On June 16, 2023, National Disease Control and Prevention Administration of the People’s Republic of China, in collaboration with other ministries, formulated and issued the Action Plan to Accelerate the Elimination of Schistosomiasis in China (2023—2030). The implementation of this plan provides an important basis for achieving the targets set in the “Healthy China 2030” action plan and the implementation of the rural revitalization strategy. This paper describes the background, principles, targets, control strategies, safeguard measures and effectiveness evaluation of the plan, in order to guide the scientific and standardized implementation of actions for schistosomiasis elimination at the grassroots level, and facilitate the progress towards elimination of schistosomiasis in China with a high quality.

Objective To investigate the epidemiological characteristics and diagnosis of imported Plasmodium malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Guangxi Zhuang Autonomous Region and Henan Province from 2014 to 2021, so as to provide insights into malaria control in these five provinces. Methods All data pertaining to malaria cases reported in five provinces of China were captured from Chinese Disease Control and Prevention Information System from 2014 to 2021, and the epidemiological characteristics of imported P. malariae and P. ovale malaria cases were analysed using a descriptive epidemiological method. The duration from onset of malaria to initial diagnosis, duration from initial diagnosis to definitive diagnosis, institutions of initial and definitive diagnoses, and proportion of correct malaria diagnosis at initial diagnosis were statistically analyzed. Results A total of 1 223 imported P. malariae and P. ovale malaria cases were reported in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021, there were 158 P. malariae malaria cases (12.92%) and 1 065 P. ovale malaria cases (87.08%). Totally 98.53% (1 205/1 223) of the imported malaria cases were from Africa, with Angola (18.99%, 30/158), Nigeria (11.39%,18/158), Cameroon (10.76%, 17/158), Ghana (10.13%, 16/158) and the Democratic Republic of the Congo (10.13%,16/158) as predominant countries where P. malariae malaria cases were from, and Ghana (23.19%, 247/1 065), Cameroon (14.74%, 157/1 065), Nigeria (9.39%, 100/1 065) and Angola (6.95%, 74/1 065) as predominant countries where P. ovale malaria cases were from. There were significant differences in the duration from onset of malaria to initial diagnosis (χ² = 27.673, P = 0.000) and duration from initial diagnosis to definitive diagnosis of P. malariae and P. ovale malaria cases (χ² = 29.808, P = 0.000), and the proportions of correct initial diagnosis of P. malariae and P. ovale malaria cases were 38.61% (61/158) and 56.53% (602/1 065). There were 74.69% (118/158) of P. malariae malaria cases with definitive diagnosis in county-, city-, and province-level medical institutions, and 79.25% (844/1 065) of P. ovale malaria cases with definitive diagnosis in county- and city-level medical institutions and county-level centers for disease control and prevention. Conclusions The imported P. malariae and P. ovale malaria cases in Anhui Province, Hubei Province, Zhejiang Province, Henan Province and Guangxi Zhuang Autonomous Region from 2014 to 2021 were mainly returned from Africa and the proportion of correct diagnosis of P. malariae and P. ovale malaria was low at initial diagnosis. Persistent improvements in the diagnostic capability of malaria are required in medical institutions.

