We would like to respond to the Letter by Ping Lu and colleagues regarding our article Schistosoma haematobium infection in workers returning from Africa to China. African schistosomiasis is caused by Schistosoma mansoni or S. hematobium. In China, only Schistosoma japonicum is endemic. However, with the rapid increase of tourism, international trade, and China-aided projects in Africa, over 1 million Chinese are now residing in Africa, who have a high risk of exposure to African schistosomiasis due to the lack of knowledge on African schistosomiasis. From 1979 to 2013, a total of 147 cases infected with S. mansoni and 283 cases infected with S. hematobium have been reported in China. But, the Chinese physicians are unfamiliar with the clinical manifestations and unaware of the possibility of African schistosomiasis. Moreover, the infected individuals might be asymptomatic or may have had minor symptoms. So, for every patient returned from Africa, there may be more individuals who, if similarly exposed, might remain asymptomatic and infected. This African schistosomiasis may be neglected, undiagnosed, or misdiagnosed. The reported cases represent only the tip of the iceberg for the actual number of cases with African schistosomiasis in China. Therefore, the public health department and Center of Disease Control should implement the epidemiological investigation of Schistosoma infections in all returners from Africa.
Although the intermediate host snails (Bulinus spp.) of S. hematobium have not been reported in China, an intermediate host (Biomphalaria straminea) of S. mansoni was found as an invasive snail species in river systems in Hong Kong and Shenzhen of southern China. Survey and control of the snails should be carried out to eliminate the risk of transmission of African schistosomiasis in China.