Table of Content

28 February 2018, Volume 36 Issue 1

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CONTENTS

A nationwide sampling survey on echinococcosis in China during 2012-2016

Wei-ping WU, Hu WANG, Qian WANG, Xiao-nong ZHOU, Li-ying WANG, Can-jun ZHENG, Jian-ping CAO, Ning XIAO, Ying WANG, Yao-yu ZHU, Yan-lin NIU, Chui-zhao XUE, Xiang-man ZENG, Qi FANG, Shuai HAN, Qing YU, Shi-jie YANG, Qing FU, Xue-fei BAI, Tian TIAN, Jun-jian LI, Meng-yuan ZHANG, Wen-ting WU, Shan-shan ZHANG, Yan-yan HOU, Yu FENG, Xiao MA, Bin LI, Fan-ka LI, Wei-dong GUO, Ya-ming YANG, Xiang-lin WU, Xiao-lin JIN, Hong-wei ZHANG, Shi-cheng YU

2018, 36(1):  1-14. 

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Objective To identify the endemic areas and endemic situation of echinococcosis in China. Methods Nine provinces and autonomous regions(Inner Mongolia, Sichuan, Tibet, Gansu, Qinghai, Ningxia, Yunnan, Shaanxi and Xinjiang (including Xinjiang Production and Construction Corps) were involved in this study during 2012-2016. In counties (cities) with suspected local cases of hydatidosis and suitable conditions for disease transmission, the numbers of administrative villages of pastoral area, semi-agricultural and semi-pastoral area, agricultural area, and town were determined according to their population sizes relative to the whole population size in the county. Sixteen villages were randomly selected, from each of which 200 residents aged > 1 year were examined by ultrasonography, accompanied by serological test for the suspected. In each county (city) surveyed, one primary school was selected from a township that was dominated by the pastoral area, semi-agricultural and semi-pastoral area, agricultural area, and town, respectively. Students in the schools were examined by ultrasonography, and blood taken for serum to detect antibody by ELISA. Twenty households raising dogs were selected from each village, and Echinococcus antigen in dog feces was detected by ELISA for one dog in each household. In each county (city), 1 000 sheep/pigs or 500 cattle raised locally were selected to examine hydatid infection in internal organs. Rodents were captured around the residence of patients with alveolar echinococcosis (AE), visceral biopsy was performed to examine lesions caused by Echinococcus multilocularis and identified by microscope. Two counties were selected In Henan and Jiangsu Provinces, respectively, where indigenous cases of hydatidosis were reported since 2000, a survey was made in human population and livestock. Then counties prevalent with echinococcosis were determined based on the survey results, local conditions for transmission, number of indigenous cases, and the prevalence of hydatidosis in regions nearby. According to the method of stratified weighting, the prevalence and the number of patients were estimated. Results A total of 413 counties were surveyed, of which 368 counties were identified as endemic counties of echinococcosis, distributed in the nine provinces and autonomous regions above. Of which, 115 counties showed mixed prevalence of cystic echinococcosis (CE) and AE. No county showed AE prevalence alone. Among 364 endemic counties, 1 001 173 residents were examined by ultrosound, of whom 5 133 (0.51%) were detected with hydatidosis, comprising 4 018 CE cases (78.28%), 1 008 AE cases (19.64%), 47 cases of mixed CE and AE (0.92%), and 60 unclassified cases (1.17%). The prevalence was estimated to be 0.28% in the whole endemic area, and the number of patients was estimated to be 166 098. Of the 364 endemic counties, 158 (43.41%) were located in Qinghai-Tibetan plateau, with a prevalence of 1.28% (4 260/332 884）, higher than that of non-Qinghai-Tibetan plateau areas (0.13%, 873/668 289) (χ² = 5 752.13, P < 0.05). The prevalence was highest in Tibet Autonomous Region (1.71%, 1 371/80 384), with significant difference comparing with other provinces (autonomous regions) (χ² = 2 435.70, P < 0.05). The prevalence of hydatidosis in pastoral area, semi-pastoral and semi-agricultural area, agricultural area and town were 1.62% (2 901/178 544), 0.50% (1 097/219 829), 0.19% (830/435 672) and 0.21% (280/131 745), respectively (χ² = 5 278.60, P < 0.05). The prevalence was higher in males (0.43%, 2 047/476 601) than in females (0.59%, 3 086/524 522) (χ² = 123.27, P < 0.05). The prevalence increased with age (χ²_trend = 247.99, P < 0.05), being highest in those of ≥ 90 years (1.35%, 6/443). There was a significant difference in prevalence among different occupations (χ² = 6 138.90, P < 0.05), with highest prevalence in the religious (4.42%, 79/1 786). As to the education level, the prevalence was highest in the illiterates (1.22%, 2 968/242 423) and there was a significant difference among education levels (χ² = 3 381.40, P < 0.05）. A total of 385 878 children were examined by ultrasonography, and the prevalence was 0.10% (371/385 878). ELISA was performed in 364 770 blood samples, with an antibody positive rate of 3.03% (11 035/364 770). The positive rate was highest among children in Qinghai (5.92%, 2 693/45 507), with significant difference comparing with other provinces (autonomous regions) (χ² = 1 481.80, P < 0.05). A total of 111 832 samples of dog feces were collected, and 4 750 were positive for Echinococcus antigen, with a positive rate of 4.25%. The positive rate of Echinococcus antigen was highest in Qinghai Province (13.02%, 1 505/11 563), with significant difference comparing with other provinces (autonomous regions) (χ² = 2 435.50, P < 0.05). Investigation of hydatid infection in livestock (sheep, cattle and pigs) in 342 endemic counties showed a prevalence of 4.68% (10 186/217 774), among which the infection rate in livestock was highest in Tibet Autonomous Region (13.21%, 283/2 143), with significant difference comparing with other provinces (autonomous regions) (χ² = 351.14, P < 0.05). The prevalence in sheep was 4.84% (8 448/178 946). A total of 42 734 rodents were captured in 54 counties with endemic AE, and 667 (1.56%) rodents were detected with AE. The AE prevalence was highest in the Tibet Autonomous Region (7 counties) (10.34%, 12/116), with significant difference comparing with other provinces (autonomous regions) (χ² = 52.82, P < 0.05). In Henan Province (Jiyuan City and Xuchang City), ELISA was performed on 549 blood samples (including 49 blood samples from adults), and all showed negative. Among 474 blood samples tested by ELISA in Jiangsu Province (Liyang City and Yixing City), the positive rate of anti-Echinococcus antibody was 5.91% (28/474), and those sero-positives all showed negative results in ultralsonography. Conclusions Combining the results of this survey and previous data, there are 368 endemic counties of echinococcosis in the 9 provinces (autonomous regions), of which 115 counties showed a mixed prevalence of CE and AE. The prevalence of hydatidosis in populations is higher in Tibet, Qinghai and Sichuan, and the prevalence in livestock was higher in Tibet, Qinghai and Xinjiang. And the positive rate of echinococcus antigen in dog feces was higher in Qinghai, Tibet and Gansu.

