Background: To explore the epidemiologic and clinical features of, and interactions among, multipathogen infections in hospitalized children with acute respiratory tract infection (ARTI). A prospective study of children admitted with ARTI was conducted. Peripheral blood samples were analyzed by indirect immunofluorescence to detect respiratory agents including respiratory syncytial virus; adenovirus; influenza virus (Flu) types A and B; parainfluenza virus (PIV) types 1, 2, and 3; chlamydia pneumonia; and mycoplasma pneumonia. A medical history of each child was taken.

This study aims to identify the landscape ecological determinants related to Oncomelania hupensis distribution, map the potential high risk of O. hupensis habitats at the microscale, and assess the effects of two environmental control strategies. Sampling was performed on 242 snail sites and 726 non-snail sites throughout Qianjiang City, Hubei Province, China. An integrated approach of landscape pattern analysis coupled with multiple logistic regression modeling was applied to investigate the effects of environmental factors on snail habitats. The risk probability of snail habitats positively correlated with patch fractal dimension (FD), paddy farm land proportion, and wetness index but inversely correlated with categorized normalized difference vegetation index (NDVI) and elevation. These findings indicate that FD can identify irregular features (e.g., irrigation ditches) in plain regions and that a moderate NDVI increases the microscale risk probability. Basing on the observed determinants, we predicted a map showing high-risk areas of snail habitats and simulated the effects of conduit hardening and paddy farming land rotation to dry farming land. The two approaches were confirmed effective for snail control. These findings provide an empirical basis for health professionals in local schistosomiasis control stations to identify priority areas and promising environmental control strategies for snail control and prevention.

IntroductionMore than 80% of schistosomiasis patients in China live in the lake and marshland regions. The purpose of our study is to assess the effect of a comprehensive strategy to control transmission of Schistosoma japonicum in marshland regions.Methodology/Principal FindingsIn a cluster randomized controlled trial, we implemented an integrated control strategy in twelve villages from 2009 through 2011 in Gong'an County, Hubei Province. The routine interventions included praziquantel chemotherapy and controlling snails, and were implemented in all villages. New interventions, mainly consisting of building fences to limit the grazing area for bovines, building safe pastures for grazing, improving the residents' health conditions and facilities, were only implemented in six intervention villages. Results showed that the rate of S. japonicum infection in humans, bovines, snails, cow dung and mice in the intervention group decreased from 3.41% in 2008 to 0.81% in 2011, 3.3% to none, 11 of 6,219 to none, 3.9% to none and 31.7% to 1.7%, respectively (P<0.001 for all comparisons). In contrast, there were no statistically significant reductions of S. japonicum infection in humans, bovines and snails from 2008 to 2011 in the control group (P>0.05 for all comparisons). Moreover, a generalized linear model showed that there was a higher infection risk in humans in the control group than in the intervention group (OR = 1.250, P = 0.001) and an overall significant downward trend in infection risk during the study period.Conclusions/SignificanceThe integrated control strategy, designed to reduce the role of bovines and humans as sources of S. japonicum infection, was highly effective in controlling the transmission of S. japonicum in marshland regions in China.Trial RegistrationChinese Clinical Trial Registry ChiCTR-PRC-12002405.

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