Interruption of schistosomiasis transmission in mountainous and hilly regions with an integrated strategy: a longitudinal case study in Sichuan, China.

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 hm2 snail habitats were given molluscicide treatment, and 357 233 hm2 snail 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. CONCLUSION: The government-directed and multi-department integrated strategy is effective for interrupting the transmission of schistosomiasis in the mountainous and hilly regions of China.

[Establishment of index system of key factors on elimination of schistosomiasis].

OBJECTIVE: To establish an index system of the key factors of elimination of schistosomiasis. METHODS: A questionnaire was designed based on the reference review, and 24 scientists working in the field of schistosomiasis control or research or management were investigated by using the Delphi method. The importance of each index reflecting the endemicity of schistosomiasis wis scored by each scientist. The assessing system for key factors of eliminating schistosomiasis was established, and the normalized weight and combined weight were calculated. RESULTS: The assessing system included three indexes in the first grade, seven indexes in the second grade and thirteen indexes in the third grade. Among the indexes in the first grade, the normalized weights of endemicity, natural environment and social environment were 0.371 1, 0.339 5, and 0.289 4, respectively. Among the indexes in the second grade, the economy showed the highest combined weight of 0.289 4 while the agriculture and sanitation both showed the lowest score of 0.112 7. Among the indexes in the third grade, the infection rate of animals showed the highest combined weight of 0.124 6 while the agriculture and plant structure both showed the lowest score of 0.053 0. CONCLUSION: The indexes of the assessing system provide the scientific evidence for surveillance work when elirnination of schistosomiasis.

[Evaluation on molluscicidal effect of chlorosalicylicamide on Oncomelania hupensis in schistosomiaisis endemic areas of eight provinces in China].

OBJECTIVE: To evaluate the effects of a novel molluscicide, the salt quinoid-2', 5-dichloro-4'-nitrosalicylanilide from niclosamide (LDS), with 10% wettable powder, in main schistosomiasis epidemic areas of China, including Hunan, Jiangxi, Hubei, Anhui, Jiangsu, Sichuan, Yunnan and Zhejiang Province. METHODS: In the immersion test, 6 effective concentrations of 10% LDS were tested respectively: 0.1, 0.2, 0.4, 0.6, 0.8, 1.0 g/m3 in the field; at the same time, 50% wettable powder of niclosamide ethanolamine salt (WPN) with effective concentrations of 1.0 g/m was used as the molluscicide control, and the fresh water as the blank control, then the mortality rates of 0. hupensis snails were recorded at 24 h, 48 h and 72 h after the immersion. In the spraying test and powder-spraying test, 5 effective dosages of 10% LDS were tested respectively: 0.2, 0.4, 0.6, 0.8, 1.0 g/m2, while 50% WPN 1.0 g/m2 was used as the molluscicide control, and the fresh water as the blank control in the field for 1 d, 3 d and 7 d, then the mortality rates of O. hupensis snails were recorded at 1 d, 3 d and 7 d after the spraying and powder-spraying. RESULTS: The snail mortality rates of LDS using the immersion test for 72 h were more than 95% in the field of eight provinces (0.1 g/m in Sichuan, Jiangxi, Jiangsu and Zhejiang provinces, 0.2 g/m3 in Yunnan, Hunan and Hubei provinces, and 0.4 g/min Anhui Province); the snail mortality rates of LDS using the spraying test for 7 d were more than 85% (0.2 g/m2 in Hunan, Hubei, Jiangxi and Zhejiang provinces, 0.4 g/m2 in Sichuan and Anhui provinces, 0.6 g/m2 in Yunnan and Jiangsu provinces). The snail mortality rates of LDS the powder-spraying test for 7 d were more than 85% (0.6 g/m2 in Yunnan, Sichuan, Hubei, Jiangxi, Anhui, Jiangsu and Zhejiang provinces). According to the standards of "Efficacy test methods and evaluation of molluscicide for pesticide registration (NY/T 1617-2008)", LDS is a qualified molluscicide. CONCLUSIONS: LDS has good molluscicidal effects through the immersion, spraying and powder-spraying test in the fields. It is suitable for a variety of environments to control O. hupensis snails of schistosomiasis endemic areas in China. The recommended dosages of LDS are 0.1-0.2 g/m3 by the immersion method, 0.2-0.4 g/m2 by the spraying method, and 0.4-0.6 g/m2 by the powder-spraying method in the fields.

