元,然后下降至2015年的11.29亿元.各行政区绿地生态系统服务价值年变化存在显著差异,于洪区、沈北新区以及和平区变化最显著,变异系数分别达到64.9%、60.4%和40.8%,不同行政区绿地生态系统服务价值也存在显著差异,皇姑区、棋盘山区和东陵区地均生态系统服务价值较高.研究区土壤保持功能的服务价值最高,占总服务价值的15%以上.研究期间,粮食生产功能的服务价值降低最明显,城市扩张和农业用地转变以及城市公园绿地的建设是绿地生态系统服务价值变化的主要因素.     

碳中和目标下中国森林固碳量跨期分配及成本

我国实现碳中和路线图的“碳排放达峰”、“快速降低碳排放”、“深度脱碳实现碳中和”3阶段具有复杂且差异的减排形势。森林固碳作为我国实现碳中和目标的重要手段,其跨期分配是平衡产业减排与森林固碳关系、降低我国实现碳中和的成本代价、以最优成本分步实现碳中和目标的重要途径。本研究从成本优化分配理论出发,引入森林边际固碳成本理论,结合国内现有产业边际减排理论,对我国实现碳中和3个阶段的成本变化过程进行模拟。结果表明: 我国在“碳排放达峰”、“快速降低碳排放”、“深度脱碳实现碳中和”3个阶段,实现成本最优的森林年固碳量分别为0.20、7.75、19.82亿t,分别占当期总减排量的1.8%、17.5%、37.6%。相较于仅依赖产业减排,在成本最优设计下发挥森林固碳成本优势,使得碳中和3个阶段的总成本分别降低0.48、791.36、9092.53亿美元。在“碳排放达峰”阶段,森林固碳的成本优势十分有限,应当主要依靠产业减排;在“快速降低碳排放”阶段,森林固碳的成本优势逐渐凸显;在“深度脱碳实现碳中和”阶段,应当充分发挥森林固碳的成本优势实现“零碳”目标,否则将会面临十分高昂的成本代价,尤其对于脱碳成本十分高昂或永远无法完全脱碳的产业。最优成本设计下森林固碳可以节约9884.37亿美元的碳中和成本。     

Epidemiology of Schistosoma japonicum in China: morbidity and strategies for control in the Dongting Lake region

Dongting Lake, covering a very large surface water area of 2691km(2), is located in Hunan Province in the southern part of the People's Republic of China. It is the second-largest freshwater lake in China and plays an important role in regulating the amount of water in the Yangtze River, China's longest river. The annual water level of the lake changes by as much as 15m, rising in summer and falling in winter. Asian schistosomiasis has been endemic in the Dongting Lake region for centuries and it has had a devastating effect on the public health of the local people. After a difficult struggle for more than four decades, a concerted programme, supported by the World Bank Loan and instigated in 1992, has resulted in remarkable progress in the control of the disease in many endemic areas of the region. However, the great challenge remains to consolidate and maintain the achievements made to date. The Schistosoma japonicum intermediate host (Oncomelania hupensis hupensis) snail habitats are huge, estimated at 1768km(2) in 1996; these are increasing at a rate of 34.7km(2) annually due to high silt deposition from the Yangtze River itself and from the connecting rivers in Hunan province, and construction of embankments in the Dongting Lake region. It is anticipated that the construction of the Three Gorges Super Dam, the largest engineering project ever undertaken, will substantially extend the range of the snail habitats and increase the number of new schistosomiasis cases. In many areas, human re-infections with S. japonicum after drug (praziquantel) treatment remain unacceptably high (up to 20% of those treated are re-infected annually) due to occupational (mainly fishing) water contact. This paper reviews the history and the current status of schistosomiasis control in the lake region, it explores the epidemiological factors which influence the prevalence of the infection and the disease it causes, and it provides insight into future approaches to control which might finally eradicate the infection.     

Shifts in the Spatiotemporal Dynamics of Schistosomiasis: A Case Study in Anhui Province,China

Background

The Chinese national surveillance system showed that the risk of Schistosoma japonicum infection fluctuated temporally. This dynamical change might indicate periodicity of the disease, and its understanding could significantly improve targeted interventions to reduce the burden of schistosomiasis. The goal of this study was to investigate how the schistosomiasis risk varied temporally and spatially in recent years.

