Effects of fish-human transmission and different life stages of fish on Clonorchiasis: A novel mathematical model.

Clonorchiasis is a zoonotic disease mainly caused by eating raw fish and shrimp, and there is no vaccine to prevent it. More than 30 million people are infected worldwide, of which China alone accounts for about half, and is one of the countries most seriously affected by Clonorchiasis. In this work, we formulate a novel Ordinary Differential Equation (ODE) model to discuss the biological attributes of fish within authentic ecosystems and the complex lifecycle of Clonorchis sinensis. This model includes larval fish, adult fish, infected fish, humans, and cercariae. We derive the basic reproduction number and perform a rigorous stability analysis of the proposed model. Numerically, we use data from 2016 to 2021 in Guangxi, China, to discuss outbreaks of Clonorchiasis and obtain the basic reproduction number R0=1.4764. The fitted curve appropriately reflects the overall trend and replicates a low peak in the case number of Clonorchiasis. By reducing the release rate of cercariae in 2018, the fitted values of Clonorchiasis cases dropped rapidly and almost disappeared. If we decrease the transmission rate from infected fish to humans, Clonorchiasis can be controlled. Our studies also suggest that strengthening publicity education and cleaning water quality can effectively control the transmission of Clonorchiasis in Guangxi, China.

High prevalence of Clonorchis sinensis infections and coinfection with hepatitis virus in riverside villages in northeast China.

In China, the prevalence of Clonorchis sinensis (C. sinensis) infections is only evaluated at the provincial level by national sampling surveys, and data from villages and counties are still lacking. In this study, we conducted a cross-sectional survey in 10 villages located along the Lalin River in northeast China. Clonorchiasis was diagnosed using a modified Kato-Katz method that detects the C. sinensis egg in stools. A total of 3,068 persons were screened and 2,911 were recruited for the study. Overall, the prevalence of C. sinensis infection was 29.3%. Among 175 participants who were cured after antiparasitic treatment, 54 (30.86%) were re-infected in this survey. After calibration of potential confounders, male gender, occupation as a farmer, smoking, and occasionally or frequently eating raw fish were independent risk factors for C. sinensis infection. The results of laboratory examinations in the C. sinensis/hepatitis B or C virus co-infection group were similar to those in the hepatitis B or C virus mono-infection groups. In conclusion, C. sinensis is highly endemic in villages along the Lalin River, and the primary route of infection is the consumption of raw freshwater fish. Co-infection with C. sinensis did't aggravate the clinical manifestations of viral hepatitis in this cross-sectional study.

Rapid screening of Clonorchis sinensis infection: Performance of a method based on raw-freshwater fish-eating practice.

Clonorchis sinensis infection is caused by ingestion of raw freshwater fish containing the infective larvae of Clonorchis sinensis. It is highly endemic in East Asia, especially in China. Selective chemotherapy of people who report habitual eating of raw freshwater fish is a control measure. As the performance of this screening technique has not yet been fully evaluated in China, a cross-sectional study was conducted, covering 17 counties in four major clonorchiasis-endemic provinces. About 1 000 participants were enrolled from each county. Fecal samples were collected and examined for helminth eggs and each person enrolled was asked about their practice with respect to eating raw freshwater fish. In total, 16 230 participants from 16 counties were finally included. The overall prevalence of C. sinensis infection was 10.8%, ranging from 0 to 53.7% in the 16 counties, while the percentage of inhabitants eating raw freshwater fish was 26.5%, ranging from 0 to 79.1%. The overall sensitivity and specificity of screening for C. sinensis infection in this approach was 82.3% and 80.3%, respectively, yielding a Youden's index of 0.6. The overall positive and negative likelihood ratios were 4.2 and 0.2, respectively, while the overall positive and negative predictive values were 33.5% and 97.4%, respectively. Furthermore, the sensitivity was higher with regard to high-intensity infections compared to light infections.

The control of clonorchiasis in Guangdong province, southern China.

