Review
Food-borne parasitic zoonoses in
China: perspective for control
Peng Zhou1*, Ning Chen1*, Ren-Li Zhang2, Rui-Qing Lin1 and Xing-Quan Zhu1
1
Department of Parasitology, College of Veterinary Medicine, South China Agricultural University, 483 Wushan Street, Tianhe
District, Guangzhou 510642, Guangdong Province, The People’s Republic of China
2
Laboratory of Molecular Biology, Shenzhen Center for Disease Control and Prevention, 21 Tian Bai No. 1 Street, Shenzhen 518020,
Guangdong Province, The People’s Republic of China
Food-borne parasitic zoonoses (FBPZs) cause death and
serious diseases in humans and animals worldwide, and
are of both public health significance and socioeconomic
importance. The FBPZ problem is severe in mainland
China, where 150 million people are suffering from
FBPZs and more people are at risk. Here, the current
status of the FBPZ problem in mainland China is
reviewed and strategies and measures for effective con-
trol of FBPZs are proposed. Major parasitic zoonoses
transmitted through consumption of infected or con-
taminated meat, fish, plants and/or water will be dis-
cussed.
Significance of food-borne parasitic zoonoses
Food-borne parasitic zoonoses (FBPZs) are human and
animal diseases caused by helminths and protozoans
through the consumption of infected or contaminated
meat, fish, plants and/or water; they pose significant public
health and socioeconomic problems [1–4]. An example of
the FBPZ problem is the continuing prevalence of human
and animal trichinellosis in many countries [5]. Cysticer-
cosis and echinococcosis also cause human death and
suffering in many countries, as well as considerable
economic losses in the meat industry [2]. The problem is
particularly severe in mainland China, where FBPZs cause
considerable socioeconomic and public health problems [6–
10]. There have been several review articles on FBPZs in
general [2–4], on a particular FBPZ [11,12] or focusing on
the FBPZ problem in particular countries [13], but there
has been no previously published overview on FBPZs in
mainland China in the English literature.
Meat-borne parasitic zoonoses
Trichinellosis
Human trichinellosis in mainland China is caused by
Trichinella spiralis and Trichinella nativa, and infection
occurs through the consumption of raw or undercooked
meat [14–16]. The recent national serological survey con-
ducted by using ELISA (enzyme-linked immunosorbent
assay) in ten endemic provinces estimated a mean preva-
lence of 3.3% [8] (Table 1). Human trichinellosis is extre-
mely serious in several provinces, in particular in Yunnan
and Inner Mongolia where it has a mean prevalence of
8.3% and 6.3%, respectively [8]. In fact, trichinellosis is
Corresponding author: Zhu, X.-Q. (xingquanzh@scau.edu.cn).
*
Authors contributed equally to this publication.
190 1471-4922/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.pt.2008.01.001 Available online 7 March 2008
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re-emerging in some areas of China, such as Qinghai
Province, because of the ‘Western Development Project’
and the developing tourist industry [15].
Infected pork is the main source of human infection with
T. spiralis, and dog meat is the source of human infection
with T. nativa [16]. The prevalence of Trichinella in pigs
and dogs is still high in some provinces (Table 1).
Cysticercosis and taeniasis
Human and pig cysticercosis is caused by Taenia solium
larvae when T. solium eggs that are released from infected
patients are accidentally ingested. Cysticercosis has been
established in 29 provinces [7,8] (Table 1). In the Yunnan,
Guizhou and Sichuan provinces, several minorities prefer
to eat raw pork and, hence, are at high risk of developing
cysticercosis [17]. For instance, the mean prevalence of
cysticercosis in the Bai and Miao minorities is 2.7% and
1.1%, respectively [8].
In China, human taeniasis is caused by the tapeworms
T. solium, Taenia saginata and Taenia asiatica [8,18]. It is
estimated that 550 000 people are infected nationwide [8].
Human infection with T. asiatica is endemic in Duyun,
Guizhou Province [19] and Lanping, Yunnan Province [20].
Swine cysticercosis is prevalent in all of the 31 mainland
provinces [17,21] (Table 1).
Toxoplasmosis
Human infection with Toxoplasma gondii has been
reported in each mainland province, with a mean infection
rate of 7.9% nationwide, as revealed by ELISA [8] (Table 1).