[Assessment of schistosomiasis transmission interruption in Beichuan County, Sichuan Province].

OBJECTIVE: To assess whether Beichuan County reaches the national standard of schistosomiasis transmission interruption. METHODS: Three villages in Beichuan County were sampled as assessment spots, and the schistosomiasis infections of residents and domestic animals, the status of Oncomelania snails and the past records were assessed according to the Criteria for Control and Elimination of Schistosomiasis in China. RESULTS: No local schistosome infections were found in residents and cattle for successive 5 years and no snails were found for 2 successive years in the 3 villages. The files were documented completely. All the indices reached the national standard of schistosomiasis transmission being interrupted. CONCLUSION: Beichuan County has reached the national standard of schistosomiasis transmission interruption. However, the endemic surveillance of schistosomiasis still needs to continue.

[Risk assessment of schistosomiasis transmission in earthquake-stricken areas after the Lushan Earthquake in Sichuan Province on April 20, 2013].

OBJECTIVE: To assess the impact of the "4 x 20" Lushan Earthquake on the risk of schistosomiasis transmission in Lushan and Tianquan counties, so as to provide the evidence for formulating appropriate measures for schistosomiasis prevention and control. METHODS: Based on a comprehensive literature review, an analysis of schistosomiasis monitoring data in the earthquake affected counties, and a field investigation, a rapid assessment on the impact of the earthquake on schistosomiasis was conducted. RESULTS: Lushan and Tianquan counties were two endemic areas of schistosomiasis with high transmission level in history, especially Lushan County where Oncomelania snail distribution/density was the highest in Sichuan Province. After the earthquake, the streams and damaged ditches were blocked up, potentially leading to the spread of Oncomelania snails, and the damaged sanitary facilities may also lead to the release of excrement, contaminating the environment where snails resided. Meanwhile, the people who were relocated due to the earthquake may have higher exposures to contaminated environment. In addition, increasing population mobility (e.g. relief workers) also had the potential to bring infection sources in the earthquake affected areas. Further, animals, which may serve as reservoirs for the parasite such as homeless dogs, may also add the complexity of local schistosomiasis transmission. CONCLUSIONS: The epidemic risk of schistosomiasis in Lushan and Tianquan counties is high. To prevent the outbreak and epidemic of schistosomiasis, the victim settlements should be established appropriately and the excrement should be managed carefully. Meanwhile, the snail control should be carried out in the high-risk environments. The health education, monitoring, patient treatments and expanded chemotherapy should be carried out and strengthened.

Approaches to genotyping individual miracidia of Schistosoma japonicum.

Molecular genetic tools are needed to address questions as to the source and dynamics of transmission of the human blood fluke Schistosoma japonicum in regions where human infections have reemerged, and to characterize infrapopulations in individual hosts. The life stage that interests us as a target for collecting genotypic data is the miracidium, a very small larval stage that consequently yields very little DNA for analysis. Here, we report the successful development of a multiplex format permitting genotyping of 17 microsatellite loci in four sequential multiplex reactions using a single miracidium held on a Whatman Classic FTA indicating card. This approach was successful after short storage periods, but after long storage (>4 years), considerable difficulty was encountered in multiplex genotyping, necessitating the use of whole genome amplification (WGA) methods. WGA applied to cards stored for long periods of time resulted in sufficient DNA for accurate and repeatable genotyping. Trials and tests of these methods, as well as application to some field-collected samples, are reported, along with the discussion of the potential insights to be gained from such techniques. These include recognition of sibships among miracidia from a single host, and inference of the minimum number of worm pairs that might be present in a host.

