Human liver flukes in China and ASEAN: Time to fight together.

The second forum on health cooperation between China and the Association of Southeast Asian Nations (ASEAN) was held in Guangxi, China, on September 19 and 22, 2018 [1].Important resolutions, including those on the cooperation between China and ASEAN member countries on traditional medicine, management of hospitals, youth exchanges, and the prevention and control of diseases, were proposed at the regional forum [1].This regional cooperation provides a platform and a potential opportunity to fight the menace of human liver flukes together.Two human liver flukes-namely, Clonorchis sinensis and Opisthorchis viverrini-exert a huge burden in China and Southeast Asia [2,3].Infections due to these human liver flukes are predominantly endemic in China and several ASEAN member countries as a result of the traditional and rooted dietary habit of ingesting raw freshwater fish.There are about 15 million people infected with C. sinensis globally, out of which 13 million are domiciled in China and 1 million in northern Vietnam [2].O. viverrini infection accounts for about 8.6 million cases, with distribution in the following ASEAN member countries: Thailand (6 million cases), Laos (2 million cases), and Cambodia (0.6 million cases) [3].O. viverrini infection is also endemic in southern Vietnam.Recent findings have revealed the distribution of O. viverrini infection in Myanmar, which has given us more insight on human liver fluke distribution in the region [4].Thus, China and ASEAN member countries share more than 90% of the clonorchiasis burden and about 100% of the opisthorchiasis viverrini burden.Both infections pose significant health concerns in the region.Long and chronic infections could lead to high morbidity in liver and the biliary system (e.g., gallstone, cholecystitis, and cholangitis) [2,5,6].In particular, only three parasites are definite carcinogens, including both C. sinensis and O. viverrini [7], which are responsible for a conservative estimate of 7,000 new cases of cholangiocarcinoma yearly [8].Thus, China and ASEAN member countries are highly afflicted with cholangiocarcinoma [9].In spite of the persistent high burden, human liver flukes are yet to receive adequate attention compared with other neglected tropical diseases, and this enhances the disease persistence in the region.For example, Guangxi, where the health cooperation meeting was held, is highly endemic with clonorchiasis.Most neglected tropical diseases have been effectively controlled in Guangxi, especially lymphatic filariasis, which was eliminated in 1985 [10], and schistosomiasis transmission, which was interrupted in 1988 [11].However, there has been an increasingly widespread distribution and prevalence of clonorchiasis over the past decades [12,13].A basis for the potential cooperation between China and ASEAN on human liver flukes already exists.First, C. sinensis and O. viverrini belong to the same family, and thus they have many similarities in biology, pathobiology, carcinogenicity, epidemiological determinants, diagnosis, treatment, control, and prevention [2, 3].Second, research and development on

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   Current status and perspectives of Clonorchis sinensis and clonorchiasis: epidemiology, pathogenesis, omics, prevention and control · 2016

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