The Guizhou, Guangxi and Jiangxi provinces have higher
prevalence rates [8]. Prevalence in these provinces has
increased sharply in comparison with the prevalence
shown in the first national survey [6]. Many animal species
are infected with T. gondii in all mainland provinces
(Table 1). For example, as the definitive host for T. gondii,
cats have a prevalence of up to 79.4% [22]. Genotyping T.
gondii isolates from cats in Guangzhou, Guangdong Pro-
vince identified two genotypes, which are different from the
Type I, II and III lineages that predominate in North
America and Europe [22].
Echinococcosis
Echinococcosis, including cystic echinococcosis caused by
the cestode Echinococcus granulosus and alveolar echino-
coccosis caused by Echinococcus multilocularis, is regarded
as one of the most serious parasitic zoonoses in China
 Review
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Table 1. The prevalence of major food-borne parasitic zoonoses (FBPZs) in mainland China
Disease Parasite Definitive host Intermediate host Prevalence, and people infected Prevalence in animal Refs
Trichinellosis Trichinella spiralis Humans and other Not applicable 3.3% in ten endemic provinces; Pig: 6.7% in Hubei, 4.3% in Henan provinces; [8,14–16]
T. nativa mammals 20 million Dog: 9.8%–44.8% in northeastern China
Cysticercosis Taenia solium Humans Humans and pigs 0.55%; 7 million Pig: 0.23% in Hubei, 3.3%–10.5% in Sichuan province [7,8,17,21]
Toxoplasmosis Toxoplasma gondii Felids Humans, other 7.9%; 100 million Pig: 32.8% in Yunnan province, 33.1% in Hebei; sheep: [8,22,65–67]
mammals and birds 6.2% in Yunnan, 13.3% in Hebei; dog: 13.2% in Beijing,
14.6% in Yunnan, 26.9% in Hebei; cat: 14.6% in Beijing,
79.4% in Guangzhou
Echinococcosis Echinococcus Dogs and wild Humans and other 0.38 million Dog: 39.9%; fox: 24.8%; sheep: 55.3%; yak: 55.3%; [8,25]
granulosus canids mammals Goats: 30.7%; pigs: 7.6% in Qinghai Province
E. multilocularis
Clonorchiasis Clonorchis sinensis Humans and other Water snails, 2.4% in 27 endemic provinces; Snail: up to 15%; [8,29,30]
mammals freshwater fish and 12.5 million Fish: up to 100%;
shrimps Cat: 45.5%; dog: up to 60.4%
Paragonimiasis Paragonimus Humans, cats, dogs Water snails and 1.7% in eight provinces; Stream crab: 9.5%–54.3% [8,33–35]
westermani and other crustaceans 29.7% children in the countryside
carnivores (Shangluo)
Angiostrongyliasis Angiostrongylus Rats Snails and slugs 400 reported cases Rat: 19.5% in Wenzhou, 6%–15.9% in Fujian Province [39–43]
cantonensis Snail: 69.4% in Wenzhou, 0%–35.6% in Fujian Province
Schistosomiasis Schistosoma Humans and other Oncomelania 0.73 million Cattle and buffalos: 4.4% in seven endemic provinces [51,52,54]
japonicum mammals hupensis
Cryptosporidiosis Cryptosporidium spp. Humans and many Not applicable 2.1% in children with diarrhea in 14 Dairy cow: 6.4% in Anhui, 32.7% in Qinghai; cattle: 35%, [55–58]
animals provinces; 10.4% in children with yak: 39.7% in Qinghai Province
diarrhea in Zhejiang Province
Giardiasis Giardia lamblia Human and other Not applicable 2.5%; 30 million Dog: 25.2% in Jilin Province [59,62]
mammals

Trends in Parasitology
Vol.24 No.4
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Review
[8,10]. Echinococcus shiquicus n. sp. [23] and a variant of E.
multilocularis have been reported in China [24], but it is
yet to be determined whether these new members of
Echinococcus are infective to humans.