Methodology/Principal Findings

Parasitological data were obtained through repeated cross-sectional surveys that were carried out during 1997-2010 in Anhui Province, East China. A multivariate autoregressive model, combined with principal oscillation pattern (POP) analysis, was used to evaluate the spatio-temporal variation of schistosomiasis risk. Results showed that the temporal changes of schistosomiasis risk in the study area could be decomposed into two sustained damped oscillatory modes with estimated period of approximately 2.5 years. The POPs associated with these oscillatory components showed that the pattern near the Yangtze River varied markedly and that the disease risk appeared to evolve in a Southwest/Northeast orientation. The POP coefficients showed decreasing tendency until 2001, then increasing during 2002-2005 and decaying afterwards.

Conclusion

The POP analysis characterized the variations of schistosomiasis risk over space and time and demonstrated that the disease mainly varied temporally along the Yangtze River. The schistosomiasis risk declined periodically with a temporal fluctuation. Whether it resulted from previous national control strategies on schistosomiasis needs further investigations.     

Prevalence and risk factors of schistosomiasis among primary school children in four selected regions of The Gambia

BackgroundThe Gambia initiated a control programme for schistosomiasis in 2015. In light of this, recent and comprehensive data on schistosomiasis is required to effectively guide the control programme. This study aimed to evaluate the prevalence and associated risk factors of schistosomiasis among primary school children in The Gambia.MethodsWe utilised data from a previous study conducted in 2015 in 4 regions of The Gambia: North Bank Region (NBR), Lower River Region (LRR), Central River Region (CRR) and Upper River Region (URR). In the parent study, ten schools were selected randomly from each region. Urine and stool samples collected from 25 boys and 25 girls (7–14 years) in each school were examined for urinary schistosomiasis (Schistosoma haematobium infection) and intestinal schistosomiasis (Schistosoma mansoni infection) using urine filtration, dipstick and Kato-Katz methods.Principal findingsUrinary schistosomiasis had an overall prevalence of 10.2% while intestinal schistosomiasis had a prevalence of 0.3% among the sampled school children. Prevalence of urinary schistosomiasis was significantly different among regions (χ 2 = 279.958, df = 3, p < 0.001), with CRR (27.6%) being the most endemic region, followed by URR (12.0%), then LRR (0.6%), and NBR (0.0%). Prevalence of intestinal schistosomiasis was also significantly variable among regions, with 4 of the 5 positive cases detected in CRR and 1 case in URR. Every school sampled in CRR had at least one student infected with S. haematobium, 50% of schools in URR had S. haematobium infection, and just one school in LRR had S. haematobium infection. While S. haematobium infection was significantly higher in boys (χ 2 = 4.440, df = 1, p = 0.035), no significant difference in infection rate was observed among age groups (χ 2 = 0.882, df = 2, p = 0.643). Two of the 5 students infected with S. mansoni were boys and 3 were girls. Four of these 5 students were in the 10–12 years age group and 1 was in the 7–9 years age group. Macrohaematuria and microhaematuria were found to be statistically associated with presence of S. haematobium eggs in urine. Being a male was a risk factor of S. haematobium infection. Bathing, playing and swimming in water bodies were found to pose less risk for S. haematobium infection, indicating that the true water contact behaviour of children was possibly underrepresented.ConclusionThe findings of this study provide invaluable information on the prevalence of schistosomiasis in The Gambia. This was useful for the schistosomiasis control efforts of the country, as it guided mass drug administration campaigns in eligible districts in the study area. More studies on S. mansoni and its intermediate snail hosts are required to establish its true status in The Gambia. As children sometimes tend to provide responses that potentially please the research or their teacher, data collection frameworks and approaches that ensure true responses in studies involving children should be devised and used.     

Urogenital schistosomiasis infection prevalence targets to determine elimination as a public health problem based on microhematuria prevalence in school-age children

BackgroundRecent research suggests that schistosomiasis targets for morbidity control and elimination as a public health problem could benefit from a reanalysis. These analyses would define evidence-based targets that control programs could use to confidently assert that they had controlled or eliminated schistosomiasis as a public health problem. We estimated how low Schistosoma haematobium infection levels diagnosed by urine filtration in school-age children should be decreased so that microhematuria prevalence was at, or below, a “background” level of morbidity.MethodologyData obtained from school-age children in Burkina Faso, Mali, Niger, Tanzania, and Zambia who participated in schistosomiasis monitoring and evaluation cohorts were reanalyzed before and after initiation of preventive chemotherapy. Bayesian models estimated the infection level prevalence probabilities associated with microhematuria thresholds ≤10%, 13%, or 15%.Principal findingsAn infection prevalence of 5% could be a sensible target for urogenital schistosomiasis morbidity control in children as microhematuria prevalence was highly likely to be below 10% in all surveys. Targets of 8% and 11% infection prevalence were highly likely to result in microhematuria levels less than 13% and 15%, respectively. By contrast, measuring heavy-intensity infections only achieves these thresholds at impractically low prevalence levels.Conclusions/significanceA target of 5%, 8%, or 11% urogenital schistosomiasis infection prevalence in school-age children could be used to determine whether a geographic area has controlled or eliminated schistosomiasis as a public health problem depending on the local background threshold of microhematuria.     

