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

Background Angiostrongylus cantonensis ( A. cantonensis ), a zoonotic nematode responsible for eosinophilic meningitis, is transmitted mainly through the ingestion of raw or under cooked invasive apple snails. Despite the widespread distribution of these snails in Jiangsu Province of China, systematic assessments of infection risks and public awareness remain limited. This study evaluated the infection status of A. cantonensis in apple snails and investigated public knowledge, attitudes, and practices (KAP) to inform targeted prevention and control strategies. Methods We carried out a cross-sectional study in six prefectural-level cities in Jiangsu during the snails’ peak reproductive season. A total of 732 wild apple snails were collected from different habitats and screened for A. cantonensis larvae by pepsin–HCl digestion and microscopy. 74 local farm markets were inspected for the sale of live or processed apple snails. Simultaneously, a validated knowledge–attitude–practice (KAP) questionnaire was conducted to 630 randomly selected residents. Data analysis employed SPSS for descriptive statistics and multivariate line regression was used to identify predictors of higher scores. Results All wild-caught snails tested negative for A. cantonensis , and no apple snails were found for sale in any market. Overall public knowledge and attitudes were favorable; however, practice gaps were evident: 40.3% of respondents reported not separating raw and cooked utensils, and 78.7% reported snail sighting to authorities, while 22.1% had ever used the Apple Snail Inspector (ASI) mini-program. KAP scores differed significantly among different demographic groups. Multivariable linear regression analysis revealed that age, city of residence, and education level were significant predictors of KAP scores. Conclusions Current infection risk of A. cantonensis infection in Jiangsu appears low, yet the widespread presence of competent apple snails and suboptimal food-handling practices warrant sustained surveillance. Targeted health education programs that address behavioral gaps among older and less-educated residents can further minimize the threat of A. cantonensis introduction and safeguard both public health and ecological security.