Objective To evaluate the molluscicidal effect of spraying different formulations of niclosamide ethanolamine salt with drones against Oncomelania hupensis in ditches. Methods A semi-dry and semi-wet ditch with O. hupensis snails was selected in the second branch field of Jiangbei Farm, Jiangling County, Hubei Province in May 2023, and divided into 4 experimental areas, named groups A1, A2, B1 and B2. Environmental cleaning was performed in groups A1 and B2, and was not conducted in groups A2 or B2. Then, 50% wettable powder of niclosamide ethanolamine salt was sprayed with drones at an effective dose of 2 g/m² in groups A1 and A2, and 5% niclosamide ethanolamine salt granule was sprayed with drones at an effective dose of 2 g/m² in groups B1 and B2. O. hupensis snails were surveyed using the systematic sampling method 1, 3, 5, 7, 14 days after spraying, and the natural mortality and corrected mortality of O. hupensis snails were calculated. Results The occurrence of frames with living snails, mean density of living snails and natural mortality of snails were 97.50% (117/120), 6.30 snails/0.1 m² and 1.18% (9/765) in the test ditch before spraying, respectively. There were significant differences in the mortality of snails among four groups 1, 3, 5, 7 and 14 days after spraying niclosamide formulations with drones (χ² = 17.230, 51.707, 65.184, 204.050 and 34.435, all P values < 0.01). The overall mortality rates of snails were 94.51% (1 051/1 112), 79.44% (908/1 143), 96.54% (977/1 012) and 88.55% (1 021/1 153) in groups A1, A2, B1 and B2 (χ² = 207.773, P < 0.05), respectively. In addition, there was no significant difference in the overall snail mortality between groups A1 and B1 (P > 0.05), and the snail mortality in groups A1 and B1 were both statistically different from that in groups A2 and B2 (all P values < 0.05). Conclusion Both 50% wettlable powder of niclosamide ethanolamine salt and 5% niclosamide ethanolamine salt granule sprayed with drones are active against O. hupensis snails in ditches, and environmental cleaning may improve the molluscicidal effect.

Objective To understand the application value of spacial clusters detection of human schistosomiasis epidemic,based on small scale level in heavy mountainous and hilly endemic areas, Songzi County,Hubei Province,China. Methods Positive results of human serological detection antibody titer equal or above 80,and positive schistosomiasis cases of fecal examination from 2016 to 2018 as research object in Songzi County.The flexible irregular space scan statistics was used to analyse the spatial clustering analysis of human schistosomiasis epidemic in the heavy mountainous and hilly endemic areas, setting parameter K=2 ,K=6 or K=10, respectively,based on small scale of village level in Songzi County. Results There was none positive schistosomiasis cases of fecal examination in Songzi County from 2016 to 2018.The number of human serological detection antibody titer equal or above 80 were  74, 206, 83, from 2016 to 2018，respectively.There was spatial clusters of positive of human serological detection antibody titer equal or above 80 for schistosomiasis cases in the county from 2016-2018. Areas of flexible irregular space scan statistic in cluster detection changing with the change of different K values. Under different parameters of flexible irregular space scan statistic results show that the most likely cluster of 40 endemic villages in three towns,inculding Laocheng town,Chendian town and Wangjiaqiao town were the prominent. Conclusion There are spatial clusters of human schistosomiasis based on small scale of village level by flexible irregular space scan statistic in mountainous and hilly endemic areas, Songzi County,Hubei Province.Therefore,the monitoring and control of schistosomiasis should be consolidated in the future,in order to achieve schistosomiasis elimination in Hubei Province at an early date.

Objective To analyze the spatial clustering of human schistosomiasis at the village level in key counties in Hubei Province, to provide scientific evidence for formulating strategies for human schistosomiasis prevention and control in the next stage. Methods Gong^'an County and Jiangling County in Hubei Province were selected as representative counties for this study. A town or village was set up as a research unit. Schistosomiasis cases of a positive fecal examination in 2015 and cases with positive detection for schistosomiasis serological antibody titer equal or above 80 in 2016-2018 were selected as research subjects in these two counties. The Kulldorff circular scan statistic was used for the spatial clustering analysis of human schistosomiasis infection status in the population. Results There was spatial clustering of positive schistosomiasis cases of fecal examination, at the level of a town or village in both counties in 2015. There was spatial clustering of positive human serological antibody detection at the level of town or village from 2016-2018. Eighty-six endemic villages in five towns in the northeast of Gong^'an County, along the Yangtze river,including Mahaokou Town, Zhakou Town, Yangjiachang Town, Jiazhuyuan Town and Douhuti Town, were the most prominent. There was no spatial clustering of positive results of human serological antibody detection at the town and village level in Jiangling County, in2017, while there was spatial clustering of human serological antibody detection in 2016 and 2018,respectively. Fifty-seven endemic villages in two towns (Puji Town and Xionghe Town) in the southwest of Jiangling County, along the Yangtze river,were the most prominent. Conclusion There were spatial clustering of human schistosomiasis epidemic at village level both in Gong^'an County and Jiangling County, Hubei Province. Compared with the previous studies, there was a trend of shrink and decline of clustering areas. Therefore, the current situation of the epidemic has put forward higher requirements for the implementation of precise prevention and control in the progress of schistosomiasis elimination work in various epidemic areas.