Analysis on disease burden of hydatid disease in China

Meng-yuan ZHANG, Wei-ping WU, Ya-yi GUAN, Li-ying WANG, Yan-yan HOU, Yu FENG, Jun-ying MA, Qian WANG, Ying WANG, Shuai HAN, Chui-zhao XUE, Wen-ting WU

2018, 36(1):  15-20. 

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Objective To define the disability weight and estimate disease burden of hydatid disease in China. Methods A hospital on hydatid disease was selected in each of the four provinces（Autonomous region） of Gansu, Qinghai, Sichuan, and Xinjiang, from December, 2016 to March, 2017. All inpatients admitted within 1 month were surveyed in each hospital. Two counties with hydatid disease prevalence were selected from each province, and in each county 25 cases of hydatid disease were selected to reach a total of 200 cases. A questionnaire was compiled based on International Classification of Functioning, Disability and Health and the MOS 36 item short form health survey, SF-36, to examine the life quality and analyze disability weights of patients. The disease burden was calculated based on the prevalence, number of patients, disability weights and demography data. Results In Gansu, Qinghai, Sichuan, and Xinjiang Province（Autonomous region） , 76, 95, 79 and 89 questionnaires were received, of which 76, 91, 79, and 88 were valid questionnaires, with a recovery efficiency of 98.53%. Of these questionnaires, 46.4% were from males, and 53.6% from females, with an average age of 45.15 (4-79). Of these patients, 73.65% (246/334) were cases of cystic echinococcosis (CE), 24.85% (83/334) were alveolar echinococcosis(AE), and 0.15%(5/334) were unclassified. The morbidity level of the disease was devided into asymptomatic, mild, medium, severe, and death, which accounted for 40.58%, 40.88%, 10.80%, 5.26% and 2.49%, respectively. The average quality score of patients was 0.716, CE being 0.735 and AE being 0.661 (t = 5.464, P < 0.01 CE vs. AE). The life quality score was 0.739 in male, and 0.696 in female (t = 2.986, P < 0.01). The disability weights of those asymptomatic, mild, medium, severe, and death cases were 0.257, 0.280, 0.359, 0.363 and 1, respectively, with an average of 0.302. The years lived with disability(YLDs) were 1.864 per patient. It was 1.864 for CE patients, for AE patients(t = 6.669, P < 0.01). It was estimated that the disease burden of hydatid disease in China added up to 322.4 thousand disability adjusted life year(DALYs), 293.4 thousand YLDs, 28.8 thousand years of life lost（YLLs). Conclusion Echinococcosis is widely prevalent with a heavy disease burden and an enormous threat to the people’s health in the country.

Prevalence and influencing factors of hydatid disease among children in Tibet Autonomous Region

Chui-zhao XUE, Wei-ping WU, Shuai HAN, Can-jun ZHENG, Ying WANG, Li-ying WANG, Qing YU, Shan-shan ZHANG, Xiao-nong ZHOU, Ning XIAO, Jian-ping CAO, Qu-zhen GONGSANG, Chun-li CAO, Tian TIAN, Wei-qi CHEN, Xin-liu YAN

2018, 36(1):  20-25. 

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Objective To understand the prevalence of hydatid disease in children in Tibet Autonomous Region and analyze the influencing factors of the disease. Methods A stratified cluster sampling method was used to select 364 villages in 70 counties (distict) from August to October, 2016. In each village, 200 residents including children were randomly selected for B ultrasound examination, accompanied by a serological test for those suspected. In each village, 20 local residents were selected using a random number table method, and in each county, a primary school was selected, from which 50 students of grades 4-6 were selected. Their knowledge and behaviors on hydatid disease control were surveyed by face-to-face Q & A. In each village, 20 dog-raising households were selected randomly and in each household, fecal sample (1-3 g) was collected from only one dog. Statistical analysis was carried out using SPSS 19.0 statistical software. Results A total of 13 651 children were examined, with a prevalence of 0.40% (55/13 651) for hydatid disease. In the 70 counties (district) surveyed, child cases were found in only 25 counties(district), of which 23 had children with cystic hydatid disease and 5 had children with alveolar hydatid disease. The top 5 counties with regard to the prevalence were Zuogong County in Changdu City (11.84%, 9/76), Cuoqin County in Ali Prefecture (1.84%, 4/218), Zhongba County in Shigatse City (1.59%, 3/189), Langkazi County in Shannan City (1.50%, 2/133), and Gaize County in Ali Prefecture (1.37%). Among 6 660 girls examined, 32 were detected with hydatid disease (0.48%), and among 6 991 boys examined, 23 were detected with hydatid disease (0.33%). Among 6 770 children under 6 years, 13 were found with hydatid disease (0.19%)(13/6 770), and among 6 881 children aged 7-12 years, 42 were found with hydatid disease (0.61%)(42/6 881)(χ² = 13.86, P < 0.05). By setting 3 years as an age subgroup, each subgroup had cases of hydatid disease, and the prevalence showed a trend of increase with age (χ² = 17.69, P < 0.05). The antigen positive rate of dog feces was a leading risk factor （OR = 3250.2,P < 0.05）, followed by age and the rate of dog-raising, and the qualified rate of questionnairing was the protective factor. Conclusion Hydatid disease in children is related to age, dog-raising and daily hygienic habits.

