Human babesiosis, an emerging tick-borne disease in the People’s Republic of China

Babesiosis is a typical zoonotic, emerging disease caused by a tick-borne intraerythrocytic protozoan of Babesia spp. that also can be transmitted by blood transfusion. Babesiosis imposes an increasing public-health threat. We reviewed and mapped epidemiological studies on Babesia in vectors and/or rodents in the People’s Republic of China (P.R. China) and found that B. microti was the predominant species detected in the investigated regions such as Heilongjiang, Zhejiang, Fujian provinces and Taiwan island. We reviewed a series of sporadic human babesiosis cases collected from 1940’s to 2013, in Yunnan, Inner Mongolia, Taiwan and Zhejiang and other regions including a main endemic area of malaria on the China-Myanmar border areas in P.R. China. Clinical manifestations of human babesiosis were also reviewed. Human babesiosis may have previously been overlooked in P.R. China due to a lack of medical awareness and the limitation of clinical diagnostic methods.National Natural Science Foundation of China (grant No. 81273192). Zhou XN was supported by Special Fund for Health Research in the Public Interest (grant No. 201202019) and the National S&T Major Program (grant No. 2012ZX10004220).http://www.parasitesandvectors.com/content/7/1/509am201

Individual and pooled preventive effects (PRs) of two consecutive rounds of ACWT against schistosome in humans.

<p>PR, ratio of infection prevalence after two rounds of ACWT to prevalence before. ACWT refers to annual community-wide treatment. Diamond and vertical dashed line indicate combined PR, and horizontal lines indicate 95% confidence intervals.</p

Heterogeneous test of effects of studies against schistosome infection within each group.

<p>Note: *ACWT refers to annual community-wide treatment.</p

Individual and pooled preventive effects (PRs) of one round of ACWT against schistosome in humans.

<p>PR, ratio of infection prevalence after one round of ACWT to prevalence before. ACWT refers to annual community-wide treatment. Diamond and vertical dashed line indicate combined PR, and horizontal lines indicate 95% confidence intervals.</p

The flow diagram of paper review process.

<p>ACWT refers to annual community-wide treatment. One article may contain one or more studies.</p

Control Efficacy of Annual Community-Wide Treatment against <i>Schistosoma japonicum</i> in China: A Meta-Analysis

<div><p>Backgrounds</p><p>Human schistosomiasis is caused by <i>schistosome</i>, with annual loss of over 70 million disability adjusted life years in the world. China is endemic with <i>Schistosoma japonicum</i> and large-scale chemotherapy with praziquantel has become the mainstay of control in China since 1990s. However, the control effects of mass treatment in the field have been uneven. Moreover, mass treatment has come into a wide use in other countries with limited health resources. Therefore, a better understanding of the control effect of mass treatment is in an urgent need.</p><p>Methods</p><p>We performed a systematic search of the literature to investigate the control efficiency of annual community-wide treatment (ACWT, treatment to an entire community without any preliminary screening) with a single dose of PZQ (40 mg kg⁻¹ bodyweight) against schistosome in humans in China. Three Chinese literature databases, including China National Knowledge Infrastructure, WanFang and Chinese Scientific Journal Databases, and the PubMed were searched. Pooled prevalence ratios (prevalence after to before treatment) were used to assess effect. Our protocol is available on PROSPERO (No. CRD42013003628).</p><p>Results</p><p>22 articles were included. Meta-analyses on data from 18 studies on one round of ACWT, 17 studies on two consecutive rounds and 6 studies on three consecutive rounds were performed. The results showed control effects of ACWT plus other measures were statistically significant, with prevalence ratios being 0.38 (0.31, 0.46) for one round, 0.28 (0.22, 0.35) for two rounds and 0.22 (0.10, 0.46) for three rounds. When ACWT was performed alone or with health education only, the values for one and two rounds were 0.389 (0.307, 0.492) and 0.348 (0.300, 0.403), respectively.</p><p>Conclusions</p><p>The control effect of ACWT alone or with other measures is significant and increases with the number of rounds. Such program is recommended in high endemic areas and the criteria yet merit further assessment.</p></div

Individual and pooled preventive effects (PRs) of three consecutive rounds of ACWT against schistosome in humans.

<p>PR, ratio of infection prevalence after three rounds of ACWT to prevalence before. ACWT refers to annual community-wide treatment. Diamond and vertical dashed line indicate combined PR, and horizontal lines indicate 95% confidence intervals.</p

Subgroup analyses of prevalence ratio (PR) accroding to endemic regions and concomitant measures.

<p>Note: <b>^*</b> ACWT refers to annual community-wide treatment. <b>^§</b> refers to a fixed effects model, otherwise a random effects model.</p

Heterogeneity and pooled seroprevalence (%, 95% CI) of studies among mobile populations by year from 1992 to 2013.

<p>Heterogeneity and pooled seroprevalence (%, 95% CI) of studies among mobile populations by year from 1992 to 2013.</p