Spatio-temporal pattern of schistosomiasis in Anhui Province,East China: Potential effect of the Yangtze River - Huaihe River Water Transfer Project

Anhui Province has been one of typical epidemic areas of schistosomiasis in East China as a wide range of large lake and marshland regions provide an ideal environment for growth and reproduction of the intermediate snail host. With the completion of the Yangtze River-Huaihe River Water Transfer Project (YHWTP), launched by the end of 2016, the epidemic areas are expected to expand and controlling schistosomiasis remains a challenge. Based on annual surveillance data at the county level in Anhui for the period 2006–2015, spatial and temporal cluster analyses were conducted to assess the pattern of risk through spatial (Local Moran's I and flexible scan statistic) and space-time scan statistic (Kulldorff). It was found that schistosomiasis sero-prevalence was dramatically reduced and maintained at a low level. Cluster results showed that spatial extent of schistosomiasis contracted, but snail distribution remained geographically stable across the study area. Clusters, both for schistosomiasis and snail presence, were common along the Yangtze River. Considering the effect of the ongoing YHWTP on the potential spread of schistosomiasis, Zongyang County and Anqing, which will be transected by the new water-transfer route, should be given a priority for strengthened surveillance and control. Attention should also be paid to Guichi since it is close to one of the planned inlets of the YHWTP.     

The effects of health education on schistosomiasis japonica prevalence and relevant knowledge in the People's Republic of China: A systematic review and meta-analysis

Schistosomiasis japonica continues to be an important zoonotic disease in the People's Republic of China (P.R. China), despite decades of dedicated control efforts. Different interventions for its control including chemotherapy of humans and animals, mollusciciding, environmental modification, and health education have been implemented at various stages of the control efforts and in different combinations, resulting in remarkable achievements. Here, we present a systematic review and meta-analysis of the documented effectiveness of health education to reduce schistosomiasis japonica transmission in P.R. China. A total of 10 relevant publications were identified and included in the meta-analysis. The reported results indicate that the prevalence of Schistosoma japonicum infection in humans and schistosomiasis-related knowledge are significantly influenced by health education. The implementation of health education over more than 2 years was associated with an overall schistosomiasis japonica prevalence decrease of 6% (95% CI: 2%, 11%) and an overall increase of 51% (95% CI: 41%, 61%) in schistosomiasis-related knowledge after controlling for confounding factors. Among control groups, the prevalence of schistosomiasis japonica and relevant knowledge levels were not significantly influenced. The relative risk (RR) of an infection with S. japonicum following health education lasting more than 2 years was 0.43 (95% CI: 0.24, 0.78). In summary, a considerable effectiveness of health education with regard to preventing S. japonicum infections in P.R. China and increasing relevant knowledge is documented in the extant literature. This suggests that the effectiveness of health education may be considerable, particularly after its long-term implementation.     

Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene.

Lethal disease due to hepatic periportal fibrosis occurs in 2%-10% of subjects infected by Schistosoma mansoni in endemic regions such as Sudan. It is unknown why few infected individuals present with severe disease, and inherited factors may play a role in fibrosis development. Schistosoma mansoni infection levels have been shown to be controlled by a locus that maps to chromosome 5q31-q33. To investigate the genetic control of severe hepatic fibrosis (assessed by ultrasound examination) causing portal hypertension, a segregation analysis was performed in 65 Sudanese pedigrees from the same village. Results provide evidence for a codominant major gene, with.16 as the estimated allele A frequency predisposing to advanced periportal fibrosis. For AA males, AA females, and Aa males a 50% penetrance is reached after, respectively, 9, 14, and 19 years of residency in the area, whereas for other subjects the penetrance remains <.02 after 20 years of exposure. Linkage analysis performed in four candidate regions shows that this major locus maps to chromosome 6q22-q23 and that it is closely linked (multipoint LOD score 3.12) to the IFN-gammaR1 gene encoding the receptor of the strongly antifibrogenic cytokine interferon-gamma. These results show that infection levels and advanced hepatic fibrosis in human schistosomiasis are controlled by distinct loci; they suggest that polymorphisms within the IFN-gammaR1 gene could determine severe hepatic disease due to S. mansoni infection and that the IFN-gammaR1 gene is a strong candidate for the control of abnormal fibrosis observed in other diseases.     

