{ "abstract": "Hookworm infection remains a neglected tropical disease in rural areas where low-level transmission may persist despite long-term control efforts. This repeated cross-sectional study evaluated changes in hookworm infection in six rural villages of Tiantai County, Zhejiang Province, China, before and after implementation of an integrated control program. In 2022, approximately 200 permanent residents aged ≥3 years were sampled from each village for the baseline survey. After one year of integrated interventions, including sanitation improvement, health education, deworming, and strengthened village-level management, another cross-sectional survey was conducted in the same villages in 2024. Hookworm infection was detected using stool examination. Prevalence was compared between survey years, and Firth penalized logistic regression was used to estimate adjusted associations with infection while addressing sparse data and complete separation. A total of 1,218 individuals were examined in 2022, of whom 58 were positive for hookworm infection, corresponding to a prevalence of 4.76%. In 2024, 1,222 individuals were examined and 13 infections were detected, corresponding to a prevalence of 1.06%. The overall prevalence decreased by 77.73%. In the Firth penalized logistic regression model adjusted for sex, age group, educational level, occupation, and village, the odds of infection in the 2024 post-intervention survey were significantly lower than those in the 2022 baseline survey (adjusted OR = 0.223, 95% CI: 0.125–0.399, P < 0.001). Male sex, primary education or below, and residence in Qianyang, Xiatang, or Xiaqiao villages were associated with higher infection odds. Hookworm prevalence declined substantially in the same villages after implementation of integrated control measures. However, the absence of non-intervention control villages limits causal attribution. Sustained surveillance and targeted interventions remain needed for high-risk populations and villages. Author summary: Hookworm infection is a parasitic disease that can cause anemia, fatigue, and poor nutrition, especially in rural communities where people often work in close contact with soil. Although national control programs have reduced infection in many places, some villages and population groups can remain at risk, and it is not always clear which measures work best in real-world settings. In this study, we compared community surveys conducted in Tiantai County, Zhejiang Province, in 2022 and again in 2024 after implementation of an integrated hookworm control pilot that included sanitation improvement, health education, and deworming treatment. The overall proportion of people with hookworm infection fell from 4.76% to 1.06%, and most baseline-positive individuals who were successfully followed became infection-free. However, infection did not disappear completely. However, this was not a randomized or controlled study, and not all baseline-positive individuals were followed; therefore, the reduction cannot be attributed solely to the intervention package. Older adults, people with lower levels of schooling, and residents in certain villages continued to have higher risk. These findings suggest that integrated approaches may help reduce hookworm transmission, but long-term success requires better monitoring of intervention coverage, behavioral practices, environmental conditions, and residual high-risk groups.", "abstract_shown": true, "affiliations": [ "Infectious Disease Prevention and Control Center, Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.", "Department of Inspection and Testing, Tiantai County Center for Disease Control and Prevention, Taizhou, Zhejiang, China.", "Tiantai County Center for Disease Control and Prevention, Taizhou, Zhejiang, China.", "Department of Infectious Diseases, People's Hospital of Tiantai County, Taizhou, Zhejiang, China.", "Department of Microbiological Laboratory, Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.", "Infectious Disease Prevention and Control Center, Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.", "Taizhou City Center for Disease Control and Prevention, Taizhou, Zhejiang, China.", "Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China." ], "article_type": "Research Article", "arxiv": null, "author_total": 10, "authors": [ { "affs": [ 0 ], "name": "Qing Gao", "orcid": "0009-0000-9854-9250" }, { "affs": [ 1 ], "name": "Haiyan Hu" }, { "affs": [ 2 ], "name": "Junhua Ge" }, { "affs": [ 2 ], "name": "Weilong Pang" }, { "affs": [ 3 ], "name": "Yingjun Chen" }, { "affs": [ 0 ], "name": "Bingzhi Chen" }, { "affs": [ 0 ], "name": "Xiang Zheng" }, { "affs": [ 4 ], "name": "Weiwei Shen" }, { "affs": [ 5 ], "name": "Jimin Sun" }, { "affs": [ 6, 7 ], "name": "Haijiang Lin", "orcid": "0000-0002-4550-0258" } ], "bibtex": "https://research.draconitic.com/paper/7ee1djqwft5c5.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014835", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014835", "id": "7ee1djqwft5c5", "issns": [ "1935-2735", "1935-2727" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014835", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Age Groups" ], [ "heading", "Animals" ], [ "heading", "Biology and Life Sciences" ], [ "heading", "Education" ], [ "heading", "Educational Attainment" ], [ "heading", "Environmental Health" ], [ "heading", "Epidemiology" ], [ "heading", "Eukaryota" ], [ "heading", "Health Care" ], [ "heading", "Health Education and Awareness" ], [ "heading", "Helminth Infections" ], [ "heading", "Helminths" ], [ "heading", "Hookworms" ], [ "heading", "Invertebrates" ], [ "heading", "Medical Conditions" ], [ "heading", "Medical Risk Factors" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Organisms" ], [ "heading", "Parasitic Diseases" ], [ "heading", "People and Places" ], [ "heading", "Population Groupings" ], [ "heading", "Public and Occupational Health" ], [ "heading", "Research Article" ], [ "heading", "Sanitation" ], [ "heading", "Schools" ], [ "heading", "Social Sciences" ], [ "heading", "Sociology" ], [ "heading", "Zoology" ], [ "plos", "/Biology and life sciences/Organisms/Eukaryota/Animals/Invertebrates/Helminths/Hookworms" ], [ "plos", "/Biology and life sciences/Zoology/Animals/Invertebrates/Helminths/Hookworms" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Health care/Environmental health/Sanitation" ], [ "plos", "/Medicine and health sciences/Health care/Health education and awareness" ], [ "plos", "/Medicine and health sciences/Medical conditions/Parasitic diseases/Helminth infections" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Environmental health/Sanitation" ], [ "plos", "/People and places/Population groupings/Age groups" ], [ "plos", "/Social sciences/Sociology/Education/Educational attainment" ], [ "plos", "/Social sciences/Sociology/Education/Schools" ] ], "openalex": null, "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014835&type=printable", "pmcid": "PMC13718970", "pmid": "42956065", "published": "2026-10-01", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/7ee1djqwft5c5.ris", "sources": [ { "first_seen": "2026-10-30T12:17:17Z", "native_id": "10.1371/journal.pntd.0014835", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014835" }, { "first_seen": "2026-10-31T00:20:39Z", "native_id": "PMC:PMC13718970", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13718970" }, { "first_seen": "2026-11-01T00:20:36Z", "native_id": "MED:42956065", "source": "europepmc", "url": "https://europepmc.org/article/MED/42956065" }, { "first_seen": "2026-11-02T12:22:53Z", "native_id": "PMC13718970", "source": "pmc", "url": "https://doi.org/10.1371/journal.pntd.0014835" } ], "subjects": [ { "field": "biology", "origin": "plos:zoology", "subfield": "zoology-behaviour" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "A comparative analysis of baseline and post-intervention surveillance in a hookworm control pilot: Evidence from Tiantai County, Zhejiang Province, 2022–2024", "title_text": "A comparative analysis of baseline and post-intervention surveillance in a hookworm control pilot: Evidence from Tiantai County, Zhejiang Province, 2022–2024", "type": "peer-reviewed", "updated_at": "2026-11-02T12:22:53Z", "url": "https://research.draconitic.com/paper/7ee1djqwft5c5", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }