The discovery and elimination of Lymphatic Filariasis in China



The discovery and elimination of Lymphatic Filariasis in China







1. The history of filariasis discovered in China

The lymphatic filariasis is the generic name of filariasis caused by Bancroft’s filaria, Brugia malayi and Timori Brugia with prosopon parasitizing in the human lymphatic system. In China, there is only prevalence of Bancroft’s filarial and Brugia malayi. Filariasis was discovered quite early in China, and the clinical manifestation similar to lymph filariasis had been recorded in traditional Chinese medicine books. In the year 610 A.D., the book “Treatise on the Root Causes of Various Diseases” written by Yuanfang Chao, an imperial court physician of the Sui dynasty, stated the relative symptoms introduced were similar to centrifugal angileucitis, adenolymphitis, chyluria and hydrocele
in the modern medicine. Subsequently, the areas with high prevalence of the disease introduced in later medicine books mainly refer to the territories between Changkiang river and Huai river, the east of Changkiang river, Lingnan, which are similar to the results of modern filariasis investigation.

There had never been a report about the etiology of filariasis until the 19th century, and the endemic areas were limited to the areas along the coast and its’ surroundings. The serial studies on filariasis was conducted by Manson Bahr between 1872 and 1879 in Xiamen had the most pioneering significance. In this investigation of 1872, the hydroceles of many patients with scrotum elephantiasis were found to have microfilaria and a section of female worm. In 1877, Manson firstly described filariasis as transmitted by mosquito in Xiamen and found that microfilaria would grow and transform in the body of Culex pipiens fatigans. A study on the relationship between Bancroft’ s microfilaria and mosquito proposed that Culex pipiens fatigans was the alternate host of Bancroftian filariasis. Later, from the study on the rhythm of microfilaria appearing in the peripheral blood in 1879, it was concluded that Bancroft’s microfilaria in Xiamen had nocturnal periodicity.

Zong’en Li, a Chineses cholar, firstly carried out a survey of filariasis in 1925, and found that the prevalence of Bancroftian Filariasis in the north of Jiangsu province was quite common. The crowd infection rate of microfilaria was 5.9% (7/119) in Xuzhou and 15.9% (31/195) in Huaiyin. In 1926, through the analysis of the experimental infection of patients infected by Bancroftian filariasis, it was reported that Culex pipiens pallens was the transmission intermediary of Bancroft’ s filaria. Subsequently, in 1931 and 1933, the well-known parasitic disease specialist Lanzhou Feng reported the natural infection of mosquito infected by Bancroft’ s filaria in the Wusong region of Shanghai City and Xiamen City of Fujian province. Then, in 1933, Lanzhou Feng found Brug’ s microfilaria in a patient from Huzhou in Zhejiang province in Xiamen. This was the first report describing the epidemic of Brug’s filariasis in China. In the same year, the overall morphology of Bancroft’ s and Brug’s microfilaria were observed. The detailed morphology was described through different methods, and a map of systematic structural pattern was drawn,. These methods are still used in China and foreign countries. In 1934, through further study of the transmission intermediary of Filariasis, professor Lanzhou Feng confirmed that Anopheles sinensis and Mansonia uniformis were the transmission intermediary of Brug’s filariasis. Two years later he wrote an article about the growth of Brug’s microfilaria in the body of Anopheles sinensis. Meanwhile, through the study on the effect of mosquito spreading filariasis in the suburb of Shanghai City and Fuzhou City of Fujian province, professor Meiji Hu reported the experimental research on the susceptibility of common mosquito to Bancroft’s filaria and Brugia filaria during 1933˜1946.


2. The distribution and damage of lymphatic filariasis in China


2.1 Epidemic intensity

It was found that the endemic of lymphatic filariasis was only in Fujian, Zhejiang, Jiangsu, Shandong and Hunan provinces by sporadic investigation of
lymphatic filariasis before the founding of New China. After the liberation, the first National Health Conference in 1950 determined health working policy for New China which contained “working for the workers, farmers and soldiers”, “focused on prevention”, “combining traditional Chinese traditional medicine with western medicine”. With the guidance, health professionals and epidemiologists carried out the epidemiological investigations of lymphatic filariasis in countryside, troops, mines, and factories.

In the mid-1950s, twelve provinces plus an autonomous Region and one large city in the mainland of China: Shandong, Henan, Hubei, Anhui, Jiangsu, Zhejiang, Jiangxi, Fujian, Guangdong, Hunan, Guizhou, Sichuan, Shanghai, and Guangxi Zhuang Autonomous Region, and over 700 cities were prevalent for lymphatic filariasis, resulting in serious medical, social, and economic damage. From February to March in 1970, two teams were organized by the Ministry of Health and the preventing leading offices from13 provinces, cities, and municipalities in south China to investigate the epidemiology, prevention and control of lymphatic filariasis. Subsequently, it was gradually discovered that 864 cities of these above mentioned 14 provinces, cities and autonomous regions were endemic regions of lymphatic filariasis; among which 461 counties were endemic regions of Bancroftian filariasis, 222 cities were that of Brug’s filariasis, 181 counties and cities were of Bancroftian filariasis and Brug’s filariasis. (Table 6.1 )








Table 6.1 The number of the endemic counties, cities of lymphatic filariasis and patients of filariasis in provinces, municipalities, autonomous regions (1980)






























































































































provinces, municipalities, autonomous regions


endemic counties, cities


patients of lymphatic filariasis (ten thousand)


Total


Bancroftian filariasis


Brug’s filariasis


Admixture


Shandong


74


74


0


0


500


Henan


71


42


1


28


253.8


Hubei


69


10


47


12


410


Anhui


82


31


18


33


353


Jiangsu


71


60


1


10


230.2


Shanghai


10


5


2


3


5.8


Zhejiang


67


3


39


25


269


Jiangxi


75


9


33


33


210


Fujian


68


16


24


28


208.4


Guangdong


62


61


1


0


240


Hunan


55


39


10


6


160.2


Guangxi


68


60


6


2


80


Guizhou


47


20


26


1


100


Sichuan


27


13


14


0


59


Henan


18


18


0


0


20


Total


864


461


222


181


3099.4


from «Elimination of lymphatic filariasis in China»


On the basis of the herd prevalence rate of microfilaria in the epidemic areas, the endemic intensities of the disease were divided into four levels. According to
the Napier stratified method, and taking county as a unit, there were 818 low and midrange epidemic areas in China which accounted 94.7%, while the high and superhigh epidemic areas accounted 5.3%.(Table 6.2 ).

The epidemic intensity of lymphatic filariasis was primarily related to economic and health conditions, human behaviors, and the species of lymphatic filariasis. In areas with poor economic and health conditions, inhabitants had the habit of sleeping outdoors in summer, consequently increasing exposure to where Bancroft’ s filaria prevalence rates were already relatively high. For instance, before 1949, the founding of the People’s Republic of China, the prevalence of microfilarria was 35.4% (139,489/394,000), prior to elimination in Fengyang County of Anhui province where the floods wrre frequent. The prevalence rate of microfilarria in this county was the highest of all the endemic areas of lymphatic filariasis in China. However, the epidemic intensity of Brug’ s filariasis had positive correlation with density of gnat, especially anthropophagy anopheline. In the Table 6.2 there were 23 counties or cities with the high and superhigh prevalence of Brug’s filariasis, of which the majority were related to the high density of anthropophagy anopheline.








Table 6.2 Prevalence rate of microfilaria in 864 counties, cities (1980)



















































































































provinces, municipalitie autonomous regions


endemic counties, cities


≤5


5.1˜20.0


20.1˜30


>30


Shandong


38


27


9



Henan


44


26


1



Hubei


36


26


7



Anhui


30


47


3


2


Jiangsu


37


33


1



Shanghai


10


0


0



Zhejiang


35


29


1



Jiangxi


41


29


5



Fujian


21


41


6



Guangdong


54


8


0



Hunan


42


12


1



Guangxi


59


9


0



Guizhou


28


14


5



Sichuan


11


12


4



Henan


14


3


1



Total


502


316


44


2


Percentage (%)


58.1


36.6


5.1


0.2


from «Elimination of lymphatic filariasis in China»



2.2 Distribution of disease


2.2.1 Geographic distribution

The endemic areas of Bancroftian filariasis were largely in the plains of China. The plains of four provinces including Jiangsu, Shandong, Anhui, Henan bordered and formed an important endemic area. Moreover, if the quantity of intermediary culex was large in the mountain areas, it also resulted in the epidemic of
Bancroftian filariasis. So was the mountain area where Sichuan, Guizhou, Hunan, Hubei bordered. The epidemic areas of Bancroftian filariasis were north to Leling County in Shandong province (north latitude 37°48′), south to Sanya City in Hainan province (north latitude 18°10′), east to Zhoushan Archipelago in Zhejiang province (east longitude 122°30′), west to Tongzi County in Guizhou province (east longitude 106°50′). The endemic areas of Brug’s filariasis were north to Bo’ai County in Henan province (north latitude 35°21′), south to Luocheng County in Guangxi Zhuang nationality autonomous region (north latitude 24°50′), east to Zhoushan Archipelago of Zhejiang province (east longitude 122°30′), west to Ya’an City in Sichuan province (east longitude103°), most of which were to the south of Changkiang River.

In 1959, Dr. Zhong-zhang Tang proposed that the sole insect and large lamellar distribution were characteristics of the geographic distribution of Bancroftian filariasis and Brug’s filariasis forming the four above mentioned areas in China. The endemic areas of Bancroftian filariasis were in the region of Shandong, Jiangsu, Henan and the north of Anhui, the region of Hainan, Guangdong, Guangxi and the south of Hunan, the region of Sichuan, Guizhou, the west of Hunan and Hubei, the region of the coast and islands of Fujian and Zhejiang. The endemic areas of Brug’s filariasis included: Zhejiang, Fujian, Jiangxi and the south of Anhui, Hubei, Hunan, Guizhou, Guangxi and the southwest of Hunan, E’mei mountain areas in Sichuan. The endemic areas that the two kinds of filariases simultaneously existed were mostly limited in small areas, and generally distributed in the epidemic areas which was the bordering region of Bancroftian filariasis and Brug’s filariasis.

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Aug 1, 2016 | Posted by in INFECTIOUS DISEASE | Comments Off on The discovery and elimination of Lymphatic Filariasis in China

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