[Surveillance of schistosome antibodies in population in mountainous schistosomiasis endemic regions in China].

OBJECTIVE: To understand the dynamics of schistosome antibodies in population in mountainous schistosomiasis low endemic regions, China, so as to provide the evaluation reference for immunodiagnosis. METHODS: The people who consecutively received the indirect heamagglutination assay (IHA) for schistosomiasis and Kato-Katz technique were enrolled in this study in Guixiang Village, Danling County, Sichuan Province from 2006 to 2011. The positive rates for schistosome antibodies, antibody titers and eggs per gram (EPG) were analyzed. RESULTS: A total of 353 people were investigated in this study from 2006 to 2011. The positive rates for schistosome antibodies decreased from 20.73% to 13.67%, and the geometric mean reciprocal titer (GMRT) decreased from 1.63 to 1.06. The antibodies tended to be negative in most antibody-positive people and the GMRT decreased gradually. The antibodies remained negative in most antibody-negative people. After chemotherapy in parasitology confirmed patients, the positive rate for schistosome antibodies decreased from 100% to 20%, and the GMRT decreased from 34.29 to 1.58. There was a highly positive correlation between GMRT and EPG (r = 0.94, P < 0.05). CONCLUSION: The positive rate for schistosome antibodies in population in mountainous schistosomiasis low endemic regions is relatively high (13.67%). The standardization of immunodiagnostic methods is necessary and the suitable diagnostic reagents should be developed in this region.

[Mid-term evaluation on schistosomiasis control effect in Lushan earthquake-stricken areas in Sichuan Province].

OBJECTIVE: To evaluate the effect of schistosomiasis control in Lushan earthquake-stricken areas in Sichuan Province, so as to provide the evidence for formulating appropriate measures for schistosomiasis prevention and control. METHODS: According to the data of historical schistosomiasis prevalence, 5 villages were selected as research sites and field investigations were conducted. RESULTS: The average density of Oncomelania hupensis snails was 0.41 snails/0.1 m2, and there were no schistosome-infected snails. There were no acute schistosomiasis cases in these five villages. For local residents, the health education leaflets were more suitable than warning signs, and for migrant population, they were more concerned about the warning signs. CONCLUSION: After the implementation of effective prevention and control works, the epidemic risks of schistosomiasis have been controlled. However, the health education, surveillance, and prevention measures for schistosomiasis still need to be persisted in.

[Investigation on current status of advanced schistosomiasis in Sichuan Province, 2010].

OBJECTIVE: To understand the current distribution and characteristics of patients with advanced schistosomiasis in Sichuan Province, so as to provide the scientific evidence for improving the management and treatment of advanced schistosomiasis. METHODS: The patients who had been diagnosed as advanced schistosomiasis or were supposed with advanced schistosomiasis were the objects of the investigation. The epidemiological survey and medical examination were used to investigate these persons one by one according to the national standard. RESULTS: There were 1 684 patients with confirmed diagnosis in 7 cities of Sichuan Province. There were 1 066 cases of splenomegaly including post-surgery (63.30%), 545 cases of ascites (32.36%), 44 cases of multiple granulomas in the colon (2.61%), and 29 cases of dwarf (1.72%). Most of the patients were old and 51.72% of them were more than 60 years old. A total of 1 331 patients (79.04%) needed treatment and assistance at present, and 36.44% of them who had ascites needed internal medicine treatment. CONCLUSION: There are also many patients with advanced schistosomiasis in Sichuan Province, and ascites and splenomegaly (post-surgery) were the main types. The patients with ascites should be the important objects of the treatment and assistance in the future.

A loop-mediated isothermal amplification method for a differential identification of Taenia tapeworms from human: application to a field survey.

In this study, we applied a loop-mediated isothermal amplification method for identification of human Taenia tapeworms in Tibetan communities in Sichuan, China. Out of 51 proglottids recovered from 35 carriers, 9, 1, and 41 samples were identified as Taenia solium, Taenia asiatica and Taenia saginata, respectively. Same results were obtained afterwards in the laboratory, except one sample. These results demonstrated that the LAMP method enabled rapid identification of parasites in the field surveys, which suggested that this method would contribute to the control of Taenia infections in endemic areas.