Objective To study the dynamic diffusion characteristics of Biomphalaria straminea in Shenzhen, Dongguan and Huizhou of Southern China. Methods B. straminea was monitored at 25 investigation points along 10 river channels in Shenzhen, Dongguan and Huizhou by salvaging method. The diffusion characteristics of snails along with water in the Guihua New Village section of the Guanlan River and the Dawei Village section of the Longgang River were analyzed by GPS location drift test. In addition, the influence of flooding on the diffusion of B. straminea in the Kuichong River both before and after Typhoon ^"Shanzhu^" was analyzed by monitoring the hydrology and distribution of snails. Results In March and October from 2016 to 2018, a total of 1 176 kg of floating objects were salvaged in rivers in Shenzhen, Dongguan and Huizhou. Scattered B. straminea were found on water hyacinths. Drift test of floats with GPS showed that the average drift speed of GPS floating objects was close to the river surface velocity. Affected by river current and wind direction, the GPS floats quickly drifted to the river bank and stopped in the stagnant area due to the blockade of water plants, stone and the bending of the shoreline. The drift distance of each time was between 136 - 715m. The test results of salvaged floating objects found that the loss rates of B. straminea were 46.70% - 60.00% and 22.10% - 30.80%, in the Guihua New Village section of the Guanlan River and the Dawei Village section of the Longgang River, respectively, which were significantly affected by the floating weight, river velocity and drifting distance. The analysis of the hydrology and distribution of B. straminea in the Kuichong River both before and after Typhoon ^"Shanzhu^" showed that the density of B. straminea in the river was significantly reduced by the flood. Conclusion B. straminea is mainly transported as suspended matter in water body, and flooding was an important factor in its long-distance diffusion.

Objective To assess the theoretical knowledge and practical skills of parasitic diseases among technicians from disease control and prevention institutions. Methods The Assessment on National Parasitic Disease Control and Prevention Techniques was organized in September,2015. Together,124 subjects from disease control and prevention institutions at prov-ince,prefecture or county levels in 31 provinces joined the assessment. A database was built consisting of subjects'basic infor-mation and assessment scores. Statistical analysis was used to analyze the scores by gender,age,professional title,institutions and places of participants. Results The average total score of all the subjects was 123.3,with a passing rate of 57.3%. The av-erage scores of male subjects(48 subjects)and female subjects(76 subjects)were 125.9 and 121.7 respectively;the average scores of the subjects aged under 30 years(57 subjects),between 30 and 40 years(61 subjects)and above 40 years(6 sub-jects)were 119.6,128.1 and 111.2 respectively;the average scores of persons with junior(94 subjects),intermediate(28 sub-jects)and senior(2 subjects)professional titles were 119.2,135.9 and 140.5 respectively. The average theoretical assessment score of all the subjects was 61.9,with a passing rate of 62.9%. The average practical skill assessment score of all the subjects was 61.4,with a passing rate of 58.1%. Conclusions The theoretical assessment results range widely. The theoretical knowl-edge results of technicians from disease control and prevention institutions are low in general. Therefore ,the specific training based on daily work needs to be enhanced.

