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Background    Schistosoma japonicum  is a major public health concern in China, with over one million people infected and another 40 million living in areas at risk of infection. Unlike the disease caused by  S. mansoni  and  S. haematobium , schistosomiasis japonica is a zoonosis, involving a number of different mammalian species as reservoir hosts. As a result of a number of published reports from China, it has long been considered that bovines, particularly water buffaloes, play a major role in human  S. japonicum  transmission there, and a drug-based intervention study (1998–2003) around the Poyang Lake in Jiangxi Province provided proof of concept that water buffaloes are, indeed, major reservoirs of human infection in this setting.    Methods and Findings  In this study we incorporated recently obtained epidemiological information to model the steady-state  S. japonicum  transmission as well as the impact of the removal of  S. japonicum  transmission attributable to water buffaloes on human infection rates across six different endemic scenarios within three villages in the Dongting (Hunan) and Poyang (Jiangxi) lakes of southern China. Similar results were obtained for all scenarios. Steady-state  S. japonicum  infection rates remained constant and human prevalence and incidence were predicted to fall considerably over time. The model showed that the contribution of  S. japonicum  water buffalo transmission to human infection ranged from 39.1% to 99.1% and predicted that the removal of water buffalo transmission would reduce parasite reproductive rates below 1. This indicates that without the contribution of water buffaloes,  S. japonicum  transmission is interrupted and unsustainable. These scenarios are generalizable to other endemic villages in the lake and marshland areas of China where a similar cycle of snail infection and infection/reinfection of humans and bovines occurs.    Conclusions  Along with previous epidemiological data, our findings strongly support water buffaloes as an important component of the transmission cycle that affects humans in the lake and marshlands region of China, a feature which appears to differ from the situation prevalent in the Philippines where their contribution is less pronounced. Our conclusions underscore the rationale for removal, replacement or treatment of water buffaloes, and for the development and deployment of a transmission blocking buffalo vaccine against  S. japonicum  for this setting to achieve the goal of transmission control. The Chinese Government has recently commenced a new integrated national strategy to improve on existing approaches to control schistosomiasis in the lake and marshlands region by reducing bovines and humans as a source of  S. japonicum  infection to  Oncomelania  snails.

Transmission Dynamics of Schistosoma japonicum in the Lakes and Marshlands of China