China’s shifting neglected parasitic infections in an era of economic reform, urbanization, disease control, and the Belt and Road Initiative

A shifting pattern of parasitic diseases in ChinaPublished estimates from China's Ministry of Health indicated that by the early 1990s China exhibited some of the world's highest prevalence rates of parasitic and other tropical diseases [1].The findings included estimates that more than 0.5 billion people were infected with ascariasis, whereas approximately 200 million people suffered from trichuriasis and hookworm infection [2, 3].In the more than two decades since the first published estimates of China's parasitic infections, the nation has undergone impressive economic development, with its GDP growth roughly increased by 10% annually and massive reductions in the numbers of Chinese living in extreme poverty [4].Indeed, the World Bank notes that China was successful in achieving all of its Millennium Development Goals [4].As a result, today China is the second largest economy globally next to the United States.In addition to rapid economic growth that promotes urbanization, significant change in agricultural practice, and improved sanitation, China has undertaken extensive parasite control measures [5].These changes have translated into impressive reductions of China's neglected parasitic diseases and other neglected tropical diseases (NTDs) during recent decades.Based on several national surveys for parasitic diseases performed by Ministry of Public Health and other public health agencies in 1994 [1, 2], 2005 [6], and 2010 [7], as well as the data from Global Burden of Disease (GBD) 2016 [8], the overall trends of China's major neglected parasitic infections are shown in Fig 1.Overall there is general concurrence between both referenced data sets.Briefly, China's major neglected parasitic diseases have declined dramatically, especially soil-transmitted helminth infections (STHs), schistosomiasis [5], and malaria [9], and lymphatic filariasis has been eliminated [10].However, the prevalence of some food-borne trematode infections and cysticercosis has significantly increased [11].Although autochthonous malaria has been nearly eliminated in China, imported malaria and other parasitic infections have been brought into China from Africa or other endemic countries as trade activities and traveling have increased during the past decades, especially after the newly launched Belt and Road Initiative.