Schistosomiasis is a zoonotic parasitic disease caused by Schistosoma japonicum infection, representing a significant public health concern for both animals and humans in China. A thorough understanding of the epidemiological features and diagnostic techniques associated with schistosomiasis is crucial for conducting prevention, control, and eradication strategies. This review provides a comprehensive update on the current diagnostic technologies and the prevalence of S. japonicum in human and wild rodent populations in China, focusing on literature published from 2015 to the present. In general, diagnostic methods include morphological identification, serological assays, and molecular techniques. While traditional methods like Kato-Katz remain widely used, emerging tools such as PCR-based assays, isothermal amplification (LAMP, RPA, RAA), and CRISPR/Cas systems offer enhanced sensitivity and suitability of field deployment. Serological tests (IHA, ELISA) are valuable for large-scale screening but face specificity challenges. A descriptive aggregation of 37 studies involving 46,910,186 human serum samples revealed an overall seroprevalence rate of 1.54% (95% CI: 1.53–1.54), with significant variation across 10 provinces (0.08% in Fujian to 4.95% in Yunnan). Higher seroprevalence was observed in males, local residents, and individuals engaged in farming or fishing. Concurrently, a narrative synthesis of 24 studies across seven provinces showed a substantially higher prevalence of 8.97% (95% CI: 8.50–9.44) in 14,381 wild rodents, with Rattus norvegicus showing the highest infection rate (37.44%). In conclusion, despite significant control progress, S. japonicum remains endemic in specific regions, with wild rodents serving as critical reservoir hosts. Integrating sensitive molecular diagnostics into surveillance programs and targeting rodent reservoirs are essential for achieving the national goal of schistosomiasis elimination by 2030.
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