Objective To explore the application architecture and effectiveness of implementation of an intelligent surveillance and early warning system for schistosomiasis based on the One Health concept in elimination areas, so as to provide insights into consolidation of schistosomiasis elimination achievements in similar areas. Methods The organizational structure of government-led and multi-sectoral collaborative surveillance and early warning for schistosomiasis was established in Changshan County, Zhejiang Province in 2024, and an intelligent surveillance and early warning system for schistosomiasis was run for integrated surveillance and early warning of human-animal-environment, which was consisted of four modules, including active surveillance of humans, surveillance of hospital visits, surveillance of host animals, and snail surveillance. Multi-source surveillance data were collected from the system from 2024 to 2025, and compared with historical baseline data. A total of indicators from 5 categories were collected, including transmission route, source of infection, control capability, population vulnerability, and natural factors, and the risk ranking of 10 administrative villages was calculated to evaluate the effectiveness in risk identification, early warning and response, and control measures. Results An intelligent multi-point triggered, government-led, multisector-coordinated, data-shared and intelligent-analyzed surveillance and early warning system for schistosomiasis was successfully established in Changshan County, which achieved all-weather, automated surveillance and data aggregation of human, livestock, host animals, snails, environments, and factors of imported risk. A total of 154 000 pieces of data pertaining to integration of medical services and prevention were automatically collected by the system, and a total of 25 303 person-time high-risk populations were screened. The time of early warning and response reduced by a mean period of 3 days compared to traditional modes, and the mean duration from data triggered to early warning information sent to administrators was shortened within 8 h. The efficiency of precise snail control increased by approximately 40% in key settings, and the coverage rate of livestock surveillance was 96.7%. A total of 11 imported risk events received successful early warning and response. Of 10 administrative villages, 4 had schistosomiasis transmission risk ranking of higher than 0.2, 5 between 0.1 and 0.2, and 1 below 0.1. Conclusion The intelligent surveillance and early warning system for schistosomiasis based on the One Health concept may effective integrate fragmented information and significantly enhance the capabilities of early detection, rapid assessment, and precise interventions for imported and re-emerging risks of schistosomiasis in elimination areas, which is an indispensable choice and a powerful tool for achieving and sustaining elimination.