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Objective: To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy., Methods: The integrated schistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectors were retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control measures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for assessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schistosomiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. japonicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails., Results: A total of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to 2019. During the 16-year period, a total of 277 437.12 hm 2 snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built, 290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm 2 water lands improved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm 2 forests planted and 38 535.27 hm 2 lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bovines in Hunan Province in 2004, with 2 449.37 hm 2 snail habitats in inner embankments and 3 423.74 hm 2 infected snail areas. In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reduced to 540.92 hm 2 (77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis control effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect index was 97.35 in 2019; the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and 100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner embankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively., Conclusions: The integrated control measures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the prevalence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infected snail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate the control achievements.

Objective: To understand the dynamic rules of schistosomiasis endemic situation before and after reaching the criteria of schistosomiasis transmission controlled or transmission interrupted, so as to provide the evidence for improving schistosomiasis control., Methods: Wuling District, Xihu District and Linli County were selected and investigated retrospectively to collect the schistosomiasis epidemiological information 10 years before they reached the criteria of transmission controlled and the subsequent years until 2008. A database of retrospective investigation was established for analyzing the trends and rules of changes of the Oncomelania hupensis snail status and infection status of cattle and human., Results: In Wuling District, the endemic situation was declining, and no schistosome infection persons, animals and snails were found after 1974. There was no rebound until 2008. In Xihu District, the endemic situation reached the criteria of transmission controlled in 1997, and the endemic situation was stable. The human infection rate was positively correlated with the area of infection snails (r = 0.584, P < 0.05). In Linli County, there were no snails, no infected persons and cattle twice, but 2 endemic rebounds, and there were positive correlations between the densities of living snails and the infection rates of human and animal during the endemic rebound period., Conclusion: The snail status is an important indicator of schistosomiasis endemic rebound. Therefore, the snail control is one of the most important schistosomiasis control measures.

Objective: To analyze the changes of schistosomiasis endemic situation before and after reaching the criteria of schistosomiasis transmission control or transmission interruption in endemic rebounded areas, so as to offer the information for modifying the criteria of schistosomiasis control and elimination, and consolidating achievements of schistosomiasis control in People's Republic of China., Methods: Twelve counties with endemic rebound were selected from seven endemic provinces and investigated with the retrospective research method. The data including the epidemic information and relative materials 10 years before the counties reached the criteria of transmission control and several years later (until 2008 or 2009) were collected. The changes of epidemic situation of these counties before and after the transmission was under control or interrupted, and the factors causing the endemic rebound were analyzed., Results: Counties consolidated the endemic situations with an average time of 5 +/- 3 years after the transmission control, with endemic rebound normally caused by single factor. The ratio of Oncomelania snail areas to historically accumulative snail areas increased over 10% in hilly endemic regions and lake endemic regions in 7 and 12 years separately, while it was stabilized in a low level in water-network endemic areas. The rebound peak time of infected snail densities was consistent with or later than that of densities of living snails. The prevalence of schistosome infection in humans in lake endemic regions rebounded 2 years after transmission under control. The transmission interruption counties consolidated the endemic situations with an average time of 7 +/- 4 years. The human prevalence of schistosome infection decreased to a very low level after the counties reaching the criteria of transmission interruption. The snail areas increased to over 2% of historically accumulative snail areas 3-6 years after transmission interruption in lake, water-network endemic areas successively, while densities of living snails and infected snails were increased at the same year or 2-3 years later., Conclusions: The endemic rebound in regions after the transmission under control or interrupted is caused by biological, natural and social factors and mainly presents as the rebound of snail status. The modification of criteria for schistosomiasis control and elimination should consider the influence of variation of snails, snail areas and density of infected snails on endemic situations in different endemic areas comprehensively. Sensitive and valid surveillance and forewarning system should be established to strengthen the monitoring and consolidating endemic situation in endemic areas after the transmission under control or interrupted.