中国西南喀斯特地区植被变化时空特征及其成因

2000年以来,国家在中国西南喀斯特地区开展一系列生态治理工程,该地区退化生态系统得到一定程度的恢复,而2008年开展石漠化综合治理工程以来该地区的植被覆盖和生产力如何变化尚不清楚。本研究利用遥感增强型植被指数(EVI)和总初级生产力(GPP)数据,研究2000—2015年西南喀斯特地区植被EVI年均值和GPP年总量的时空变化特征,重点探讨2008年以来石漠化综合治理工程、气候变化等因素对植被覆盖及生长的影响,进而评估石漠化综合治理工程的成效。结果表明,2000—2015年西南喀斯特地区植被EVI总体显著增加,其中2008—2015年植被EVI均值和变化率分别比2000—2007年高6.9%和85.7%,EVI显著增加的区域占西南喀斯特地区的13.4%;该区域GPP年总量亦呈显著增加趋势(20.58 g C m-2a-1)。2008—2015年气温和降水对植被EVI变化趋势的贡献仅占28.3%,退耕还林还草等生态恢复措施、大气CO2浓度、大气氮沉降的增加可能是该区域植被覆盖显著增加的主要贡献因子。在100个首批石漠化综合治理试点县中,大部分试点县植被EVI的变化趋势受非气候因子的影响,其中治理面积大的县受非气候因子的影响显著高于治理面积小的县,表明石漠化综合治理工程的实施有效地促进了试点县植被覆盖的增加。     

Bayesian estimation of community prevalences of Schistosoma japonicum infection in China

A Bayesian approach to overcome the imperfections of an immunological test (an antibody-based ELISA) and a parasitological test (Kato-Katz) in the detection of Schistosoma japonicum infection, was used to estimate community prevalences of S. japonicum infection in China. At the same time, the similarity between the prevalence estimates based on data from ELISA alone and those using data from both ELISA and Kato-Katz tests was explored. The database from the third nationwide sampling survey of schistosomiasis in China, 2004, was used for analysis, in which a total of 239 endemic villages were sampled from seven endemic provinces through a stratified cluster sampling technique and 250,987 residents aged from 6 to 65 years, were examined by ELISA followed by a Kato-Katz test applied to the seropositives. Bayesian hierarchical models incorporating random effects to reflect the nested data structure and uncertainty about test properties were employed to analyse the data. Our analysis suggested that using data from ELISA alone or both ELISA and Kato-Katz tests resulted in similar prevalence estimates, probably owing to the lack of sensitivity of Kato-Katz and the fact that Kato-Katz was only applied to the seropositives. We conclude that it is feasible to employ only ELISA, instead of combined ELISA and Kato-Katz tests, to estimate prevalence of S. japonicum infection in large-scale epidemiological settings. This study confirmed heterogeneity in the prevalence of S. japonicum infection in space by the fact that the estimated prevalences of S. japonicum infection in the sampled villages ranged from 0.02% to about 56% (posterior median). It is indicated that the disease remains a threat in some areas along the Yangtze River, although great achievements have been made in the control programme of schistosomiasis in China.     

MICA/B基因多态性与血吸虫病相关性研究

本研究采用PCR-SSP与PCR-SBT方法对正常健康对照组与血吸虫病感染组、血吸虫病性重度肝纤维化病人组和轻度肝纤维化病人组中MICA/B基因进行分型,并比较各组基因的多态性。结果在血吸虫感染组与健康对照组中共发现13种MICA等位基因和5种MICA-STR基因型,MICA*012:01(11.58%vs 5.83%)、MI-CA*017(2.11%vs 0.00%)及MICA*027(3.16%vs 0.97%)在对照人群组较血吸虫病人组中分布频率较高,但Pc值显示没有统计学意义(Pc>0.05)。MICA-STR型别分析显示,MICA-STR与血吸虫病易感没有相关性,但MICA*A5基因型的分布频率在重度肝纤维化组显著高于轻度肝纤维化组(45.10%vs 26.92%,Pc<0.05)。在血吸虫病人组中一共检出10种MICB等位基因。在本研究人群中未发现与日本血吸虫感染显著相关的MICB等位基因。同时MICB等位基因多态性在重度纤维化组、轻度纤维化组、以及正常对照组相互之间均无显著的相关性。研究显示在血吸虫病人组中,MICA和MICB具有连锁不平衡,其中单倍型MICB*008-MICA*002:01和MICB*014-MICA*045在血吸虫病人组中显示具有显著的连锁不平衡。     

Sociocultural and dietary practices among Malay subjects in the north-eastern region of Peninsular Malaysia: a region of low prevalence of Helicobacter pylori infection