This report presented the endemic status of schistosomiasis in the People's Republic of China at national level in 2013. By the end of 2013,there are 184 943 schistosomiasis japonica cases. Meanwhile,nine acute cases were reported,and 4 cases reduced compared with that of 2012. A total of 29 796 advanced cases were reported;while 911 cases were determined as advanced cases and 1 700 cases were dead in 2013. Nationally,there were around 365 467.99 hm2 Oncomelania snail infested areas in total and 9.25 hm2 of them habituated infected snails in 2013. There were 287.28 hm2 of snail infested areas found in non?endemic areas historically. Moreover,962 065 cattle were estimated to be raised in endemic regions and 633 cattle were deter?mined as positive by stool examinations. The data showed that the endemicity of schistosomiasis in China decreased further. How?ever,challenges exist to reach the aims of the medium and long term national program. Further control and effective surveillance need to be strengthened as the endemicity of schistosomiasis is unstable in the areas after schistosomiasis transmission under con?trol or interruption.

Objective To evaluate the cost-effectiveness of the comprehensive control measures carrying out in schistosomia-sis endemic inner embankment of marshland and lake regions from 2006 to 2010,so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination. Methods With ref-erence to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province,Jiangling County,one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture,was selected for the study. A definition of the infection rates of human and do- mestic animals was used for endemic villages stratified by different layers(i.e.,the village with the infection rates of human and domestic animals ≥3% belonged to the first layer,≥ 1% belonged to the second layer;<1% belonged to the third layer). By us- ing the stratification method and cost-effectiveness analysis,the endemic villages stratified with the different layers were investi- gated and all the data of schistosomiasis endemic situation,cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010. Results In the effectiveness of schistosomiasis control,by the end of 2010, there were no first layer villages,there were 114 second layer villages,and there were 18 third layer villages in Jiangling Coun- ty. In the former first layer villages,the schistosomiasis patients decreased year by year ultimately to 0;but in the second and third layer villages,the schistosomiasis patients increased. In the fecal treatment and management,the coverage rates of harm- less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages,whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years,the input of comprehensive control measures was 10 266 3900 Yuan,much higher than the human and buffalo examinations and treatments,Oncomelania hupensis snail investi- gation and elimination(4 183 000 Yuan)and other labor inputs(2 239 500Yuan). In the ratio of cost-effectiveness,the annual ratio of unit cost(1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas)increased yearly. In addition, the semi-logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers(logarithmic values of any two layers of pair-wise comparison were <1,and in the third layer villages, the annual average logarithmic values of 5 years were <1). Whereas,in the first and second layer villages,the annual average cost was fluctuated(the costs was higher than the inputs). Conclusion The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas,the main infection source(buffaloes)still exists and the present control mea- sures including fecal management should be further strengthened. In the resource allocation,in the field of health,the annual distribution of key inputs and unit-cost control also has a further space of adjustment.

Objective To analyze the time and space aggregation of acute schistosome infections in marshland and lake areas in five provinces(Jiangsu,Anhui,Jiangxi,Hubei and Hunan province)from 2005 to 2012,so as to provide the evidence for es-tablishing control strategies and taking effective control measures. Methods The data of patients with acute schistosome infection in marshland and lake areas in five provinces from 2005 to 2012 were collected and analyzed with the concentration ratio and circu-lar distribution methods for the epidemic season features and time aggregation of the infection,and with the spatial autocorrelation analysis for the space aggregation of the infected cases. Results According to the concentration ratio,the occurrence of acute schistosome infection had strong seasonality,and the concentration ratio was 0.758;according to the circular distribution method, the peak day of acute schistosome infections was 10th,August. The spatial analysis suggested that the infected cases highly gath-ered around Poyang Lake,Dongting Lake and Yangtze River Basin in 23 counties of the five provinces,and the result of spatial au-tocorrelation analysis showed that the spatial autocorrelation index I was 0.16(P=0.01). Conclusion The occurrence of acute schistosome infections in lake regions of the 5 provinces shows strong seasonality and space aggregation,therefore we can bring the control mark forward,and take targeted prevention and control measures in high aggregation areas of acute schistosomiasis.