Oriental liver fluke disease (clonorchiasis), caused by Clonorchis sinensis, is endemic in 81 counties in Guangdong province, China. This study was conducted following increasing lack of clonorchiasis awareness and increased consumption of raw freshwater fish and raw fish porridge at home and restaurants, which has been attributed to improved living standards in China, and is considered to have led to a higher C. sinensis infection rate in the country. A total of 61,517 individuals were investigated from 123 sites during a provincial survey in 1988, with average C. sinensis infection rate of 1.82% that increased to 4.08% (335/8217) in 1997. Higher infection rate was observed in adult men than women, with heavy infection rate in fishermen and businessmen because they have access and means to get raw fishes for consumption. Thus, clonorchiasis has become a serious public health problem in Guangdong province. Efforts targeting clonorchiasis prevention and control in Guangdong province started in the 1990s. These included carrying out large-scale surveys and chemotherapy in epidemic regions, research on promotion of environmental sanitation and methods for freshwater aquaculture. Establishment and promotion of clonorchiosis demonstration plots for comprehensive control measures, as well as the development of clonorchiasis-prevention community-out-patient clinics were initiated and their effectiveness was evaluated. However, there seem to be no obvious decline in the prevalence of C. sinensis with 4.90% (608/12,401) in 2015, at Guangdong province due to the people's habit of eating raw fishes in endemic areas. This has led to increasing calls to improve environmental sanitation in the aquaculture industry. It is, however, believed that control efforts on clonorchiosis in the province are at an early stage and require strengthening through the cooperation of different departments to work out effective strategies for sustainable field application of control mechanisms.

Mathematical modeling the dynamics of Clonorchiasis in Guangzhou City of China.

In this paper, we have set up a mathematical model on the basic life cycle of clonorchiasis to fit the data of human clonorchiasis infection ratios of Guangzhou City of Guangdong Province in China from 2006-2012. By this model, we have proved that the condition of the basic reproductive number R0>1 or R0<1 corresponds the globally asymptotically stable of the endemic equilibrium or the disease-free equilibrium, respectively. The basic reproductive number is estimated as 1.41 with those optimal parameters. Some efficient strategies to control clonorchiasis are provided by numerical analysis of the mathematical model.

[(CLONORCHIASIS: GLOBAL AND REGIONAL EPIDEMIOLOGY)].

All over the world, much attention is given to the comprehensive studies of parasites and their induced diseases in order to devise effective methods for the diagnosis, treatment, and prevention of parasitic diseases. This review summarizes the information available in the literature on the epidemiology of clonorchiasis caused by the Chinese liver fluke Clonorchis sinensis, including global and regional risk factors for the infection and its transmission. The existing knowledge of this important, but far from the most studied zoonosis, the cause of severe human hepatobiliary diseases, is required for the success of future investigations of parasitic infections.

Risk factors for Clonorchis sinensis infection transmission in humans in northern Vietnam: A descriptive and social network analysis study.

Clonorchis sinensis is major fish-borne trematode, endemic in North Vietnam. Risk factors described so far include individual eating behaviors and environmental factors. Here, additional to conventional risk factors, we report on socially influenced liver fluke transmission in endemic communities. A cross-sectional study on risk factors and fish sharing networks was conducted in 4 villages of Gia Thinh Commune, Ninh Binh Province. A total of 510 residents in 272 households were recruited for risk factor analysis while 220 households, 28 fishermen and 10 fish-sellers were enrolled for social network study. Fecal examination for C. sinensis eggs was performed. Average C. sinensis infection rate at Gia Thinh commune was 16.5% (range 2% to 34.4%). Higher infection rates were significantly associated with males, lower educational levels, eating raw fish, and location of the villages. Social network analysis (SNA) showed a strong positive correlation between ego network size (number of households in fish sharing network) and quantity of raw fish consumed (r=0.603, P<0.05). The infection rate in people who ate raw-fish caught from a nearby river was significantly higher than those who consumed fish taken from farmed ponds (P<0.05). The amount of raw-fish meal consumed per resident/year was significantly higher in villages that had a strong network of sharing raw-fish food (P<0.001). This study reports for the first time on fish-food sharing among neighbors, proximity to water bodies, frequency of eating raw fish from natural water bodies and low education were key risk factors in C. sinensis infection transmission in northern Vietnam.

The role of evolutionary biology in research and control of liver flukes in Southeast Asia.

Stimulated largely by the availability of new technology, biomedical research at the molecular-level and chemical-based control approaches arguably dominate the field of infectious diseases. Along with this, the proximate view of disease etiology predominates to the exclusion of the ultimate, evolutionary biology-based, causation perspective. Yet, historically and up to today, research in evolutionary biology has provided much of the foundation for understanding the mechanisms underlying disease transmission dynamics, virulence, and the design of effective integrated control strategies. Here we review the state of knowledge regarding the biology of Asian liver Fluke-host relationship, parasitology, phylodynamics, drug-based interventions and liver Fluke-related cancer etiology from an evolutionary biology perspective. We consider how evolutionary principles, mechanisms and research methods could help refine our understanding of clinical disease associated with infection by Liver Flukes as well as their transmission dynamics. We identify a series of questions for an evolutionary biology research agenda for the liver Fluke that should contribute to an increased understanding of liver Fluke-associated diseases. Finally, we describe an integrative evolutionary medicine approach to liver Fluke prevention and control highlighting the need to better contextualize interventions within a broader human health and sustainable development framework.

