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      Surveillance systems for neglected tropical diseases: global lessons from China’s evolving schistosomiasis reporting systems, 1949–2014

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          Abstract

          Though it has been a focus of the country’s public health surveillance systems since the 1950s, schistosomiasis represents an ongoing public health challenge in China. Parallel, schistosomiasis-specific surveillance systems have been essential to China’s decades-long campaign to reduce the prevalence of the disease, and have contributed to the successful elimination in five of China’s twelve historically endemic provinces, and to the achievement of morbidity and transmission control in the other seven. More recently, an ambitious goal of achieving nation-wide transmission interruption by 2020 has been proposed. This paper details how schistosomiasis surveillance systems have been structured and restructured within China’s evolving public health system, and how parallel surveillance activities have provided an information system that has been integral to the characterization of, response to, and control of the disease. With the ongoing threat of re-emergence of schistosomiasis in areas previously considered to have achieved transmission control, a critical examination of China’s current surveillance capabilities is needed to direct future investments in health information systems and to enable improved coordination between systems in support of ongoing control. Lessons drawn from China’s experience are applied to the current global movement to reduce the burden of helminthiases, where surveillance capacity based on improved diagnostics is urgently needed.

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          Most cited references83

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          Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk.

          An estimated 779 million people are at risk of schistosomiasis, of whom 106 million (13.6%) live in irrigation schemes or in close proximity to large dam reservoirs. We identified 58 studies that examined the relation between water resources development projects and schistosomiasis, primarily in African settings. We present a systematic literature review and meta-analysis with the following objectives: (1) to update at-risk populations of schistosomiasis and number of people infected in endemic countries, and (2) to quantify the risk of water resources development and management on schistosomiasis. Using 35 datasets from 24 African studies, our meta-analysis showed pooled random risk ratios of 2.4 and 2.6 for urinary and intestinal schistosomiasis, respectively, among people living adjacent to dam reservoirs. The risk ratio estimate for studies evaluating the effect of irrigation on urinary schistosomiasis was in the range 0.02-7.3 (summary estimate 1.1) and that on intestinal schistosomiasis in the range 0.49-23.0 (summary estimate 4.7). Geographic stratification showed important spatial differences, idiosyncratic to the type of water resources development. We conclude that the development and management of water resources is an important risk factor for schistosomiasis, and hence strategies to mitigate negative effects should become integral parts in the planning, implementation, and operation of future water projects.
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            Urbanisation and health in China

            Summary China has seen the largest human migration in history, and the country's rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China's rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.
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              Conquering schistosomiasis in China: the long march.

              The last half-century of schistosomiasis control activities in China have brought down the overall prevalence of human infection with Schistosoma japonicum to less than 10% of the level initially documented in the mid 1950s. Importantly, this reduction is not only, or even mainly, due to the advent of praziquantel in the 1970s and its subsequent dramatic fall in price. Instead, it is the result of a sustained, multifaceted national strategy, adapted to different eco-epidemiological settings, which has been versatile enough to permit subtle adjustments over time as the nature of the challenge changed. Consequently, prevalence has been falling relatively smoothly over the whole period rather than suddenly dropping when mass chemotherapy became feasible. Thus, early recognition of the huge public health and economic significance of the disease, and the corresponding political will to do something about it,underpinned this success. In addition, intersectoral collaboration and community participation played important roles in forming a sustained commitment to a working control strategy based on local resources. The unfolding story is presented from the early years' strong focus on snail control, by means of environmental management, to the last period of praziquantel-based morbidity control carried out under the 10-year World Bank Loan Project (WBLP). An important legacy of the WBLP is the understanding that a research component would sustain control measures and enable future progress. We are now witnessing the payoffs of this forward thinking in the form of a new promising class of drugs, improved diagnostics, and budding vaccine development in addition to novel ways of disease risk prediction and transmission control using satellite-based remote sensing. Different aspects of social and economic approaches are also covered and the importance of health promotion and education is emphasized. Issuing from the review is a set of recommendations, which might further consolidate current control activities, with the ultimate aim to eliminate schistosomiasis from the Chinese mainland.
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                Author and article information

                Contributors
                songliang@ufl.edu
                changhong_yang@sccdpc.gov.cn
                zhongbo1968@163.com
                jiagangg@gmail.com
                lhzcdc@126.com
                elizabeth.carlton@ucdenver.edu
                mcfreem@emory.edu
                justin.remais@emory.edu
                Journal
                Emerg Themes Epidemiol
                Emerg Themes Epidemiol
                Emerging Themes in Epidemiology
                BioMed Central (London )
                1742-7622
                25 November 2014
                25 November 2014
                2014
                : 11
                : 19
                Affiliations
                [ ]Department of Environmental and Global Health, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, 1225 Center Drive, Gainesville, FL 32611 USA
                [ ]Sichuan Center for Disease Control and Prevention, Institute of Public Health Information, 6 Middle School Road, Chengdu, Sichuan, 610041 China
                [ ]Sichuan Center for Disease Control and Prevention, Institute of Parasitic Diseases, 6 Middle School Road, Chengdu, Sichuan, 610041 China
                [ ]Department of Schistosomiasis, Institute of Parasitic Diseases. Chinese Center for Disease Control and Prevention, Shanghai, China
                [ ]Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
                [ ]Department of Emergence Response, Chinese Center for Disease Control and Prevention, Beijing, China
                [ ]Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO USA
                [ ]Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322 USA
                Article
                138
                10.1186/1742-7622-11-19
                4531518
                26265928
                7ab486d1-970e-47a4-a089-168e3996e387
                © Liang et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 June 2014
                : 7 November 2014
                Categories
                Analytic Perspective
                Custom metadata
                © The Author(s) 2014

                Public health
                neglected tropical diseases,parasitic disease,case ascertainment,schistosomiasis,surveillance,sampling,china

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