The recent nationwide ELISA survey estimated that
380 000 people are infected with echinococcosis and 50
million are at risk of infection [8] (Table 1). The endemic
provinces include Inner Mongolia, Ningxia, Qinghai, Jilin,
Henan, Sichuan, Guizhou, Yunnan, Shaanxi, Gansu, Tibet
and Xinjiang; of these, Xinjiang, Sichuan, Qinghai, Gansu
and Tibet have the most severe problems [8]. The preva-
lence of Echinococcus in animals is still unacceptably high
in northwestern China [25] (Table 1). Genotyping hydatid
cysts from humans and gravid tapeworms from dogs in
Xinjiang in northwestern China revealed that the E. gran-
ulosus G1 genotype is the major source of human cystic
echinococcosis, although the G6 genotype also was present
[26].
Sparganosis
Sparganosis is caused by larvae of the tapeworm Spirome-
tra spp. Humans become infected by: (i) drinking inade-
quately treated water contaminated by procercoid-infected
crustaceans; (ii) eating the raw or insufficiently heated
meat of second intermediate or paratenic hosts, such as
frogs and snakes, that are infected with plerocercoids; and
(iii) placing poultices of frog or snake flesh on open wounds
or other lesions, in particular on the eyes. If the flesh is
infected with plerocercoids, these plerocercoids can
actively penetrate into the treated lesion [10]. A total of
1000 cases of human sparganosis have been reported in
22 provinces [10]. Frogs are the main source of human
infection; their plerocercoid prevalence ranges from 8.1%
to 71.4% [27,28].
Fish-, shellfish- and mollusk-borne parasitic zoonoses
Clonorchiasis
Clonorchiasis caused by the oriental liver fluke Clonorchis
sinensis is considered to be one of the major parasitic
zoonoses in some parts of Asia [29]. Humans and other
mammals become infected with C. sinensis when they
consume raw or undercooked freshwater fish and shrimp
infected by C. sinensis metacercariae [29]. The recent
national survey showed that human clonorchiasis is ende-
mic in 27 provinces (including municipal cities and
autonomous regions) [8] (Table 1). The southern province
Guangdong has the largest number of infected people (5.5
million) because of the local custom of eating raw and
undercooked fish [8,29]. In China, 140 species of fresh-
water fish and four species of shrimp have been recognized
as second intermediate hosts for C. sinensis [30]. The
prevalence of infected fish is still high in some provinces
(Table 1). Cats and dogs are the most important animal
reservoirs for human infection and have high prevalence in
some provinces [30] (Table 1).
Anisakiasis
Human anisakiasis is caused by larvae of some genera of
the family Anisakidae (such as Anisakis, Contracaecum
and Pseudoterranova), and infection occurs through eating
raw or inadequately cooked fish infected with anisakids
192
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[31]. Since 1980, a total of 3591 marine fish specimens off
the Chinese coasts, representing 177 fish species, have
been surveyed for the prevalence of anisakid nematodes.
The results revealed that 47.1% of the fish specimens,
representing 151 fish species (85.3%), are infected with
anisakids [32], and several fish species have a prevalence of
100% [32]. In China, human infection with anisakids has
been reported in the media, but there have been no case
reports documented in scientific literature.
Paragonimiasis and pagumogonimiasis
Human paragonimiasis is caused by the consumption of
raw or undercooked stream crabs that are infected with
Paragonimus westermani or drinking water contaminated
by metacercaria. This disease is prevalent in 24 provinces
[8] [Table 1]. People in Shanghai and Chongqing have the
highest prevalences, at 5.1% and 4.1%, respectively [8].
Children in the endemic regions are at high risk of infection
with this parasite [33] [Table 1]. The prevalence of para-
gonimiasis in stream crabs is high [34,35] (Table 1). Cats,
dogs and civet cats are considered to be the most important
reservoir hosts of Paragonimus spp. in the endemic regions
[34] (Table 1). Human pagumogonimiasis is caused by
Pagumogonimus skrjabini through the ingestion of meta-
cercaria in crabs, and human cases have been reported in
14 provinces in mainland China [9,36].
