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Major Parasitic Diseases of Poverty in Mainland China: Perspectives for Better Control Jin-Lei Wang†, Ting-Ting Li†, Si-Yang Huang*, Wei Cong and Xing-Quan Zhu*

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Major Parasitic Diseases of Poverty in Mainland China: Perspectives for Better Control Jin-Lei Wang†, Ting-Ting Li†, Si-Yang Huang*, Wei Cong and Xing-Quan Zhu* Wang et al. Infectious Diseases of Poverty (2016) 5:67 DOI 10.1186/s40249-016-0159-0 SCOPING REVIEW Open Access Major parasitic diseases of poverty in mainland China: perspectives for better control Jin-Lei Wang†, Ting-Ting Li†, Si-Yang Huang*, Wei Cong and Xing-Quan Zhu* Abstract Significant progress has been made in the prevention, control, and elimination of human parasitic diseases in China in the past 60 years. However, parasitic diseases of poverty remain major causes of morbidity and mortality, and inflict enormous economic costs on societies. In this article, we review the prevalence rates, geographical distributions, epidemic characteristics, risk factors, and clinical manifestations of parasitic diseases of poverty listed in the first issue of the journal Infectious Diseases of Poverty on 25 October 2012. We also address the challenges facing control of parasitic diseases of poverty and provide suggestions for better control. Keywords: China, Poverty, Parasitic diseases of poverty, Epidemic characteristics, Prevention, Control, Elimination Multilingual abstracts is a vicious cycle: poverty due to endemic IDoPs Please see Additional file 1 for translations of the depresses economies in the affected communities by abstract into the six official working languages of the reducing people’s ability to work. This in turn renders United Nations. the poor less able to pay for treatment and also aggra- vates transmission of IDoPs [2–6]. Background Although tremendous achievements have been made Infectious diseases of poverty (IDoPs) are a series of in fighting IDoPs in China in the past 60 years, the diseases closely related to poverty, which are mainly sheer scale of the task means that the country still prevalent in the least developed countries and regions accounts for a large percentage of the global burden of of the world [1–3]. Most IDoPs are neglected tropical disease due to IDoPs. For example, schistosomiasis diseases, causing disabling chronic infections, and still affects at least a hundred thousand people in even death [2]. In addition, IDoPs can result in huge China,andupto90%oftheworld’sburdenof economic losses and make it more difficult for poor alveolar echinococcosis is attributed to China, where people to improve their quality of life and social about 86 million people are at risk [7–9]. Of the 15 status [3]. million people who are infected with Clonorchis It has been estimated that IDoPs affect three billion sinensis globally, over 85 % live in China [7–9]. people worldwide, and they kill almost nine million In this review, our main objectives are to describe people each year, many of them are children under five the prevalence rates, geographical distributions, epi- [3]. Factors such as climate change and population demic characteristics, risk factors, and clinical mani- migration have accelerated the spread of these diseases, festations of parasitic diseases of poverty listed in causing health and socioeconomic problems globally. It first issue of the journal Infectious Diseases of Poverty on 25 October 2012, which have caused extensive * Correspondence: [email protected]; [email protected] damage in China (see Table 1) [1]. We also discuss †Equal contributors State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of the current challenges and strategies for controlling Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research these diseases. Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, People’s Republic of China © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. Wang Table 1 Key characteristics of parasitic diseases of poverty in China a b Disease Parasite Definitive host Intermediate host Factors relating to infection Clinical manifestations DALYs (thousands) et al. Infectious Diseases of Poverty Vector-borne diseases Malaria [10–13] Plasmodium spp. Humans and Mosquito Children, pregnant women, humble Fever, headache, shock, jaundice, 82 685 other animals house, lack of bed nets, immigrants abnormal bleeding, nausea, vomiting, from epidemic regions, occupation diarrhea, anemia, hepatosplenomegaly dependent exposure to mosquitoes Leishmaniasis [26–28] Leishmania spp. Humans and Sandfly Children, the older, males, dog CL: Skin papules, plaque, ulcer and 3 317 other mammals