Objective: To summarize and analyze the process of the changes of schistosomiasis infection and Oncomelania snails in schistosomiasis transmission-controlled areas to explore the rules of the impact of changes of snail indexes on human infection before and after the stage of transmission control, so as to provide the evidence for editing snail indexes in the schistosomiasis controlled criterion and a more scientific, standardized control assessment and evaluation., Methods: Twenty-one schistosomiasis transmission-controlled or transmission-interrupted counties in lake endemic areas and hilly endemic areas in 8 provinces were selected and investigated retrospectively to collect schistosomiasis epidemiological information 10 years before these counties reached the criterion of transmission control and the subsequent years until 2008 or 2009. A " Standard county schistosomiasis epidemic survey data review software" was developed to establish a national epidemic retrospectively database; the trends of changes of snail status, infected snail status and human infection status were analyzed in different years. The trends and rules of the changes of snail areas, emerging snail areas, living snail densities, infected snail densities, snail infection rates and human infection rates were analyzed and compared before and after the counties reached the schistosomiasis transmission-controlled criterion in different types of endemic areas., Results: Before the transmission control, the human infection rate presented a declining trend in endemic areas. In lake endemic areas, the human infection rate declined to below 5% 4 years before the transmission control; in hilly endemic areas, the human infection rate declined to below 3% 8 years before the transmission control, and the human infection rates of the lake and hilly endemic areas declined to 2.10% and 1.45%, respectively, at the year of transmission control. However, 3 to 4 years after transmission control, the disease began to rebound, especially in lake endemic areas. The snail areas and snail densities declined year by year 10 years before the transmission control in the lake and hilly endemic areas, and the proportion of snail areas occupying the historic snail areas declined the lowest, being 2.75% and 0.55%, respectively, at the year of transmission control. The average densities of living snails kept a low level from 3-4 years before the transmission control to 9-10 years after the transmission control, and then rebounded. The new snail areas appeared 6-7 years after the transmission control and the snail areas and densities of living snails rebounded 9-12 years after the transmission control., Conclusions: The snail status can maintain a relatively low level during about 10 years after the transmission control in the lake and hilly schistosomiasis endemic areas, but the schistosomiasis status rebounded 5 years after the transmission control. While the comprehensive measures mainly including infectious source controlled are implemented, the snail surveillance and control should be still strengthened, and it is recommended that "the proportion of snail areas decreased" and "the control of infected snails" would be the indicators of the criterion of schistosomiasis transmission control.

Objective: To analyze the changing rules of schistosomiasis endemic situation in the area of transmission that has been interrupted before and after they reach the criteria of transmission interruption, so as to offer the basis of amending to the criteria of schistosomiasis transmission interruption and a more scientific, standardized assessment and evaluation of the effects of schistosomiasis control in the future., Methods: Nineteen counties of transmission that has been interrupted in 9 provinces nationwide were selected and investigated with the retrospective research method to collect and record the endemic detailed data 10 years before they reach the criteria of transmission interruption and several years later (ended in 2008 or 2009) and then a database was established. The changing rules of various disease indices in different endemic areas before and after reaching the criteria of transmission interruption were analyzed and compared., Results: The average time from the transmission control to the transmission interruption was 17 years in the 17 counties. After reaching the criteria of transmission interruption, the infection rates of people turned down to a minimum level in various endemic areas, the infection rates in a few numbers of lake endemic areas and hilly endemic areas increased slightly after the transmission interruption 4-9 years later, but all of them were below 1%. The densities of living Oncomelania snails in lake endemic areas and water-network endemic areas were high and the changes were great each year, and the densities of living snails were much lower in hilly endemic areas than in the above two types of areas and they came to the lowest 4 years before and after the transmission interruption. The infected snails appeared occasionally in lake endemic areas, and they recurred 6 years and 10 years after the transmission interruption in water-network endemic areas and hilly endemic areas, respectively. The continued time without infected snails found before reaching transmission interruption was 2.71 +/- 1.10 years averagely in transmission-interrupted counties with endemic stable, and was 3. 80 +/- 1.43 years in lake endemic areas., Conclusions: It is possible to maintain a low level of population schistosome infection, and the endemic rebound is shown as snail rebound after the endemic areas reach the criteria of transmission interruption, The infected snails could be the comprehensive index reflecting the control achievement and the risk of schistosomiasis transmission. So the persistent control of infected snails is the fundament of schistosomiasis transmission interruption. It is suggested that in our current social and economic development and science and technology capacity conditions, the status of no infected snails found continuously for 5 years would be one of the criteria of schistosomiasis transmission interruption.