Echinostomiasis
Human echinostomiasis is caused by the ingestion of
metacercariae of digenean trematodes of the family Echi-
nostomatidae in raw or undercooked mollusks, fish, crus-
taceans and amphibians (tadpoles or frogs) from fresh or
brackish water [3,37]. In mainland China, human infection
with echinostomiasis has been reported in at least eight
provinces, with an average prevalence of 0.015% [6], and an
average prevalence of 5% was reported in some parts of the
Fujian and Guangdong provinces [36,37]. Animal infection
with echinostomes is common in some provinces of China;
for example, in the southern part of Fujian Province, the
prevalence in dogs and cats is 39.7% and 9.5%, respectively
[36].
Angiostrongyliasis
Human angiostrongyliasis is caused by the larvae of rat
lungworm Angiostrongylus cantonensis and leads to eosi-
nophilic meningitis. Humans become infected by ingesting
freshwater and terrestrial snails and slugs [38,39]. The
first case of human angiostrongyliasis in mainland China
was reported in 1984 [38]. Since then, 400 human cases
have been reported (Table 1), including outbreaks of 65
cases in Wenzhou City of Zhejiang Province in 1997 [39]; 30
cases in Fuzhou, Fujian Province, in 2002 [39]; 28 cases in
Yunnan Province between 2003–2005 [40]; and 131 cases
in Beijing in 2006 [41]. Other sporadic cases occurred in the
Heilongjiang, Liaoning, Jiangsu, Zhejiang, Fujian, Guang-
dong, Yunnan, Beijing and Tianjin provinces [39].
Rats of 11 species are the definitive hosts for A. canto-
nensis and have prevalence up to 19.5% [42,43] (Table 1).
The prevalence of A. cantonensis larvae in Ampullaria
gigas, one of its intermediate hosts, is unacceptably high
in some endemic areas [42,43] (Table 1).
Review
Plant- and water-borne parasitic zoonoses
Fasciolopsiasis
Fasciolopsiasis in pigs and humans is caused by Fascio-
lopsis buski through ingestion of freshwater plants or
water containing metacercariae of this trematode [2,44].
The first national survey between 1988 and 1992 revealed
that fasciolopsiasis is distributed across 16 provinces and
affects a total of 9531 infected people [45]. Pig infection
with F. buski is common in the southern provinces of
China, and its prevalence is 7.5% in Hunan Province [46].
Fascioliasis
Human and animal fascioliasis is caused by infection with
Fasciola hepatica and Fasciola gigantica through ingestion
of freshwater plants or water containing metacercariae of
these trematodes [2]. In China, an intermediate Fasciola
between F. hepatica and F. gigantica has been identified
genetically [47].
A national survey between 1988 and 1992 revealed
that 148 people were infected with F. hepatica and nine
people were infected with F. gigantica [45]. Animal in-
fection with Fasciola spp. is common and causes signifi-
cant economic losses. For example, in Tongren, Guizhou
Province, the prevalence of cattle with F. hepatica and F.
gigantica is 68.9% and 37.6%, respectively [48]. A survey
in an abattoir in Nanning, Guangxi Zhuang Autonomous
Region, revealed that 50.5% of examined cattle and
53.9% of examined buffalos are infected with F. gigantica
[49].
Schistosomiasis
Human schistosomiasis caused by the trematode Schisto-
soma japonicum was once a devastating disease in China.
It is still considered the most important parasitic zoonosis
and has been listed as one of China’s three most important
communicable diseases to control and prevent from
spreading, together with HIV/AIDS and tuberculosis
[50–52]. Humans become infected with S. japonicum by
drinking water containing cercariae or through skin con-
tact with cercariae in the water [2]. In the mid-1950s,
schistosomiasis was endemic in 12 southern provinces,
with 12 million people being infected, and killed millions
of people [50–53]. After continued efforts for effective con-
trol for 50 years, schistosomiasis has been eliminated in
five of the 12 previously endemic provinces and the preva-
lence of schistosomiasis has dropped significantly in the
remaining seven endemic provinces since 2005 [52]
(Table 1).
In China, 40 species of mammals are the natural hosts
for S. japonicum. Buffalos and cattle have high prevalence
among animals and are the main reservoir hosts for human
infection [54] (Table 1).