Prevalence of hydatid disease in regions of four production types in Tibet Autonomous Region

Yang-jin BAIMA, Shuai HAN, Rui-feng HE, Qu-zhen GONGSANG, Wang-jie SUOLANG

2018, 36(1):  26-30. 

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Objective To investigate the prevalence of echinococcosis in regions of four production types in Tibet Autonomous Region. Methods Seventy villages were selected using the stratified cluster sampling method in 7 cities/districts of four types of production (pastoral area, semi-agricultural and semi-pastoral area, agricultural area, and town), from August to October, 2016. B ultrasound examination was performed in residents aged > 1 year. Results Among the 77 049 persons receiving B ultrasound examination, 1 230 were detected to have hydatid disease (1.60%), dominated by cystic echinococcosis (87.64%, 1 078/77 049). The prevalence was highest in pastoral area (2.48%, 572/23 038), lowest in agricultural area (0.78%, 29/3 719), and 1.46%（470/32 173）and 0.94%（159/16 899）in semi-agricultural and semi-pastoral area and town, respectively, and was significantly different among the regions of four types of production (χ² = 171.670, P < 0.05). The prevalence in males and females was both highest in pastoral area (2.05%, 220/10 756 and 2.74%, 352/12 854). In females, it was higher than that in males in pastoral area (2.74%, 352/12 854 versus 2.05%, 220/10 756; χ² = 11.899, P < 0.01) as well as in semi-agricultural and semi-pastoral area (1.66%, 310/18 632 versus 1.14%, 160/14 011; χ² = 15.347, P < 0.05). Among different age groups, the prevalence was highest in the population group of > 60 years in pastoral area (5.56%, 130/2 338) and lowest in the group of < 15 year in town; the prevalence showed a trend of increase with increased age in agricultural areas, pastoral area, and semi-agricultural and semi-pastoral area, with a significant difference (χ²_trend = 39.057, 179.698, 100.914; P < 0.05). Among different educational levels, the prevalence was highest in illiteracy population in pastoral area (3.21%, 438/13 633) and no case was found in the preschool children in the town. There was a significant difference in prevalence among different education groups in regions of each type of production (χ² = 99.676, 16.683, 16.650, 11.222; P < 0.05). The prevalence was highest in populations with settlement type of summer nomads and winter settlers in semi-agricultural and semi-pastoral area (4.09%, 73/1 783) and no case was found in populations with other settlement types in pastoral area and agricultural area (χ² = 178.608, P < 0.01). There was a significant difference in prevalence among different settlement types in regions of each type of production (χ² = 503.452,P < 0.01). Conclusion The prevalence of echinococcosis in human population is highest in pastoral area in Tibet. In particular, specific attention of disease prevention should be paid to the older population, the illiteracy, and females.

Epidemiological survey on hydatid disease in livestock in Tibet Autonomous Region

Wang-jie SUOLANG, Wei-ping WU, Wang-jiu DANZHEN, Zhang-you LONG, Qu-zhen DANZENG, Zhao-hui LUO, Qu-zhen GONGSANG

2018, 36(1):  30-34. 

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Objective To investigate the prevalence of hydatid disease and influencing factors in livestock in Tibet Autonomous Region. Methods A simple and stratified random sampling method was used to select villages of different types of production according to the proportions of populations in pastoral area, semi-agricultural and semi-pastoral area, agricultural area and town, from 63 counties in seven prefectures (cities) (Shigatse, Qamdo, Nagqu, Lhasa, Shannan, Nyingchi and Ali) of Tibet Autonomous Region. Ten sheep (pigs) or 5 cattle were selected in each village to examine cysts in liver and lung, accompanied by recording the animal age and number of cysts found. Twenty families were randomly selected in each village to collect basic information including householder name, family size, ethnicity, numbers of dogs, sheep and/or cattle raised, number of livestock slaughtered in each year and the slaughtering time, source of drinking water. Logistic regression analysis was performed using livestock having hydatid cyst(s) as dependent variable Y and using city, livestock type, tooth age and type of production as independent variable X. Results A total of 2 143 livestock were examined, comprising 995 cattle (46.43%), 1 047 sheep (48.86%), and 101 pigs (4.71%), and comprising 834 (38.92%) from pastoral areas, 922 (43.02%) from semi-agricultural and semi-pastoral area, 362 (16.89%) from agricultural area, and 25 (1.17%) from town. The infection rate of hydatid cysts in livestock was 13.21% (283/2 134), and that in sheep, cattle and pigs were 18.24% (191/1 047), 9.15% (91/995), 0.99% (1/101), respectively (χ² = 50.633, P < 0.01). The cysts were mainly distributed in liver (69.9%, 178/283). The infection rate was highest in Ali (28.82%, 66/229), and lowest in Nyingchi (0.71%, 1/140) (χ² = 123.946, P < 0.01). Among different tooth age groups, the infection rate was the highest in the age group of > 10 tooth age (18.85%, 33/175) (χ² = 14.488, P < 0.01). Among different production types, the highest infection rate was detected in pastoral area (17.03%, 142/834) and lowest in town (no livestock infected) (χ² = 26.316, P < 0.01). Of the 7 334 families surveyed, up to 6 722 raised livestock (91.7%), and 5 286 slaughtered livestock by themselves (72.1%), and the slaughter mainly occurred in November. Multivariate analysis showed that the infection rate of hydatid cysts in livestock was correlated with prefecture (city), species of livestock, tooth age, and type of production. Conclusion There is a high prevalence of hydatid disease in sheep and cattle in Tibet Autonomous Region. Comprehensive measures are needed to reduce the infection.

Investigation of Echinococcus infection in dogs in Tibet Autonomous Region

Yi-xi KANGZHU, Can-jun ZHENG, Rui-feng HE, Qu-zhen GONGSANG, Yang-jin BAIMA, Wang-jie SUOLANG, La-mu CIREN, Bin LI

2018, 36(1):  35-37. 

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Objective To understand the infection status of Echinococcus in dogs in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select 7 prefectures (cities) of Tibet Autonomous Region (Nagqu, Ali, Shannan, Lhasa, Changdu, Shigatse, Nyingchi) to investigate the infection status of Echinococcus in dogs. Counties in 7 cities were divided into pastoral area, semi-agricultural and semi-pastoral area, agricultural area and town based on the type of production. Villages for investigation were assigned into counties with an appropriate proportion. Twenty households raising dogs were selected, and fecal sample of one dog was collected from each household. The positive rate of Echinococcus antigen in fecal samples was determined by ELISA. The positive rate was compared among different groups using χ² test. Results The positive rate of Echinococcus antigen in dog feces was 6.31% (458/7 259). The positive rate in Nagqu, Ali, Shannan, Lhasa, Changdu, Shigatse, Nyingchi was 10.08%(109/1 081), 8.04%(34/423), 6.87%(64/932), 6.30%(66/1 047), 5.74%(78/1 358), 4.64%(89/1 917)and 3.59%(18/501)respectively, significantly different among cities (χ² = 44.671, P < 0.01). The antigen positive rate in domestic dog feces and stray dog feces was 6.28% (133/2 119) and 6.32% (325/5 140), respectively (χ² = 0.005, P > 0.05). It was highest in the pastoral area (8.41%, 187/2 224), and significantly different among the production types(χ² = 25.221, P < 0.01). Conclusion There is a high positive rate of Echinococcus antigen in dog feces in Tibet Autonomous Region, especially in Nagqu, Ali Prefecture and Shannan City and in pastoral area.

Survey on knowledge, attitude and behaviors toward hydatid disease among villagers and students in Tibet Autonomous Region

Xin-liu YAN, Qu-zhen GONGSANG, Wei-ping WU, Can-jun ZHENG, Chui-zhao XUE, Wei-qi CHEN, Shuai HAN, Bin LI

2018, 36(1):  38-42. 

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Objective To understand the knowledge, attitude and behaviors toward hydatid disease among villagers and students in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select villages in 70 counties (districts) of Tibet Autonomous Region, and 20 households where dogs were raised were selected in each village. A questionnaire survey was made on one person in each of the households. In each county, a primary school was selected, from which no less than 50 students of each grade in grade 4-6 were selected for questionnairing. Questionnaire content included the cause of human hydatid infection, a habit of handwashing before eating, whether plays with dogs, disposal of diseased organs of sheep after slaughter, and willingness of free deworming for dogs. Questionnaires were read and filled in by investigators. The constitution ratio of knowledge, attitude, and behaviors was calculated and analyzed by χ² test. Results A total of 364 villages were surveyed in 70 counties (districts), of which 109, 148, 87 and 20 villages were selected from pastoral area, semi-agricultural and semi-pastoral area, agricultural area and town, respectively. A total of 7 279 villagers were surveyed and 7 210 valid questionnaires received. Seventy primary schools were selected for a total of 10 799 students with 10 274 valid questionnaires enrolled. The overall qualified rate of knowledge, behavior and attitude toward hydatid disease was 33.76% (5 902/17 484). The qualified rate in villagers was 26.62% (1919/7 210), and that in students was 38.77% (3 983/10 274) (χ² = 279.88, P < 0.01). Only 6.23% (449/7 210) of the villagers knew that hydatid disease is a dog-transmitted disease, and it was 34.30% (3 524/10 274) in students (χ² = 1 901.42, P < 0.01). Only 23.27% (1 678/7 210) of the villagers had a habit of handwashing before eating, but higher in students (49.74%, 5 110/10 274) (χ² = 1 249.29, P < 0.01). In addition, 68.14% (4 913/7 210) of the villagers never played with dogs, while in students this was 45.75% (4 700/10 274) (χ² = 858.47, P < 0.01). With regard to the correct disposal of diseased organs, both villagers (16.92%, 1 220/7 210) and students (26.91%, 2 765/10 274) had poor knowledge (χ² = 240.36, P < 0.01). As to the willingness of free deworming for dogs, 93.4% of the villagers showed willingness of cooperation, while only 63.23% of the students did（χ² = 2 094.706, P < 0.01）. Conclusion Villagers and students in Tibet Autonomous Region have a poor knowledge, attitude and behaviors toward hydatid disease. Efforts should be made on health education.

Analysis of hydatid disease cases in Tibet Autonomous Region

Wei-qi CHEN, Ya-lan ZHANG, Qu-zhen GONGSANG, Wei-ping WU, Shuai HAN, Chui-zhao XUE, Can-jun ZHENG, Jia-jia AI

2018, 36(1):  43-47. 

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Objective To understand case composition, regional distribution and lesion distribution of hydatid disease in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select 364 villages from 70 counties of 7 prefectures(cities) in Tibet Autonomous Region to perform an epidemiological survey on hydatid disease from August to October, 2016. B ultrasound was conducted on residents, accompanied by serological examination for suspected cases. Clinical and suspected cases were investigated individually. All the cases were finally identified by an imaging expert based on a combination of imaging and serological results. Negative cases were excluded. Data were analyzed by SPSS 20.0 software. Results A total of 77 049 residents received B ultrasound examination, and 1 230 were detected with hydatid disease(1.60%, 1 230/77 049), comprising 1 078 cystic echinococcosis (CE) (87.64%), 136 alveolar echinococcosis(AE) (11.06%), and 16 unclassified cases (1.30%). The 7 prefectures(cities) were all found with CE and AE cases, of which CE dominated the case composition with regard to city, gender, age, ethnicity, occupation, educational level, and type of production in place of residence. The cases were dominated by those uneducated 71.95% (875/1 214). There was a significant CE case accumulation with the increase of age. Among different occupations, the CE case composition of herdsmen (91.02%) was higher than that of farmer-and-herdsmen (87.78%) (χ² = 10.710, P < 0.05). Lesions distributed mainly in the right liver, with > 79% cases having only one focal lesion. Conclusion There is a wide prevalence of hydatid disease in Tibet Autonomous Region, and herdsmen are the major target population for control.

Analysis of echinococcosis prevalence in Nagqu Prefecture

Wang-jiu DANZHEN, Chui-zhao XUE, Qu-zhen GONGSANG, Jia-jia AI, Zhao-hui LUO, Qu-zhen DANZENG, Xiao-gang WEI, Can-jun ZHENG

2018, 36(1):  47-53. 