ownership, herdsman, humble nodular prurigo house, sleeping outside, occupation ML: Edema and erythema on nose, dependent exposure to sandfly nasal stuffiness or bleeding, mucosal lesions VL: Fever, weight loss, anemia, (2016) 5:67 hepatosplenomegaly Lymphatic filariasis [31–33] Wuchereria bancrofti Humans Mosquito Humble house, lack of bed nets, Lymphangitis, lymphnoditis, 2 775 Brugia malayi occupation dependent exposure lymphoedema, elephantedema Brugia timori to mosquitoes hydrocele, chyluria Snail-borne diseases Schistosomiasis [35–37] Schistosoma spp. Humans and Oncomelania hupensis Males, high frequency of water Fever, headache, abdominal pain, 3 309 other mammals contact, occupation dependent hematuria, anemia, bloody stool, exposure to snails, snails hepatosplenomegaly, colonic related practices tumoroid proliferation, ascites, hydronephrosis, dwarfism, megalosplenia Clonorchiasis [42–44] Clonorchis sinensis Humans and Water snails, fish Males, the older, high frequency Inappetence, abdominal pain, 275 other mammals and shrimps of eating of raw or undercooked gallstone, jaundice, anemia, freshwater fish hepatosplenomegaly, pyogenic cholangitis, cholecystitis Paragonimiasis [54] Paragonimus spp. Humans, cats, dogs Water snails and Children, high frequency of Chronic cough, chest pain, hemoptysis, 197 and other carnivores crustaceans eating of raw or undercooked pleurisy, dyspnea, freshwater crabs abdominal pain, epilepsy Fascioliasis [57–59] Fasciola gigantica Humans and Water snails Children, females, high frequency Fever, anemia, hepatic lesions and 35 Fasciola hepatica other mammals of eating of raw vegetables or fibrosis, hepatomegaly, jaundice, untreated water and contact cholangitis, cholecystitis with ruminants Soil-transmitted helminthiasis Ascariasis Ascaris lumbricoides Humans - Ascariasis and trichuriasis: Inappetence, undernutrition, 1 315 school-aged children abdominal pain, diarrhea, anemia, Trichuriasis Trichuris trichiura Humans - 638 Hookworm: the older and farmers growth and cognitive deficits Hookworm [63–66] Ancylostoma duodenale Humans - 3 231 Necator americanus Enterobiasis [66, 70, 72] Enterobius vermicularis Humans - School-aged children, crowded Inappetence, restlessness, perianal - Page 2 of 13 pruritus and discomfort, insomnia, irritability, growth and cognitive deficits Table 1 Key characteristics of parasitic diseases of poverty in China (Continued) Wang Zoonotic diseases et al. Infectious Diseases of Poverty Taeniasis/Cysticercosis Taenia solium Humans Humans, pig Pigs related practices, high Headaches, ocular disorders, epilepsy, 503 [73, 74, 76] Taenia saginata and cattle frequency of eating of raw pork seizure, neurological symptoms Taenia asiatica Echinococcosis Echinococcus Dogs and Humans and Females, the older, herdsmen AE: Tumour-like multi-vesicular 144 [77–80, 84–86] granulosus wild canids other animals slaughter and viscera disposal CE: Unilocular fluid-filled bladders Echinococcus practices, dog related practices multilocularis Water-borne diseases Cryptosporidiosis [88–90] Cryptosporidium spp. Humans and - Children, immunocompromised Diarrhea, growth deficits, 8 372 other animals individuals, poor water treatment malnutrition, weight loss (2016) 5:67 Giardiasis [95] Giardia spp. Humans and - Children, poor water treatment Diarrhea, malnutrition, growth - other animals deficits, weight loss Toxoplasmosis [98–101] Toxoplasma gondii Felids Humans and The older, cancer patients, Blindness, mental deficiency, - other animals immunocompromised individuals, encephalitis, stillbirths, abortion cat related practices Outbreak parasitic diseases Angiostrongyliasis Angiostrongylus Rats Snails and slugs High frequency of eating of raw Eosinophilic meningitis, - [104–107] cantonensis or undercooked snails headache, somnolence, ocular angiostrongyliasis aPoverty, poor sanitation and inadequate hygiene and poor knowledge of, attitudes towards and practice relating to parasites are also the predisposing factors to these diseases. bSource: WHO, Global Burden of Diseases 2010 [42, 130] Page 3 of 13 Wang et al. Infectious Diseases of Poverty (2016) 5:67 Page 4 of 13 Review launched in 2010, the incidence of locally transmitted P. Vector-borne parasitic diseases vivax malaria has declined, but numbers of imported P. Malaria vivax and P. falciparum malaria cases have increased Malaria, one of the most threatening diseases worldwide, significantly due to the large number of migrant workers is endemic in over 100 developing countries, with about and travelers coming into China. P. falciparum has be- 58 % of deaths due to malaria occurring in poor com- come the major imported
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