Cryptosporidiosis
Cryptosporidium spp. represents one of the most common
enteric protozoan parasites of vertebrates and causes
diarrhea in humans and domestic animals [12]. Cryptos-
poridiosis is transmitted to humans either when they
drink water with oocysts or when they eat raw vegetables
or plants containing infective stages of Cryptosporidium
[12]. Human cases of cryptosporidiosis have been
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Trends in Parasitology Vol.24 No.4
recorded in 14 provinces, with young children being more
susceptible to infection than adults [55] (Table 1). For
example, Cryptosporidium oocysts were found in 57 of 548
children with diarrhea (10.4%) in Zhejiang Province [56].
The prevalence of Cryptosporidium spp. in animals is high
in some provinces [57,58] (Table 1).
Giardiasis
Giardiasis is caused by Giardia lamblia, which constitutes
the most common cause of protozoan diarrhea worldwide.
Contaminated water is an important source of human
infection, either through direct consumption or through
the use of contaminated water in food processing or prep-
aration [4].
Human infection with G. lamblia has been documented
in every mainland province [59] (Table 1). The prevalence
is high (9.3%) in Xinjiang, where people used to drink
untreated or poorly treated water. Giardia is more com-
mon in children (<10 years old), and the prevalence varies
from 5.0% in children aged 5–9 years to 4.2% in children
aged 10–14 years [59]. Genotyping G. lamblia isolates of
human origin from China revealed that the Chinese G.
lamblia isolates represent Group 2, Group 3, and the
mixture of Groups 1 and 3 [60,61]. Giardia is commonly
found in the feces of pets, livestock and wild animals, but
generally it is not considered to cause significant animal
disease [4]. Prevalence of Giardia in dogs in Jilin Province
is high [62] (Table 1).
Other FBPZs
In addition to the major FBPZs mentioned above,
there are some other parasites that cause emerging
FBPZs. These include Mammomonogamus laryngeus,
Babesia sp., Gnathostoma spinigerum, Armillifer spp.,
Heterophyes heterophyes, Cyclospora cayetanensis, Enta-
moeba histolytica and Balantidium coli [6–10]. These
parasites also should be taken into consideration when
implementing strategies and measures for controlling
FBPZs.
Problems in the control of FBPZs in China
China has undergone major socioeconomic development in
the past two decades, and one of her achievements is her
tremendous progress in the control of major human para-
sitic diseases transmitted mainly via soil, such as hook-
worms, Ascaris lumbricoides and Trichuris trichiura [8].
For instance, the total number of people infected with soil-
transmitted parasites has decreased significantly from
5360 million in 1990 to 1290 million in 2004 [8]. However,
compared with the first national survey carried out be-
tween 1988 and 1992, there has been a significant increase
in the total number of people suffering from FBPZs such as
clonorchiasis, trichinellosis, paragonimiasis and angios-
trongyliasis [6,8]. Some emerging FBPZs are causing sig-
nificant public health problems [8–10]. The most striking
example is clonorchiasis, for which the average national
prevalence has increased by 75% when compared with the
results of the first national survey. In particular, the
prevalence has increased by 182% in the province of
Guangdong, 162% in the province of Guangxi and 630%
in the province of Jilin [8]. In the west region of China, the
193
Review
prevalences of trichinellosis and toxoplasmosis are 69.4%
and 45.2% higher, respectively, than in the east region.
Several factors are considered to contribute to the
increase of FBPZ prevalence in mainland China:
(i) the habit of eating raw or undercooked fish and
meat, and the pursuit of eating exotic and
delicate foods such as sushi (in which raw fish
is the main component) and cisheng (sliced raw
fish);
(ii) the increase in income and living standard that
offers more opportunities for people to eat in
restaurants, providing more chances for infection
with FBPZs;
(iii) the relatively slow development in the detection and
quarantine of meat and fish for zoonotic pathogens,
which cannot match with the rapid development of
livestock and fishery industries; and
(iv) the insufficiency of comprehensive and inclusive
control strategies for several important FBPZs.