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Objective To understand the prevalence of echinococcosis in Nagqu Prefecture in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select villages in 10 counties(districts) in Nagqu Prefecture from August to October, 2016. B ultrasound examination was performed in residents aged > 1 year, to calculate the morbidity rate of hydatid disease and estimate the prevalence and the case number. The prevalence of hydatid disease in intermediate hosts including cattle, sheep and rodents was investigated by visceral dissection combined with PCR. Echinococcus antigen in dog fecal samples was determined by ELISA. Knowledge on echinococcosis prevention and control was surveyed in 20 residents randomly selected in each village and grade 4-6 students in a primary school in each county by questionnairing. Comparison of hydatid disease prevalence among different populations was performed by χ² test. Results A total of 11 897 residents in 58 villages of 11 counties(districts) received B ultrasound, of whom 382 showed hydatid disease (3.21%). The prevalence in human population was estimated to be 3.37%, and the number of cases in the Prefecture was estimated to be 15 565. The 11 counties(districts) were all found with cystic echinococcosis cases and 7 were also found with alveolar echinococcosis, dominated by cystic echinococcosis (88.74%, 339/382). Among populations in different counties(districts), the prevalence was highest in Andou County(6.00%, 50/833), and lowest in Bange County (1.44%, 12/833), with a significant difference among counties(districts)(χ² = 43.22, P < 0.05). The prevalence in females was 3.66% (236/6 451), significantly higher than that in males (2.68%, 146/5 446) (χ² = 8.77, P < 0.05). Among different age groups, the prevalence was highest in the age group of ≥ 80 years (10.00%, 8/80), and lowest in the age group of 1-9 years (0.3%, 5/1 665), with a significant difference among age groups (χ² = 123.29, P < 0.05), showing a trend of increase with age (χ²_trend =123.29, P < 0.05). Among different occupations, the prevalence was highest in other occupations (5.94%, 13/219), and lowest in students (0.19%, 2/1 075) (χ² = 76.51, P < 0.05 among occupations). Among populations with different education levels, the prevalence in the educated (2.61%, 88/3 377) was lower than that in the illiteracy (3.45%, 294/8 520) (χ² = 5.29, P < 0.05) (χ² = 15.62, P < 0.05 among education groups). The prevalence in pastoral area (3.37%, 339/10 072) was higher than that in semi-agricultural and semi-pastoral area (2.36%, 43/1 825) (χ² = 4.75, P < 0.05). Rodents were investigated only in Biru County. A total of 304 Ochotona curzoniae were examined, with an infection rate of 0.33% (1/304). A total of 366 livestock (cattle and sheep) were examined, with a prevalence of 5.74% (21/366), highest in Shenzha County (32.5%, 13/40). The positive rate of Echinococcus antigen in dog fecal samples was 10.08% (109/1 081). The populational qualified rate on knowledge of echinococcosis prevention was 31.01% (824/2 657), being higher in pupils (34.29%,539/1 572) than in residents (26.27%,285/1 085) (χ² = 18.93, P < 0.05). Conclusion Both cystic echinococcosis and alveolar echinococcosis are prevalence in Nagqu, an estimated prevalence of 3.37%. More attention should be paid to females, herdsmen and those with less education, and residents in pastoral area.

Prevalence of hydatid disease in Ali Prefecture

Dan XIAO, Wei-ping WU, Lian XUE, Qu-zhen GONGSANG, La-mu CIREN, Zhuo-ma BIANBA, Dong-min WANG

2018, 36(1):  54-57. 

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Objective To investigate the prevalence of hydatid disease in Ali of Tibet Autonomous Region, in order to lay foundation for setting up control strategy for the disease. Methods Administrative villages were selected from 7 counties (Geer, Gaize, Pulan, Zhada, Geji, Ritou and Cuoqin) using stratified cluster sampling method from August to October, 2016. Residents received B ultrasound examination, and diagnosed based on a combination of epidemiological history, clinical manifestations and imaging features. Serological test was performed in those suspected cases. In each village, 20 local residents were selected using a random number table method. In each county, a primary school was selected, from which 50 students of grades 4-6 were selected using a random number table method. Their knowledge on echinococcosis control and behaviors were surveyed by face-to-face Q & A. Statistical analysis was carried out using SPSS 19.0 statistical software. Echinococcus antigen in the dog feces was detected by ELISA. Data were analyzed by SPSS 19.0. Results A total of 4 740 residents in 22 villages of the 7 counties were examined, and 111 were found with hydatid disease (2.34%), comprising 94 with cystic echinococcosis (1.98%) and 13 with alveolar echinococcosis (0.27%), and 4 unclassified cases (0.08%). There was a significant difference in the prevalence among the 7 counties (χ² = 45.816, P < 0.01), with the top 3 being Cuoqin County (3.76%, 31/824), Gyeonggi County (3.18%, 32/1 007) and Gyar County (2.13%, 18/847). The residents examined had a male-to-female ratio of 1 : 1.92. The prevalence in females was 2.93% (73/2 489), significantly higher than that in males (1.69%, 38/2 251) (χ² = 8.008, P < 0.01). The prevalence was highest in the age group of > 60 years (4.05%, 9/222), and was significantly different among different age groups (χ² = 43.161, P < 0.01). The prevalence was highest in herdsmen (3.34%, 78/2 338) among different occupations; and was highest in pastoral area (2.53%, 87/3 437). Conclusion Hydatid disease occurs heavily in Ali. More efforts should be made to prevent the disease. More attention should be paid to females, herdsman and those with an old age.

Epidemiological status of echinococcosis in Lhasa City

La-mu CIREN, Xin-liu YAN, Wang-jiu DANZHEN, Zhang-you LONG, Qu-zhen DANZENG, Jia-jia AI, Dong-ming WANG, Jing-zhong LI

2018, 36(1):  58-63. 