Background and Aim: The prevalence of Helicobacter pylori infection is exceptionally low among the Malays in the north‐eastern region of Peninsular Malaysia. The reasons are unknown. Our aim was to compare environmental factors that differed in relation to H. pylori prevalence among Malays born and residing in Kelantan. Methods: A case–control study was conducted among Malays in Kelantan who underwent upper endoscopy between 2000 and 2008. Helicobacter pylori status was determined by gastric histology. Sociocultural and dietary factors were assessed using a validated investigator‐directed questionnaire administered after 2008, and the data were analyzed using logistic regression analysis. Results: The study group consisted of 161 subjects (79 H. pylori positive and 82 controls). Univariable analysis identified five poor sanitary practices associated with an increased prevalence of H. pylori infection: use of well water, use of pit latrine, less frequent boiling of drinking water, and infrequent hand wash practice after toilet use and before meals. Multivariable logistic regression analysis identified three variables inversely associated with H. pylori infection: frequent consumption of tea (OR: 0.023, 95% CI: 0.01–0.07), frequent use of “budu” or local anchovy sauce (OR: 0.09, 95% CI: 0.1–0.7), and frequent use of “pegaga” or centenella asiatica (OR: 0.25, 95% CI: 0.1–0.65). Conclusions: Under the assumption that sanitary, sociocultural, and dietary habits have not changed over the years, we can conclude that an increased risk of H. pylori was associated with unsanitary practices whereas protection was associated with consumption of tea and locally produced foods, “pegaga” and “budu.” These dietary factors are candidates for future study on the effects on H. pylori transmission.     

A Bayesian-based approach for spatio-temporal modeling of county level prevalence of Schistosoma japonicum infection in Jiangsu province, China

Spatio-temporal variations of Schistosoma japonicum infection risk in Jiangsu province, China, were examined and the relationships between key climatic factors and infection prevalence at the county level were determined. The parasitological data were collected annually by means of cross-sectional surveys carried out in 47 counties from 1990 to 1998. Climatic factors, namely land surface temperature (LST) and normalized difference vegetation index (NDVI), were obtained from remote sensing satellite sensors. Bayesian spatio-temporal models were employed to analyze the data. The best fitting model showed that spatial autocorrelation in Jiangsu province decreased dramatically from 1990 to 1992 and increased gradually thereafter. A likely explanation of this finding arises from the large-scale administration of praziquantel for morbidity control of schistosomiasis. Our analysis suggested a negative association between NDVI and risk of S. japonicum infection. On the other hand, an increase in LST contributed to a significant increase in S. japonicum infection prevalence. We conclude that combining geographic information system, remote sensing and Bayesian-based statistical approaches facilitate integrated risk modeling of S. japonicum, which in turn is of relevance for allocation of scarce resources for control of schistosomiasis japonica in Jiangsu province and elsewhere in China, where the disease remains of public health and economic significance.     

Bayesian spatial analysis of a national urinary schistosomiasis questionnaire to assist geographic targeting of schistosomiasis control in Tanzania, East Africa

Spatial modelling was applied to self-reported schistosomiasis data from over 2.5 million school students from 12,399 schools in all regions of mainland Tanzania. The aims were to derive statistically robust prevalence estimates in small geographical units (wards), to identify spatial clusters of high and low prevalence and to quantify uncertainty surrounding prevalence estimates. The objective was to permit informed decision-making for targeting of resources by the Tanzanian national schistosomiasis control programme. Bayesian logistic regression models were constructed to investigate the risk of schistosomiasis in each ward, based on the prevalence of self-reported schistosomiasis and blood in urine. Models contained covariates representing climatic and demographic effects and random effects for spatial clustering. Degree of urbanisation, median elevation of the ward and median normalised difference vegetation index (NDVI) were significantly and negatively associated with schistosomiasis prevalence. Most regions contained wards that had >95% certainty of schistosomiasis prevalence being >10%, the selected threshold for bi-annual mass chemotherapy of school-age children. Wards with >95% certainty of schistosomiasis prevalence being >30%, the selected threshold for annual mass chemotherapy of school-age children, were clustered in north-western, south-western and south-eastern regions. Large sample sizes in most wards meant raw prevalence estimates were robust. However, when uncertainties were investigated, intervention status was equivocal in 6.7-13.0% of wards depending on the criterion used. The resulting maps are being used to plan the distribution of praziquantel to participating districts; they will be applied to prioritising control in those wards where prevalence was unequivocally above thresholds for intervention and might direct decision-makers to obtain more information in wards where intervention status was uncertain.