[Surveillance of schistosomiasis in Sichuan Province, 2005-2010].

OBJECTIVE: To understand the epidemic trend of schistosomiasis in Sichuan Province so as to provide the evidence for formulating schistosomiasis control strategy. METHODS: According to the National Schistosomiasis Surveillance Protocol, the national surveillance sites in Sichuan Province were selected. The schistosomiasis surveillance was carried out continuously from 2005 to 2010. RESULTS: Nine national schistosomiasis surveillance sites were established in Pujiang, Guanghan, Zhongjiang, Fucheng, Dongpo, Danling, Renshou, Xichang and Dechang counties. The Oncomelania hupensis snail area decreased from 351 853 m2 in 2005 to 128 285 m2 in 2010, the snail density from 0.70 to 0.21 per 0.1 m2, the snail infection rate from 0.06% to 0, the positive rate of human serum schistosome antibody from 19.41% to 7.62%, the schistosome infection rate of human population from 1.93% to 0.10%, and the infection rate of livestock from 4.50% to 1.02%. The snails were found mainly in ditch, rice field and other moist field. CONCLUSIONS: Though the endemic of schistosomiasis has reached a low level in Sichuan Province, the endemic situation fluctuates at a narrow range in some surveillance sites. Therefore, the surveillance work should be carried out continuously.

[Effect of ecological civilized homestead construction on schistosomiasis control].

OBJECTIVE: To evaluate the effect of Ecological Civilized Homestead Construction on schistosomiasis control. METHODS: The data of ecological civilized homestead construction and schistosomiasis control were collected and analyzed in Meiwan Village, Shuangqiao Town, Danling County, Sichuan Province from 2004 to 2010. RESULTS: Ecological Civilized Homestead Construction was carried out from 2004 to 2010. Totally 454 bio-gas pools were built. All the farmers used well water. The popularized rates of the household bio-gas pool, sanitary toilet, sewage treatment pool reached 100%. The number of cattle was 4, which decreased by 91.30% compared with that in 2004, and all the cattle were fed in captivity. The schistosome infection rates of populations were 0.26% and 0.30% in 2005 and 2008, respectively, and nobody was infected in other years. The infection rate of cattle was 0 from 2004 to 2010. The awareness rate of knowledge about schistosomiasis control achieved 100% in the population over 6 years old. Most of the farmers could use certain protective measures while they were farming. CONCLUSION: The effect of ecological civilized homestead construction on schistosomiasis control is remarkable.

[Effect of comprehensive control pattern on soil-transmitted nematodiasis in Danling County].

The comprehensive control pattern centering on health education, deworming and improving drinking water and lavatories was adopted to control soil-transmitted nematodiasis in Danling County, Sichuan Province from 2007-2009. In 2009, the infection rate of soil-transmitted nematodes decreased from 57.12% of the baseline survey in 2006 to 10.06%.

[Control strategy of schistosomiasis and key points in the 12th Five-Year Plan in China].

Based on the objective of long- and mid-term development program for schistosomiasis control in China, the paper presents an analysis of strategy for schistosomiasis control and its function in the 12th Five-Year Plan. Meanwhile, the strategy and key elements of schistosomiasis control for recent years are put forward for different endemic areas.

[Strengthening the achievements of schistosomiasis control in hilly regions of China].

In this paper we summarize the epidemiological characteristics, trends, and control achievements of schistosomiasis in hilly regions of China, as well as analyze the challenges of schistosomiasis control in these areas after transmission control, and further explore the control measures and strategies in the post-transmission control period to strengthen the control achievements and sustainable development with the ultimate goal of achieving transmission interruption.

Post-treatment follow-up study of abdominal cystic echinococcosis in tibetan communities of northwest Sichuan Province, China.