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Objective To investigate the prevalence of echinococcosis in Lhasa. Methods A stratified cluster sampling method was used to select 8 counties (Damxung, Lhünzhub, Nyêmo, Maizhokunggar, Dagzê, Qüxü,Doilungdegen and Chengguan) in Lhasa City to investigate the prevalence of echinococcosis, and they were divided into pastoral area, semi-agricultural and semi-pastoral area, agricultural area and towns based on the type of production. Villages for investigation were assigned into the 8 counties with an appropriate proportion. In each village, at least 200 residents were examined by B ultrasound. When there were fewer than 200 people in a village, residents from its neighbor village would be enrolled. Twenty villagers were randomly selected in each village, and no less than 50 students were selected from each of grades 4-6 in primary schools(one primary school from each county) for survey on the knowledge of and behaviors in relation to echinococcosis prevention by questionnairing. Twenty dog-raising households were selected from each village, and Echinococcus antigen in dog feces was detected by ELISA. In each village, 10 sheep/pigs or 5 cattle were selected to examine internal organs including liver and lung. The number of cysts found were recorded. Difference in prevalence among groups was analyzed by χ² test. Results In 2016, the prevalence of echinococcosis in Lhasa was 1.38% (151/10 917), dominated by cystic echinococcosis (82.12%, 124/151). There was no significant difference in prevalence among the counties (χ² = 13.322, P > 0.05) and between males (1.12%, 48/4 267) and females (1.55%, 103/6 650) (χ² = 3.425, P > 0.05). All age groups were found with hydatid disease, with the ≥ 70 years group having the highest prevalence (2.99%, 19/635). The prevalence showed a trend of increase with age (χ² = 39.544, P < 0.01). The prevalence was higher in herdsmen (3.16%, 38/1 263), semi-farmer-and-herdsmen (1.93%, 15/777), and houseworkers (1.59%, 8/504) , with a significant difference among occupations (χ² = 53.199, P < 0.01). There was a significant difference in prevalence among educational levels (χ² = 34.138, P < 0.01), highest in the illiterates (2.08%, 99/4 755) and lowest in those with a high school level or above (0.47%, 3/638). There was also a significant difference in prevalence between the settled-down residents (3.03%, 8/264) and the nomadic population (1.34%, 143/10 653) (χ² = 4.215, P < 0.05). In addition, the prevalence was highest in pastoral area (2.63%, 40/1 995) and lowest in town (0.84%, 21/2 512) (χ² = 11.206, P < 0.05). The qualified rate on knowledge of echinococcosis prevention in selected residents was 40.20% (907/2 256). The positive rate of Echinococcus antigen in dog fecal samples was 6.30% (66/1 047). The prevalence of hydatid infection was 16.36% (29/185) in livestock. Conclusion There is a high prevalence of hydatid disease in Lhasa, especially in pastoral area.

Prevalence of echinococcosis in Shannan City

Yang-jin BAIMA, Wei-ping WU, Rui-feng HE, Qu-zhen GONGSANG, Yi-xi KANGZHU, Wang-jie SUOLANG, Bin LI

2018, 36(1):  63-68. 

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Objective To investigate the prevalence of echinococcosis in Shannan City of Tibet Autonomous Region. Methods Villages were selected using stratified cluster sampling method from the counties of Langkazi, Longzi, Cuona, Zhanang, Gonggar, Qiongjie, Gacha, Sangri, Qusong, Luozha and Naidong District in Shannan City, from August to October, 2016. In each village, 200 residents aged > 1 year were selected for B ultrasound examination to calculate the prevalence of hydatid disease among the populations. Visceral necropsy was performed in livestock to investigate the status of hydatid infection. Feces from home-raised dogs were collected to examine Echinococcus antigen using ELISA method. Knowledge on echinococcosis control was surveyed in 20 randomly-selected residents in each village and no less than 50 students of each grade of grades 4-6 in a selected primary school in each county. Results Among the 10 287 persons receiving B ultrasound examination, 103 were detected to have hydatid cysts (1.00%), dominated by Echinococcus granulosus (97.09%). The 11 counties(districts) were all found with cases of hydatid disease, of which Langkazi County, Longzi County, and Cuona County had a high prevalence of 2.03% (17/836), 1.81% (15/830), and 1.43% (12/839), respectively, while Luozha County had the lowest prevalence of 0.11% (1/931). There was a significant difference in prevalence among the 11 counties/districts. There was no significant difference between males (0.84%, 31/3 683) and females (1.09%, 72/6 604) (χ² = 1.47, P > 0.05). The detection rate elevated with increased age (χ²_trend = 25.64, P < 0.01), being highest in the population groups of ≥ 60 years (1.76%, 30/1 708) and 45-59 years (1.32%, 44/3 333), and was significantly different among occupations (χ² = 20.73, P < 0.05), being highest in herdsmen (1.81%, 17/937), farmers (1.04%, 64/6 155), and semi-herdsman-and-farmers (1.03%, 18/1 740). The prevalence showed a trend of decrease with higher educational level (χ²_trend = 7.63, P < 0.05), being highest in those illiterates (1.26%, 63/5 009). The prevalence of hydatid disease was highest in pastoral area (1.19%, 20/1 682); there was no significant difference in the prevalence of hydatid disease among populations with different types of production (χ² = 0.85, P > 0.05). Among the 307 livestock examined, the prevalence of hydatid disease was 11.40% (35/307). There was a significant difference in livestock prevalence among the 11 counties(districts) (χ² = 175.409, P < 0.01), with Qusong County having the highest prevalence. Among the 932 fecal samples collected, the positive rate of Echinococcus antigen was 6.87% (64/932), with Langkazi County having the highest positive rate (27.50%, 22/80), followed by Cuona County (13.75%, 11/80)and Longzi County (7.50%, 6/80)[χ² = 61.41, P < 0.01, among the 11 counties(districts)]. The overall qualified rate on knowledge of echinococcosis control was 51.63% (1 343/2 601) in the residents. It was better in Sangri County (97.83%, 225/230) and Qusong County (91.34%, 211/231), and poor in Cuona County (10.24%, 17/166) and Langkazi County (18.55%, 41/221) [χ² = 605.52, P < 0.05, among the 11 counties(districts)]. Conclusion There is a high prevalence of hydatid disease in human populations, a high positive rate of Echinococcus antigen in dog feces, and poor knowledge on echinococcosis control in some counties of Shannan City, Tibet.

