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Understanding the trends, clustering, and risk factors of pinworm infection in preschool settings: A repeated
Fanzhen Mao1,2, Xuecheng Li1, Sheng Ye1
1School of Public Health, Key Laboratory of Public Health Safety and Emergency Prevention and Control Technology of Higher Education Institutions in Jiangsu Province, Nanjing Medical University, Nanjing, China.
Insights
Pinworm (Enterobius vermicularis) infections in Chinese preschools show a downward trend but persist with clustering. Migrant children are at higher risk, with parental education and income mediating the infection link.
Area of Science:
- Pediatric infectious diseases
- Public health epidemiology
- Parasitology
Background:
- Pinworm (Enterobius vermicularis) is the most common helminth infection in young children globally.
- Despite control efforts, pinworm infections remain a significant public health issue in Chinese preschools.
Purpose of the Study:
- To investigate the epidemiological trends, spatial-temporal clustering, and risk factors of pinworm infections in preschools in Jiangsu, China.
- To identify key determinants influencing pinworm transmission within preschool settings.
Main Methods:
- A repeated cross-sectional study involving 27,925 children across 45 counties in Jiangsu Province from 2019 to 2024.
- Utilized multi-stage cluster sampling and adhesive cellophane tape swabs for diagnosis.
- Employed permutation analysis for clustering and logistic regression for risk factor assessment.
Main Results:
- Overall pinworm infection rate decreased from 1.22% in 2019 to 0.11% in 2024.
- Significant within-preschool clustering was observed in 2019 and 2021.
- Migrant children (OR=3.91) and older age (OR=1.44) were identified as risk factors; parental education and income mediated 55.2% of the migrant status association.
Conclusions:
- Pinworm infections exhibit within-preschool clustering, necessitating targeted interventions.
- While infection rates are declining, specific attention should be given to migrant children in preschool settings.
- Findings support the development of enhanced strategies to control enterobiasis and safeguard preschool children's health.
Background:
Pinworm (Enterobius vermicularis) remains the most prevalent helminth among preschool-aged children worldwide. Despite China's rapid development and decades of mass deworming, pinworm infection persists as a significant paediatric public-health problem. In this study, we aimed to understand the trends, clustering, and risk factors of pinworm infection in preschool settings of Jiangsu, China.
Methods:
A repeated cross-sectional study was conducted in 45 counties of Jiangsu Province from 2019 to 2024. Multi-stage cluster convenience sampling was applied. Each year, one rural preschool and one urban preschool were selected per county. The sample size for each school was 229 to obtain a 5% margin of error, an arbitrary design effect of 1.5 for a prevalence estimate of 10%, and a 10% nonresponse rate. A total of 27,925 children were investigated. Adhesive cellophane tape swabs were collected for confirmation of pinworm infection. A preschool-level permutation approach was used to evaluate clustering effects of pinworm infections within preschools, measured by infection rate ratio (IRR). Risk factors of pinworm infections were assessed by multiple logistic regression. Mediation analysis was conducted between the risk factor and pinworm infection.
Results:
The overall pinworm infection rate was 0.48%, ranging form 1.22% in 2019 to 0.11% in 2024 and showing a downward trend (χ2 = 52.436, P < 0.001). Significant within-preschool clustering effect was observed in 2019 (IRR = 5.95, 95% lower CL = 3.77) and 2021 (IRR = 1.96, 95% lower CL = 1.35). Risk factors for preschool pinworm infection included migrant children (OR=3.911, 95%CI = 2.749-5.610) and older age (OR=1.443, 95%CI = 1.209-1.730). Mediation analysis indicated that parental education and family income collectively explain 55.2% of the association between migrant status and infection.
Conclusions:
Pinworm infections among preschool children demonstrate a within-preschool clustering effect. Despite the observed decline in infection rate of pinworms, targeted interventions are necessary in preschools, especially for migrant children. This study contributes to the broader understanding of enterobiasis and support the development of strategies to protect children's health in preschools.
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