In 1994, examinations for students of elementary and middle schools at Taierzhuang台兒莊 district in Tsaozhuang found the average infection rate was 7.2%
and the highest rate was 23.5%. During 1985-1995, investigations and measures of control were widely conducted for five times and the infection rate was reduced to 1%.
In 2000, sample surveys found the infection rate was 0.3% (5/1550).190 In Boxing博 興 County, surveys at Dongjia Village董家村 in 1992 found the infection rate was 4.8% (104/2164) for residents and 6.6% (28/426) for students.191
A review article in 2007 contended that the infection of CS in Shandong had been brought under control because of the following reasons: (1) A combination of investigation, control, and health education had produced significant effects; (2) The people had changed their daily habits along with the improvement of economic conditions and popularity of health knowledge; (3) As the climate in Shandong continued to be dry, many ponds had dry up and wild fishes and snails lost the environment for propagation. It was suggested that the experience of control and health education in Shandong could provide a good example for other provinces.192 (2) Hebei
In Hebei, there were surveys at Tangshan唐山 and Funing撫寧 in 1980 and found the infection rates of CS among residents were respectively 3.6% (3/83) and 4.9% (46/936), and that of elementary school pupils was 1.5% (4/266).193 Available data are mostly related to Tianjin. From September 2003 to May 2004, sample surveys at 30 locations of Tianjin area found the infection rate was 0.16% (19/12000);
among the locations investigated, only Jixian薊縣 had 0.51% and Wuqing武清 had 0.06% while others had no infection. The higher infection rate at Jixian was possibly due to the habit of eating raw fish.194
4. Concluding Remark
The infection of Clonorchis sinensis forms a cycle among the parasite, the intermediate hosts, and the final hosts. Rivers, lakes and ponds provide suitable environment for intermediate hosts to propagate but it is human actions that make this cycle to run over and over again. Human practices in fish culture implied an idea of utilizing waste but the danger of parasitic infection was ignored. Moreover, the habit
189 Li Ping-luan et al., 2001; Fu Mei-rong, 2003.
190 Xue Ying-hui et al., 2001.
191 Li Guo-qian et al., 1998.
192 Li Deng-jun et al., 2007.
193 Huang su-fang et al., 1983; Gao Yong, 1983.
194 Zhu Chuan-fang et al., 2006.
of eating raw or half-cooked fish induced the infection of CS. Besides the infection rates in each area presented above, there are also substantial studies on intermediate hosts and other animal hosts but they should be discussed in another paper.
It should be noted that as early as 1925 Faust pointed out the necessity of educating Cantonese about the harmfulness of eating raw fish in order to eliminate the infection of CS in the next generation.195 In 1937, Hsü and Chow also emphasized that it was urgent to educate Cantonese and if they could give up eating raw fish, the infection of CS would disappeared naturally.196
Since the 1990s, the infection of CS in Taiwan and Mainland China was gradually under control with medical treatment. However, the opening of trade and traveling between Taiwan and the Mainland as well as entrance of foreign brides and workers into Taiwan also brought certain danger of new infection. Particularly, the appearance of Thai liver fluke should not be overlooked. In Mainland China, in many places measures of control had been adopted and the infection rate had been reduced to some extent, however, the infection rate was still increasing in many other places as economic conditions were gradually improved since the late 20th century and there were more people who could afford and had acquired the habit of consuming raw fish.
Moreover, the increasing opportunities of traveling to endemic area also help in spreading the infection. Thus, in addition to medical care, whether education alone can be effective in preventing the infection of CS among the people and to break the cycle of transmission is a problem required serious study.197
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