Prevalence of echinococcosis in Changdu City

Qu-zhen GONGSANG, Bin LI, Wei-qi CHEN, Song GA, Wang-jie SUOLANG, Dong-min WANG, Yi-xi KANGZHU, Jing-zhong LI

2018, 36(1):  68-74. 

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Objective To investigate the prevalence of echinococcosis in Changdu City. Methods Administrative villages were selected using stratified cluster sampling method in counties of Jiangda, Gongjue, Leiwuqi, Dingqing, Chaya, Basu, Zuogong, Mangkang, Luolong, Bianba, and Karuo District, covering four types of regions (pastoral area, semi-agricultural and semi-pastoral area, agricultural area, and town). Two hundred residents were selected for B ultrasound examination, and blood samples were collected from those with suspected infection. Specific antibody against Echinococcus in serum was detected by ELISA. Twenty household raising dogs were selected from each village, and Echinococcus antigen in dog feces was detected by ELISA. In each village, 10 sheep/pigs or 5 cattle were selected to examine internal organs including liver and lung. The ages of animals and number of cysts found were recorded. At least 300 adult rodents were caught within 1 km away from the spots of the residents who were detected to have alveolar echinococcosis, and hydatid cysts in liver and lung were examined by autopsy. Twenty villagers were randomly selected in each village, and no less than 50 students were selected from each of grades 4-6 in primary schools(one primary school from each county) for survey on the knowledge of echinococcosis prevention and behaviors by questionnairing. Results Sixty-eight villages were examined in 11 counties/regions of Changdu City, all were found with cases of cystic echinococcosis, and all had cases of alveolar echinococcosis except Mangkang County. The morbidity rate by B ultrasound was 1.44% (206/14 289). The estimated prevalence of hydatid diseases in Changdu City was 1.50%, with an estimated number of cases being 9 842, and they were dominated by cystic echinococcosis (81.07%, 167/206). The prevalence elevated with age, being highest in the population group of ≥ 70 years (4.05%, 9/222); it was significantly different among occupations (χ² = 208.146, P < 0.05), being highest in herdsmen (4.66%, 103/2 208); and it showed a trend of decrease with higher educational level (χ² = 6.831, P < 0.05), being highest in those illiterates (2.00%, 149/7 455). The prevalence of hydatid diseases in pastoral area, semi-agricultural and semi-pastoral area, agricultural area, and town were 1.71% (48/2 800), 1.69% (144/8 506), 0.43%(11/2 578) and 0.74% (3/405), respectively (χ² = 15.726, P < 0.01). The prevalence showed a significant difference among populations with different types of production activities(χ² = 25.335, P < 0.05). The infection rate was 2.17% (2/92) in intermediate host rodents and 12.09% (41/339) in livestock. The antigen positive rate in dog feces was 5.74% (78/1 358). The qualifying rate on the knowledge of echinococcosis control was 17.83% (271/1 520) in residents and 21.82% (340/1 558) in pupils (χ² = 7.714, P < 0.05). Conclusion Echinococcosis is widely prevalent in Changdu City, with a high infection rate and a high risk of infection.

Prevalence of echinococcosis in Nyingchi City

Dong-min WANG, Rui-feng HE, Qu-zhen GONGSANG, Dan XIAO, Wang-jie SUOLANG, Lian XUE, Zhuo-ma BIANBA, Jing-zhong LI

2018, 36(1):  75-79. 

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Objective To understand the prevalence of echinococcosis in Nyingchi City in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select 6 counties among pastoral area, agricultural area, semi-agricultural and semi-pastoral area, and town, from August to October, 2016. In each county, the number of villages for survey was determined by the population size of each county. Two hundred residents were selected, residents aged > 1 year received B-ultrasound examination in combination with epidemiological history, clinical manifestations and imaging features for diagnosis. Those suspected were also subjected to a serological test. In each village, 20 local residents were selected using a random number table method, and in each county, a primary school was selected, from which 50 students of grades 4-6 were selected. Their knowledge on hydatid disease control and their behaviors were surveyed by face-to-face Q & A. In each village, 20 dog-raising households were selected using a random number table method, and in each household fecal samples (1-3 g) were collected from only one dog. Echinococcus antigen was detected by ELISA in dog feces. In each village, 10 sheep/pigs or 5 cattle were selected to examine internal organs including liver and lung. The ages of animals and number of cysts found were recorded. At least 300 adult rodents were caught within 1 km away from the spots of the residents who were detected to have alveolar echinococcosis, and hydatid cysts in liver and lung were examined by autopsy. Prevalence of hydatid disease in cattle and sheep was investigated by biopsy combined with PCR. Statistical analysis was carried out using SPSS 19.0 statistical software. Results A total of 28 villages were investigated in 6 counties, and 5 016 residents received B-ultrasound examination, among whom 47 were detected with hydatid disease, comprising 42 cases of cystic hydatid disease(89.36%, 42/47) distributed in the 6 counties and 5 cases of alveolar hydatid disease(10.64%, 5/47) distributed in 3 counties (Gongbu Jiangda, Chayu, Bomi). The prevalence in males and females was 0.78% (17/2 167) and 1.05 % counties(30/2 849), respectively. From the youngest of 2 years to the oldest of 93 years, each age group was found with hydatid disease, and the prevalence increased with age (χ² = 16.151, P < 0.05). There was no significant difference in the prevalence by education levels (χ² = 3.073, P > 0.05). Of the only two production types in Nyingchi City, the prevalence was higher in semi-agricultural and semi-pastoral area (1.01%, 44/4 376) than in agricultural area (0.47%, 3/640) (χ² = 1.733, P > 0.05). Higher prevalence in semi-agricultural and semi-pastoral area was also found in males (4.02%, 8/199) and females (3.43%, 7/204). The antigen positive rate in dog feces was 3.59% (18/501), 3.21% (11/343) in domestic dogs and 4.43% (7/158) in stray dogs (χ² = 0.467, P > 0.05). The infection rate in rodents in Chayu County was 1.45% (5/345). Only 1 pig was detected. The qualified rate of knowledge on hydatid disease control was 27.40% (385/1 405). Conclusion Cystic hydatid disease is prevalent in all the 6 counties, while alveolar hydatid disease is detected in 3 counties of Nyingchi.