The major difficulties and problems we are confronting
in the control of FBPZs include:
(i) the insufficiency of comprehensive and authoritative
data on the prevalence and epidemiology of FBPZs in
animal hosts and the slack in validation and
standardization of detection and diagnostic tech-
niques for FBPZs in humans and animals, which has
resulted in difficulties when comparing similar
prevalence data obtained by different institutions
in the same provinces;
(ii) the insufficiency of financial supports for both
research and control from central and local govern-
ments, which has resulted in the slow increase in
fundamental research relating to the control of
FBPZs;
(iii) the decrease in the number of personnel dedicated to
the control of FBPZs and the high turnover rate of
research staff; and
(iv) the lack of coordination between the control of FBPZs
in humans and in animals.
Perspectives for effective control of FBPZs in China
Effective control of FBPZs is a tough task in China, a
country with more than 1.3 billion people of 56 nation-
alities. China’s economical development is uneven; the
west part of China is generally less developed than the
other parts of China, and hence China is implementing
the strategy of the ‘Western Development Project’. The
control of FBPZs requires the consideration of several
factors, including the thorough understanding of para-
sites’ life cycles, biology, transmission and epidemiology
as well as the hygiene habits of the population, climate
conditions and the culture and customs of different
nationalities. Finally, an educational campaign and
executive measures need to be implemented. Given that
FBPZs cause death and serious diseases in humans and
animals as well as significant socioeconomic and public
health problems in China, there are various strategies
and measures that can be taken to control FBPZs (Box
1). Although FBPZs remain a severe problem in China, it
could be well under control in the near future after our
painstaking efforts to execute these strategies and
194
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Trends in Parasitology Vol.24 No.4
Box 1. Strategies and measures that can be taken to control
FBPZs in China
(i) Political commitment and increase of financial support and
dedicated personnel by the central and local governments. This
is the key element for the effective control of FBPZs. For
example, when the World Bank Loan Project ended in 2001,
there was a corresponding drop in funding to control schisto-
somiasis, which in turn caused the increase of human cases of
schistosomiasis in 2003.
(ii) Regular epidemiological survey of FBPZs in humans and
animals, and the establishment of national and local informa-
tion networks dedicated to FBPZs. This will provide the
foundation (i.e. base-line information) for the design and
implementation of control strategies and measures.
(iii) Enhancement of fundamental research relating to the effective
control of FBPZs, such as the elucidation of parasite life cycles
and transmission, genetic variation, immune response and
protective immunity, epidemiology and diagnostic and control
techniques. The Chinese Central Government has demonstrated
its commitment to enhance fundamental research into the FBPZ
problem by funding a project for basic research relating to the
control of schistosomiasis and malaria through the National
Basic Research Program of China (i.e. the 973 program) in 2007.
(iv) Enhancement of food safety by implementing stricter quaran-
tine techniques and detection methods for FBPZ-causing
pathogens at the production, processing, distribution and
buying stages. This measure can ensure that food of animal
origins on the market is safe. Significant advances have been
made in the development of rapid detection and quarantine
techniques for FBPZ pathogens.
(v) Enhancement of collaboration with the World Health Organiza-
tion, the Food and Agriculture Organization of the United Nations
(FAO), the Office International Des Epizooties, the World Bank
and other countries. For example, the FAO has established a
global network of professionals directly involved in food-borne
zoonotic diseases including cysticercosis and echinococcosis,
which provides a basic framework for the spread of information
related to the diagnosis, prevention and control of major zoonotic
diseases [63]. Significant progress has been made in interna-
tional cooperation on the control of schistosomiasis, cysticerco-
sis and echinococcosis in China [53,64].
(vi) Educational campaigns utilizing various media, in particular TV
and radio, to promote awareness of the significance of and
control strategies for FBPZs. The change of people’s unhealthy
eating habits is crucial to the successful control of FBPZs in
some parts of China, particularly for some ethnic groups.
measures with support from the Chinese central and
local governments.
Acknowledgements
This work is supported, in part, by grants from the National Basic
Research Program of China (Grant Nos. 2007CB513104 and
2007CB116301), the Program for Changjiang Scholars and Innovative
Research Team in University (Grant No. IRT0723), the National Natural
Science Foundation of China (Grant No. 30671578), the Key Research
Programs in Natural Sciences for Institutions of Higher Education in
Guangdong Province (Grant No. 06Z004) and the Scientific and
Technological Programs of Guangdong Province (Grant No.
2005B20201003) to X.Q.Z.
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