Objective To study the impact of precipitation and water level on acute schistosomiasis for providing reference to control acute schistosomiasis in advance. Methods The historical data on precipitation and water level as well as acute schistosomiasis from 2003 to 2007 in Eastern, Southern and Western Dongting Lake regions were collected and analysed for the correlation between acute schistosomiasis and precipitation and water level in local areas. Results Acute schistosomiasis gradually decreased year by year from 2003 to 2007. Compared with 2003, the number of acute schistosomiasis in 2007 reduced by 95.37%. There was no outbreak of acute schistosomiasis from 2005 to 2007.In the period of peak acute schistosomiasis, the average monthly rainfall reduced from year to year for the successive 5 years. There was a significantly correlation between acute schistosomiasis and monthly average water level. Conclusions The acute schistosomiasis is directly affected by nature factors and has a close correlation with the rainfall and water level in Dongting Lake regions.