Current prevalence of echinococcosis in Shigatse City

Zhuo-ma BIANBA, Bin LI, Wei-qi CHEN, Dong-ming WANG, Dan XIAO, Ba BIAN, Qu-zhen GONGSANG

2018, 36(1):  80-86. 

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Objective To understand the prevalence of echinococcosis in Shigatse City in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select villages in 17 counties(district) in Shigatse City from August to October, 2016. B ultrasound examination was performed in residents aged > 1 year, accompanied by a serological test for those suspected, to calculate the prevalence of hydatid disease. The prevalence and the number of cases in the population of the city were estimated. Ten pigs/sheeps or 5 cattle were randomly selected in each village, to examine the status of echinococcosis disease in livestock by visceral dissection. In counties found with cases of echinococcosis, no less than 300 adult rodents were captured in places of patient residence and with frequent activity of humans and dogs, to calculate the prevalence of echinococcosis in rodents. In each village, 20 households raising dogs were randomly selected to collect dog feces. Echinococcus antigen in fecal samples was determined by ELISA. Knowledge on echinococcosis prevention and control was surveyed in 20 residents randomly selected in each village, and in grade 4-6 students in a primary school of each county questionnairing. Results A total of 21 497 residents in 96 villages of 18 counties(district) received B ultrasound, of whom 289 were detected with echinococcosis (1.34%). The prevalence in population was estimated to be 1.10%, and the number of cases was estimated to be 7 792. The cases were dominated by cystic echinococcosis (90.31%, 261/289). The 18 counties(district) were all found with cystic echinococcosis cases, and 13 were also found with alveolar echinococcosis. The estimated prevalence was highest in Zhongba County (4.03%, 33/819), and lowest in Renbu County (0.24%, 2/833), with significant difference among the counties (χ² = 39.963,P < 0.05). The prevalence in females was 1.50% (191/12 737), significantly higher than that in males (1.12%, 98/8 760) (χ² = 5.676, P < 0.05). Among different age groups, the prevalence was highest in the age group of ≥ 70 years (2.75%, 22/799), and lowest in the age group of 1-9 years (0.34%, 12/3 479), showing a trend of increase with age (χ² = 61.390, P < 0.05). As to the education levels, the prevalence was highest in the illiterates (1.56%, 190/12 214), and lower in those with a primary school level (1.04%, 74/7 086) and college and above (1.08%, 4/372) (χ² = 61.502,P < 0.05, among different education levels). The prevalence showed a trend of decrease with increased education level (χ² = 5.704, P < 0.05). The prevalence was highest in herdsmen (2.68%, 76/2831) (χ² = 75.110, P < 0.05, among different occupations). The prevalence was highest in pastoral area (1.83%, 85/4 654) and lowest in agricultural area (0.91%, 75/8 285) (χ² = 24.450, P < 0.05, among different production types). The positive rate of Echinococcus antigen in dog fecal samples of the terminal host dogs was 4.73% (92/1946), showing no significant difference (χ² = 3.155, P > 0.05) between domestic dogs (5.42%, 66/1 218) and stray dogs (3.57%, 26/728). The infection rate in rodents was 1.02% (3/293), and that in livestock (cattle, and sheep) was 11.61% (67/577). The populational qualified rate on knowledge of echinococcosis prevention was 33.08% (1 500/4 534), being higher in pupils (39.57%, 1 064/2 689) than in residents (23.63%, 436/1 845) (χ² = 125.541, P < 0.05). Conclusion Echinococcosis both in human populations and animals are widely prevalent in Shigatse. More attention should be paid to females, herdsmen and populations with older age and less education.

Input and need analysis of dog deworming in echinococcosis control program in Daofu County of Sichuan Province

Yao-yu ZHU, Wei-ping WU, Ya-yi GUAN, Li-ying WANG, Shuai HAN, Yan-lin NIU, Xue-fei BAI, DANZENG, Qu-zhen JIANGYANG

2018, 36(1):  87-92. 

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Objective To understand the input and need for dog deworming in echinococcosis control program in Daofu County, estimate annual cost of deworming and analyze influence factors, in order to provide reference for investment. Methods Thirty villages were randomly selected in Daofu County in November, 2015, to field-survey the cost at various steps of dog deworming, including material cost (deworming drug and bait), village-level deworming cost (drug delivery, mobilization, household deworming and feces disposal) and dog deworming administration cost (training and supervision). Main influencing factors for the annual cost were analyzed with a multiple linear regression model, and the annual cost of the whole county was further estimated based on the regression equation. Results The investment need for deworming in the 30 villages was 41 977.05 yuan, and the actual investment was 13 575.54 yuan, with a gap of 28 401.51 yuan between them. The gap was largest in Qimeier Village (5 059.85 yuan), followed by Qimeisan Village (2 852.74). The overall gap in the 158 villages was estimated to be about 149 581.29 yuan. The regression equation was established as Y = -11.60 + 1 600.63X₁ + 33.46X₂, in which the type of production (X₁) and dog number in a village (X₂) were the main factors for annual cost of dog deworming (Y) (F = 39.57, P < 0.05, adjusted R² = 0.727). The overall annual cost of dog deworming in Daofu County was estimated to be 183 323.00 yuan based on the regression equation. The top 5 villages with regard to annual deworming cost were: Qimeier Village (6 746.46 yuan/year), Quer Village (5 509.30 yuan/year), Xiapulong Village (5 269.63 yuan/year), Xianfeng Village (5 074.32 yuan/year), and Gexi Village (4 901.57 yuan/year). As for geographical distribution, the deworming cost was highest in Baimei District in the southeast of Daofu, including the townships of Longdeng, Xiede, Bamei and Seka, with an annual deworming cost > 15 000 yuan/year, then in Yuke District in the north of Daofu County, particularly the townships of Qimei and Mazi, where the annual deworming cost was 10 000-14 999 yuan/year. In Yinen Town, Weita Town and plateau agriculture district in the center of Daofu, including the townships of Konse, Geka, Gexi and Jiasikong, the annual deworning cost was 5 000-9 999 yuan/year. Conclusion Current fund input on dog deworming can not meet the primary need of “drug delivery to every dog, and deworm in every month”. More input is needed to ensure implementation of dog deworming project.