Schistosomiasis control and the health system in P.R. China

Please see Additional file 1 for translations of the abstract into the six official working languages of the United Nations.Schistosomiasis japonica is mainly prevalent in People’s Republic of China (P.R. China), the Philippines and small pockets of Indonesia, although P.R. China is the most heavily endemic of the three countries [1,2]. A large-scale epidemiological survey at the beginning of 1950s found that the disease was endemic in 10 provinces, one autonomous region and one municipality (city) mainly along the Yangtze River in the south of China [3]. It was estimated that 11.6 million people were infected with schistosomes and more than 100 million people were at risk of infection in the 1950s. There were 1.2 million infected cattle and the habitat area of Oncomelania hupensis, the intermediate host snails of S. japonicum, reached 14.3 billion m2. A great deal has been achieved in controlling schistosomiasis in P.R. China [1,4,5]. Between 1985 and 1995 disease transmission was interrupted in five provinces namely Guangdong, Shanghai, Fujian, Guangxi, and Zhejiang. By 2010, three provinces - Sichuan, Yunnan, and Jiangsu - reached the criteria of transmission control (both human and livestock prevalence less than 1%). Four other provinces characterized with complicated environments and easily affected by the water level of the Yangtze River- Hubei, Hunan, Jiangxi and Anhui - reached the criteria of infection control in 2008 (both human and livestock prevalence less than 5%). The number of infected cases has been reduced by over 97% since the 1950s, reaching the lowest historic level of 325,824 infections in 2010 [6]. The area of Oncomelania hupensis habitats was estimated to be 3.7 billion m2 which is about 25% of that in 1950s [7].Having noted the above achievements, there are still many major challenges such as the existing extensive snail habitats with complicated environments, ecosystem changes caused by the construction of the Three Gorges Dams and the South