Rapid detection and differentiation of Clonorchis sinensis and Opisthorchis viverrini using real-time PCR and high resolution melting analysis.

Clonorchis sinensis and Opisthorchis viverrini are both important fish-borne pathogens, causing serious public health problem in Asia. The present study developed an assay integrating real-time PCR and high resolution melting (HRM) analysis for the specific detection and rapid identification of C. sinensis and O. viverrini. Primers targeting COX1 gene were highly specific for these liver flukes, as evidenced by the negative amplification of closely related trematodes. Assays using genomic DNA extracted from the two flukes yielded specific amplification and their identity was confirmed by sequencing, having the accuracy of 100% in reference to conventional methods. The assay was proved to be highly sensitive with a detection limit below 1 pg of purified genomic DNA, 5 EPG, or 1 metacercaria of C. sinensis. Moreover, C. sinensis and O. viverrini were able to be differentiated by their HRM profiles. The method can reduce labor of microscopic examination and the contamination of agarose electrophoresis. Moreover, it can differentiate these two flukes which are difficult to be distinguished using other methods. The established method provides an alternative tool for rapid, simple, and duplex detection of C. sinensis and O. viverrini.

The zoonotic, fish-borne liver flukes Clonorchis sinensis, Opisthorchis felineus and Opisthorchis viverrini.

Clonorchis sinensis, Opisthorchis felineus and Opisthorchis viverrini are the three most important liver flukes involved in human health, infecting more than 45 million people worldwide. Both C. sinensis and O. viverrini, and possibly O. felineus, can induce human cholangiocarcinoma as well as inducing other hepatobiliary pathology. Although the life cycles of all three species are similar, only that of O. felineus in Europe remains predominantly zoonotic, while O. felineus in Asia and C. sinensis have a stronger mixture of zoonotic and anthroponotic components in their life cycles. Opisthorchis viverrini from the Mekong area of southeastern Asia is predominantly anthroponotic. Here we discuss the comparative epidemiology of these three taxa comparing in detail the use of first, second and final animal hosts, and consider the potential role of humans in spreading these pathogens. In addition we discuss the genetic structure of all three species in relation to potentially cryptic species complexes.

[Status of Clonorchis sinensis infection and its influencing factors among migrant workers in Baoan District, Shenzhen City].

OBJECTIVE: To understand the status of Clonorchis sinensis infection and its risk factors among migrant workers in Baoan District of Shenzhen City, so as to provide the evidence for the development of control strategies. METHODS: A total of 642 migrant workers were chosen as the investigation samples by the stratified cluster sampling method. Their sera were collected and tested for Clonorchis sinensis infection with ELISA, and a questionnaires survey was performed to collect the information of clonorchiasis sinensis related to knowledge and behaviors. The influencing factors were summarized with the case-control study method. RESULTS: A total of 642 subjects were investigated, in which 530 subjects received the serological examinations and the positive rate was 6.6% (35/530). The significant differences were not found between genders (Chi2 = 1.19, P = 0.28) or among the age groups (Chi2 = 0.45, P = 0.80). The awareness rates of knowing infection route, health hazard and prevention knowledge were 50.16%, 33.64% and 27.41%, respectively. The rates of healthy behaviors such as not eating semi-cooked fish, not feeding pets with raw fish or shrimps, and differentiating between the raw and cooked food when using cutting boards were 80.67%, 78.41% and 45.95%, respectively. The awareness rate of prevention knowledge was positively related to the infection (OR = 0.16, P < 0.01). CONCLUSION: The prevention and control of Clonorchis sinensis infection among migrant workers could not be neglected, and the health education should be strengthened.

[Epizootiological characteristics of clonorchiasis foci in the Amur River ecosystem in the Jewish autonomic region].

