Cross-sectional assessment of Angiostrongylus cantonensis transmission risk mediated by invasive apple snails in Jiangsu Province of China

PLOS Neglected Tropical Diseases

Dear Dr. LIU,

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Kind regards,

Angela Monica Ionica, Ph.D.

Academic Editor

PLOS Neglected Tropical Diseases

Krystyna Cwiklinski

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

Journal Requirements:

1) Please ensure that the CRediT author contributions listed for every co-author are completed accurately and in full.

At this stage, the following Authors/Authors require contributions: Qiang Zhang, Fanzhen Mao, Bixian Ni, Jiayao Zhang, Feng Tang, Xinyi Gong, and Yaobao Liu. Please ensure that the full contributions of each author are acknowledged in the "Add/Edit/Remove Authors" section of our submission form.

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2) We notice that your supplementary Table is included in the manuscript file. Please remove it from the main file of the manuscript as it should be uploaded separately with the file type 'Supporting Information'. 

3) Please amend your detailed Financial Disclosure statement. This is published with the article. It must therefore be completed in full sentences and contain the exact wording you wish to be published.

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Reviewers' Comments:

Comments to the Authors:

Please note that two reviews are uploaded as attachments.

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: -Are the objectives of the study clearly articulated with a clear testable hypothesis stated? YES

-Is the study design appropriate to address the stated objectives? YES

-Is the population clearly described and appropriate for the hypothesis being tested? YES

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested? PERHAPS

-Were correct statistical analysis used to support conclusions? I HAVE CONCERNS ABOUT THE MULTIVARIATE ANALYSIS - NEED MORE DETAILS

-Are there concerns about ethical or regulatory requirements being met? NO

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: -Does the analysis presented match the analysis plan? YES

-Are the results clearly and completely presented? SOMEWHAT - SEE MY COMMENTS ON THE ATTACHED MANUSCRIPT

-Are the figures (Tables, Images) of sufficient quality for clarity? TEXT ON THE FIGURE COULD BE LARGER FOR READABILITY

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: (No Response)

Reviewer #2: Yes

Reviewer #3: -Are the conclusions supported by the data presented? UP TO A POINT - SEE MY COMMENTS ON THE ATTACHED MANUSCRIPT

-Are the limitations of analysis clearly described? YES - TO THE EXTENT THAT THE PAPER MAY NOT BE ACCEPTABLE

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study? YES

-Is public health relevance addressed? YES

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: Most of my comments are of minor detail, including minor adjustments to the English. All are on the marked-up Word file, which I attach and that should be sent to the authors (the Word file not a pdf as conversion from Word to pdf will truncate at least some of the comments).

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: Although this is an interesting study, in my opinion, the results are not scientifically robust enough to warrant publication in this journal. The manuscript does not provide substantial new insights into the ecological or health-related drivers of Angiostrongylus cantonensis transmission. Therefore, I would suggest that the authors consider submitting the article to PLOS Global Public Health, where it may be a better fit in terms of scope and focus. Please find my comments in the attached file.

Reviewer #2: 1. KAP should be defined the first time it is used, in the abstract

2. Why is T1 considered as Supplemental? It should be just Table 1 in the paper and adjust other accordingly.

3. L201, big space unneeded

4. L199, Why is 78.7% respondents referred to as ‘only’ 78.7%. That is a pretty big number of respondents

5. L 238 Indent needed for consistency

6. L 272.Again, why is 78.7% considered as a ‘low’ reporting rate, to me seems pretty high.

7. L290 Remove either ‘such as’ or ‘like’, so don’t need both.

8. Why wasn’t PCR testing conducted, it’s much more sensitive?

Reviewer #3: This is an unusual paper. It's in two parts: 1) a survey of snails in the wild and a search for snails for sale in markets to detect the rat lungworm parasite (Angiostrongylus cantonensis), which uses snails as intermediate hosts and is the cause of eosinophilic meningitis in humans, and 2) a KAP survey of people's responses to various questionsa about apple snails.

Regarding (1) no wild snails were found to be infected and no snails were even seen in the markets, so one could argue that there is no risk - the paper reports a non-result. Despite this, regarding (2) the KAP survey showed that people were aware to some extent of the possibility of snails being infected and that they could transmit rat lungworm, so if either infected snails were to spread into the region or the resident snails should become infected by transmission from incoming infected rats, the people are to an extent aware of the risks, receptive to education, and prepared to take appropriate measures to reduce the risk. Thus the KAP survey had some public health value. However, the major limitation of the wild snail survey was that only visual inspection of dissected snails was used to detect infection. A molecular genetic screening method would be much more sensitive and it is possible that it may have detected infected snails.

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Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: PlosNTD revision 2025.pdf

Attachment

Submitted filename: PNTD-D-25-01764 Manuscript REVIEWED.docx

Dear DR LIU,

We are pleased to inform you that your manuscript 'Cross-sectional assessment of Angiostrongylus cantonensis transmission risk mediated by invasive apple snails in Jiangsu Province of China' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Angela Monica Ionica, Ph.D.

Academic Editor

PLOS Neglected Tropical Diseases

Krystyna Cwiklinski

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

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