BACKGROUND: Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, with the liver as the most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province. Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during treatment. METHODOLOGY/PRINCIPAL FINDINGS: Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of 196 CE cases were identified by ultrasound, of which 37 (18.9%) showed evidence of spontaneous healing/involution of hepatic cyst(s) with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16) were considered to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24) were improved, 14.3% (7) remained unchanged, and 4.1% (2) became aggravated. In general, patients with CE2 type cysts (daughter cysts present) needed a longer treatment course for cure (26.4 months), compared to cases with CE1 (univesicular cysts) (20.4 months) or CE3 type (detached cyst membrane or partial degeneration of daughter cysts) (9 months). In addition, the curative duration was longer in patients with large (>10 cm) cysts (22.3 months), compared to cases with medium (5-10 cm) cysts (17.3 months) or patients with small (<5 cm) cysts (6 months). At diagnosis, seven (53.8%) of 13 cases with CE1 type cysts without any previous intervention showed negative specific IgG antibody response to E. granulosus recombinant antigen B (rAgB). However, following 3 months to 18 months albendazole therapy, six of these 7 initially seronegative CE1 cases sero-converted to be specific IgG antibody positive, and concurrently ultrasound scan showed that cysts changed to CE3a from CE1 type in all the six CE cases. Two major profiles of serum specific IgG antibody dynamics during albendazole treatment were apparent in CE cases: (i) presenting as initial elevation followed by subsequent decline, or (ii) a persistent decline. Despite a decline, however, specific antibody levels remained positive in most improved or cured CE cases. CONCLUSIONS: This was the first attempt to follow up community-screened cystic echinococcosis patients after albendazole therapy using ultrasonography and serology in an endemic Tibetan region. Cyclic albendazole treatment proved to be effective in the great majority of CE cases in this resource-poor area, but periodic abdominal ultrasound examination was necessary to guide appropriate treatment. Oral albendazole for over 18 months was more likely to result in CE cure. Poor drug compliance resulted in less good outcomes. Serology with recombinant antigen B could provide additional limited information about the effectiveness of albendazole in CE cases. Post-treatment positive specific IgG antibody seroconversion, in initially seronegative, CE1 patients was considered a good indication for positive therapeutic efficacy of albendazole.

Toward sustainable and comprehensive control of schistosomiasis in China: lessons from Sichuan.

Triggered by a fascinating publication in the New England Journal of Medicine detailing China's new multi-pronged strategy to control and eventually interrupt the transmission of Schistosoma japonicum, this PLoS Neglected Tropical Diseases Debate critically examines the generalizability and financial costs of the studies presented from the marshlands of the lake region. Edmund Seto from the University of California and colleagues emphasize that the epidemiology and control of schistosomiasis varies according to the social-ecological context. They conjecture that the successful intervention packages piloted in the lake region is not fully fit for the hilly and mountainous environments in Sichuan and Yunnan provinces, and hence call for more flexible, setting-specific, and less expensive control strategies. In response, Xiao-Nong Zhou from the National Institute of Parasitic Diseases at the Chinese Center of Disease Control and Prevention and colleagues explain the steps from designing pilot studies to the articulation and implementation of a new national control strategy through a careful process of scaling-up and adaptations. Finally, the two opponents converge. The need for integrated, intersectoral, and setting-specific control measures is stressed, supported by rigorous surveillance and continuous research. Experiences and lessons from China are important for shaping the schistosomiasis elimination agenda.

Compensatory density feedback of Oncomelania hupensis populations in two different environmental settings in China.

BACKGROUND: The most recent strategy for schistosomiasis control in the People's Republic of China aims to reduce the likelihood of environmental contamination of schistosome eggs. Despite considerable progress, it is believed that achievements would be further consolidated with additional intermediate host snail control measures. We provide an empirical framework for discerning the relative contribution of intrinsic effects (density feedback) from other extrinsic drivers of snail population dynamics. METHODS: We set up experiments in two study locations to collect reproduction data of Oncomelania hupensis, the intermediate host snail of Schistosoma japonicum. We applied a set of four population dynamic models that have been widely used to study phenomenological time-series data to examine the properties of demographic density feedback patterns from abundance data. We also contrasted the obtained results with the component feedback of density on survival rate to determine whether adult survival was the principal driver of the demographic feedback observed. RESULTS: Demographic density feedback models (Ricker- and Gompertz-logistic) accounted for > 99% of Akaike's information criterion model weight, with the Gompertz ranking highest in all O. hupensis population groups. We found some evidence for stronger compensatory feedback in the O. hupensis population from Sichuan compared to a Jiangsu population. Survival rates revealed strong component feedback, but the log-linear relationships (i.e. Gompertz) had less support in the demographic feedback analysis. CONCLUSIONS: Our findings indicate that integrated schistosomiasis control measures must continue to reduce parasite abundance further because intermediate host snail populations tend to grow exponentially at low densities, especially O. hupensis populations in mountainous regions. We conclude that density feedback in adult survival is the principal component contribution to the demographic phenomenon observed in the population fitness (r)-abundance relationship.

Genetic assignment methods for gaining insight into the management of infectious disease by understanding pathogen, vector, and host movement.

For many pathogens with environmental stages, or those carried by vectors or intermediate hosts, disease transmission is strongly influenced by pathogen, host, and vector movements across complex landscapes, and thus quantitative measures of movement rate and direction can reveal new opportunities for disease management and intervention. Genetic assignment methods are a set of powerful statistical approaches useful for establishing population membership of individuals. Recent theoretical improvements allow these techniques to be used to cost-effectively estimate the magnitude and direction of key movements in infectious disease systems, revealing important ecological and environmental features that facilitate or limit transmission. Here, we review the theory, statistical framework, and molecular markers that underlie assignment methods, and we critically examine recent applications of assignment tests in infectious disease epidemiology. Research directions that capitalize on use of the techniques are discussed, focusing on key parameters needing study for improved understanding of patterns of disease.

A 5-year longitudinal study of schistosomiasis transmission in Shian village, the Anning River Valley, Sichuan Province, the Peoples' Republic of China.

BACKGROUND: Schistosoma japonicum is a major public health concern in the Peoples' Republic of China (PRC), with over one million people infected and another 50 million living in areas at risk of infection. Based on ecological, environmental, population genetic and molecular factors, schistosomiasis transmission in PRC can be categorised into four discrete ecosystems or transmission modes. It is predicted that the Three Gorges Dam (TGD) will impact upon the transmission of schistosomiasis in the PRC, with varying degree across the four transmission modes. We undertook longitudinal surveillance from 2002 to 2006 in sentinel villages both above and below the TGD across five provinces (Hunan, Jiangxi, Hubei, Anhui and Sichuan) to determine whether there was any impact of the TGD on schistosomiasis transmission during its construction. Here we present the results from a schistosomiasis-endemic village located above the dam in Sichuan Province. RESULTS: Baseline results showed a human S. japonicum prevalence of 42.0% (95% CI: 36.6-47.5). At follow-up, results showed that the incidence of S. japonicum infection in the selected human cohort in Shian decreased by three quarters from 46% in 2003 to 11.3% in 2006. A significant (P < 0.01) downward trend was also evident in the yearly adjusted (for water contact) odds ratios. Over the four years of follow-up, the incidence of S. japonicum infection in bovines declined from 11.8% in the first year to zero in the final year of follow-up. CONCLUSIONS: The substantial decrease in human (75%) and bovine (100%) incidence observed in Shian village can probably be attributed to the annual human and bovine PZQ treatment of positives; as seen in drug (PZQ) intervention studies in other parts of PRC. If an increase in schistosome transmission had occurred as a result of the TGD, it would be of negligible size compared to the treatment induced decline seen here. It appears therefore that the construction of the TGD had virtually no impact on schistosomiasis transmission in Shian village over the period of study. Furthermore, contrary to previous reports from Sichuan downplaying the role of animals in human schistosome transmission, bovines may indeed play a role.