Malacofaunal and ichthyoparasitological studies were conducted in the floodplain-river ecosystem in the middle course of the Amur River. The studies covered its channels and tributaries, such as Big and Small Bira, Bidzhan, In, and Vertoprashikha Rivers, in the Birobidzhan, Leninskoye, and Smidovich districts of the Jewish Autonomic Region in the second half of August 2011. It was established that there were biotopes of the mollusk Parafossalurus manchouricus, the first intermediate host of Clonorchis sinensis, in the exosystems of the In, Bira, and Bidzhan Rivers. Sporadic P. manchouricus specimens were found in the Bidzhan channel in the vicinity of its estuary and on the flooded bank of the In River. The bay of the Bira River (the town of Birobidzhan) exhibited a biotope of P. manchouricus with a mollusk population density of 180 to 300 specimens/m2. Seven of 16 examined fish species showed metacercariae of Clonorchis. Among them there were not only Cyprinidae, but also representatives of other families and orders. The two-year-olds of orca-skripuns (Pseudobagrus fulvidraco), orca-whips (Tachysyrus ussuriensis), and Brazhnikov's orsas (Liocassis braschnikowi) were infected with C. sinensis metacercariae. Clonorchis metacercariae were first detected in Amur sleepers (Percottus glehni). This fish species has not been heretofore recorded as the second intermediate host ofC. sinensis. The highest invasion extent for C. sinensis metacercariae was revealed in Amur bitterlings (Rhodeus sericeus) born during the current year. In the biotopes ofdifferent water reservoirs, it changed from 10.0 to 48.0%. In 4 of 6 water reservoirs, Amur bitterlings were found to have larvae of this species of trematodes. The invasion rates were in the range from 1 to 4 metacercariae per fish. Only in individual cases, they were as great as 28 parasitic larvae per fish.

The current status of opisthorchiasis and clonorchiasis in the Mekong Basin.

This review highlights the current status and control of liver fluke infections in the Mekong Basin countries where Opisthorchis and Clonorchis are highly endemic. Updated data on prevalence and distribution have been summarized from presentations in the "96 Years of Opisthorchiasis. International Congress of Liver Flukes". It is disturbing that despite treatment and control programs have been in place for decades, all countries of the Lower Mekong Basin are still highly endemic with O. viverrini and/or C. sinensis as well as alarmingly high levels of CCA incidence. A common pattern that is emerging in each country is the difference in transmission of O. viverrini between lowlands which have high prevalence versus highlands which have low prevalence. This seems to be associated with wetlands, flooding patterns and human movement and settlement. A more concerted effort from all community, educational, public health and government sectors is necessary to successfully combat this fatal liver disease of the poor.

Clonorchiasis--a historical review of contributions of Japanese parasitologists.

In the early stage of research on Clonorchis and clonorchiasis, Japanese parasitologists made a tremendous contribution on the elucidation of the life cycle of this parasite and on the epidemiology of the disease. Harujiro Kobayashi first identified cyprinoid fish as the second intermediate hosts for Clonorchis sinensis in 1912, Subsequently Parafossarulus snails were identified as the first intermediate host by Masatomo Muto in 1918. Kenso Ishisaka recorded the first human case of clonorchiasis in Japan in 1877, and two Japanese clinicians, Shigeru Matsumoto and Tsukasa Ohi, recorded the endemic nature of this disease in Korea and Taiwan respectively, in the same year, 1915.

Experimental model in rats for study on transmission dynamics and evaluation of Clonorchis sinensis infection immunologically, morphologically, and pathologically.

This study aims to gain a better insight into the transmission patterns and immunologic profile of Clonorchis sinensis infection and make a headway on the pathogenesis regarding cholangiocarcinoma and hepatic lesions. Experimental models orally infected by C . sinensis metacercariae were constructed in rats. Immunological assays were performed to measure serum level of IgA, IgE, IgG1, IgG2a, IFN-gamma, and IL-4. Infection parameters were assessed by worm recovery rate, eggs per gram faece and worm size. Pathological sections with livers were managed with immunofluorescence, hematoxylin, eosin, and Masson's trichrome staining to evaluate the hepatic pathological changes. Interestingly, rats infected with only one C . sinensis metacercariae even gained a high worm recovery rate of 83.3% compared with rats infected with more metacercariae. Serological changes according to different infection doses indicated that immune response presented a tendency to Th2 type by expressing transient high level of IgG1, IL-4, and IgE. Hepatic tissues appeared inflammatory and fibrotic, revealed by different stainings. Intrahepatic bile ducts displayed cholangiectasis and proliferation with excreted/secreted antigen histologically located. C . sinensis, as a fish-borne zoonosis, presented novel transmission patterns which explained high infection rate in endemic areas; infection rate of C . sinensis was frequency-dependent and dose-related. Humoral immunity played a prevalent role in resisting to C . sinensis based on the rat models. C . sinensis infection played an undoubted role in biliary and hepatic diseases.

