Objective To investigate the endemic status and distribution of hepatic hydatidosis in Jigzhi County, Qinghai Province. Methods Six natural villages (or towns), including Zhiqingsongduo, Mentang, Baiyu, Suohurima, Wa’eryi and Wasai, were selected as survey sites from July to December, 2018. Abdominal ultrasound examination was performed in full-time residents with age over 6 years old. Anti-Echinococcus IgG was detected in the sera from the villagers who were willing to donate blood by ELISA. The endemic status of hepatic hydatidosis in Jiuzhi population was analyzed. Results A total of 23 505 subjects underwent the abdominal ultrasound examination, 345 of them were diagnosed as hepatic hydatidosis with the detection rate of 1.47%, of which 126 as hepatic cystic echinococcosis (0.54%) and 219 as hepatic alveolar echinococcosis (0.93%), with higher prevalence of hepatic alveolar echinococcosis than that of cystic echinococcosis(P < 0.05). The prevalence of hepatic hydatidosis in male (0.86%, 99/11 560) was lower than that in female (2.06%, 246/11 945) with significant difference (P < 0.01). Wa’eryi and Baiyu villages in Jiuzhi County owned the higher prevalence of 3.89% (147/3 782) and 3.01% (149/4 949), respectively, than the rest villages (χ²= 277.926, P < 0.01). Regarding the occupation, self-employed businessmen/the unemployed and those doing housework showed the higher prevalence of 20.40% (20/98) and 17.39% (60/345) compared with other occupational groups (P < 0.05). Those with age within 20-29 and 30-39 years old had the higher prevalence of 2.01% (112/5 563) and 2.16% (189/8 756), respectively, with significant differences compared to other age groups (P < 0.01). Among all subjects, 7 845 were involved in the ELISA assay for testing serological anti-Echinococcus IgG and 2 305 of them were antibody positive with the positive rate of 29.38%. The positive rate of anti-Echinococcus IgG was 100% in 107 cases confirmed by the abdominal ultrasound examination. Among 126 cases with hepatic cystic echinococcosis, 49 of them had cyst over 10 cm in diameter (38.9%). Among 219 cases with hepatic alveolar echinococcosis, 116 presented the infiltrating type, 34 calcified and 69 with liquid/cavitary type. Conclusion The prevalence of hepatic echinococcosis is still high in the population in Jiuzhi, Qinghai, with mixed cystic and alveolar echinococcosis. Alveolar echinococcosis was dominant in this endemic county. People with middle age, female, working at home or other business, living in Wa’eryi and Baiyu villagers had the highest prevalence of hepatic hydatidosis and should be the main target for treatment and prevention.