[Epidemiological studies on Clonorchis sinensis infection along the Zhujiang River in Lou village of Shenzhen].

OBJECTIVE: To study the transmission route and epidemiological features of Clonorchis sinensis infection in Shenzhen area--the biggest immigration city of Southern China. METHODS: In this study, we examined 1473 individuals (710 males and 763 females) to determine the current status of C. sinensis infection among the people in one village in Zhujiang river region, Guangdong province, China. Blood samples were detected on antibody of C. sinensis with enzyme linked immunosorbent assay,and stool specimens from sera positive cases were examined by modified Kato-Katz thick smear to confirm the density of infection. People were interviewed on their life styles under the structured questionnaire which was administered by trained staff members. Major content of the questionnaire included eating raw fish, using the same utensils for both raw fish and cooked food, using feces of domestic animals and human feces to feed fish and so on. RESULTS: Among 1473 people examined, 70 (4.75%) were found infected with C. sinensis. By counting eggs per gram feces (EPG), it was found that heavy intensities of infection in males was stronger than that of females,and the overall average EPG was 41.87. Of 1473 interviewees, 54% of them did not know about fluke disease or its transmission route, 12% of those who knew about the fluke but believed that the infection caused no harm or only slight harm to their health. 27% of the interviewees ate raw fish at least 1-2 times per months with 5% of the families using the same utensils for both raw fish and cooked food. 40% of the fish ponds owners fed their fish with the feces of domestic animals and human feces. CONCLUSION: Together with these results, unhealthy behaviors, poor knowledge, inappropriate farming/fishery practices, eating raw fish were important factors influencing the C. sinensis prevalence in humans.

Clonorchis sinensis: development and evaluation of a nested polymerase chain reaction (PCR) assay.

Clonorchis sinensis is a fish-borne trematode endemic to East Asia, which infects over 35 million people globally. In the study described here, we developed a nested polymerase chain reaction (PCR) method for the specific and reliable detection of C. sinensis. The primers designed from the nucleotide sequence data derived in this study were evaluated for their specificity and sensitivity for the detection of C. sinensis. The specific amplification products were obtained only with C. sinensis and no amplifications occurred with the DNA of closely related trematodes including Opisthorchis viverrini demonstrating the specificity of the assay. The novel PCR method described here will be useful for the quarantine of fishery products and evaluation of transmission status of clonorchiasis in the endemic areas.

Investigation on the epidemiological factors of Clonorchis sinensis infection in an area of south China.

To detect the epidemiological factors of Clonorchis sinensis infection in Hengxian County, one of counties in Guangxi Zhuang Autonomous Region where Schistosoma japonicum was endemic but eliminated in the late 1980s, a questionnaire was designed with 37 questions covering socioeconomic conditions and human behavior, contamination of the environment and fish ponds, inadequate farming/fishery practices; and the formalin-ether sedimentation technique was used to examine the feces of cats, dogs and pigs for the eggs of C. sinensis. Fresh fish was sliced and digested to detect the metacercariae of C. sinensis under a stereomicroscope. Of 1,521 people interviewed, 64% of the interviewees did not know about fluke disease or its transmission route, 46% of those who knew about the fluke believed that the infection caused no harm or only slight harm to their health. More than half of the interviewees (51%) ate raw fish at least 1-2 times per month, more among the middle-aged males. Eight percent of them used the same utensils for both raw fish and cooked food. When advice was given not to eat raw fish, 73% of the interviewees thought it was not feasible. In relation to pisciculture, 25% and 9% of the owners of fish ponds fed their fish with feces of domestic animals and human feces, respectively. The prevalences of C. sinensis infection in cats, dogs and pigs were 70, 50 and 27%, respectively, and the infection rate in fish was 40%. These results indicate the poor knowledge, and beliefs, and unhealthy behaviors in the human population. They also show poor environmental hygiene and inappropriate farming/fishery practices are important in the increase of C. sinensis prevalence in humans. Combined interventions, including health education, environmental modification, reform of traditional farming/fishery practices, mass screening and chemotherapy for humans, and the management of domestic animals are needed in developing control strategies to decrease C. sinensis infection in the human population.