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Additional file 6. Table S10. Top 5 cities of cystic and alveolar echinococcosis prevalence in China. Table S11. Top 10 counties of cystic and alveolar echinococcosis prevalence in China.

Additional file 5. Table S1. Demographic characteristics of human Echinococcosis in Inner Mongolia. Table S2. Demographic characteristics of human Echinococcosis in Sichuan. Table S3. Demographic characteristics of human Echinococcosis in Yunnan. Table S4. Demographic characteristics of human Echinococcosis in Tibet. Table S5. Demographic characteristics of human Echinococcosis in Shaanxi. Table S6. Demographic characteristics of human Echinococcosis in Gansu. Table S7. Demographic characteristics of human Echinococcosis in Qinghai. Table S8. Demographic characteristics of human Echinococcosis in Ningxia. Table S9. Demographic characteristics of human Echinococcosis in Xinjiang.

Additional file 7. Table S12. Statistic results of GLM model for cystic and alveolar echinococcosis.

Additional file 1. Questionnaire 1. Household basic information questionnaire. Questionnaire 2. Knowledge for echinococcosis prevention and control.

Additional file 2. Figure S1. The spatial distribution of environmental, biological and social factors adopted in this study. Figure S2. Correlation and variance inflation factorof variables adopted in cystic echinococcosis modeling. Figure S3. Correlation and variance inflation factorof variables adopted in alveolar echinococcosis modeling. Figure S4. Sex-age specific distribution of cystic echinococcosisand alveolar echinococcosisat nation level. Figure S5. Sex-age specific distribution of cystic echinococcosisand alveolar echinococcosisby province.

What is already known about this topic? Existing manual deworming programs launched have made great progress in reducing the Echinococcus infection rate of domestic dogs, but significant challenges remain in scattered nomadic communities inhabiting the Tibetan Plateau. The low deworming frequency and low levels of coverage were responsible for the high infection rate of Echinococcus spp. among dogs. What is added by this report? Smart deworming collars controlled by a remote management system (RMS) was found to increase the deworming frequency and coverage and subsequently reduce the canine infection rates with Echinococcus spp. . What are the implications for public health practice? As an innovative tool, smart deworming collars may drive the paradigm shift from manual deworming to smart deworming and stop the transmission of echinococcosis.

Background Echinococcosis, a zoonotic parasitic disease, is caused by larval stages of cestodes in the Echinococcus genus. Echinococcosis is highly prevalent in ten provinces/autonomous regions of western and northern China. In 2016, an epidemiological survey of Tibet Autonomous Region (TAR) revealed that the prevalence of human echinococcosis was 1.66%, which was much higher than the average prevalence in China (0.24%). Therefore, to improve on the current prevention and control measures, it is important to understand the prevalence and spatial distribution characteristics of human echinococcosis at the township level in TAR. Methods Data for echinococcosis cases in 2018 were obtained from the annual report system of echinococcosis of Tibet Center for Disease Control and Prevention. Diagnosis had been performed via B-ultrasonography. The epidemic status of echinococcosis in all townships in TAR was classified according to the relevant standards of population prevalence indices as defined in the national technical plan for echinococcosis control. Spatial scan statistics were performed to establish the geographical townships that were most at risk of echinococcosis. Results In 2018, a total of 16,009 echinococcosis cases, whose prevalence was 0.53%, were recorded in 74 endemic counties in TAR. Based on the order of the epidemic degree, all the 692 townships were classified from high to low degrees. Among them, 127 townships had prevalence rates ≥ 1%. The high prevalence of human echinococcosis in TAR, which is associated with a wide geographic distribution, is a medical concern. Approximately 94.65% of the villages and towns reported echinococcosis cases. According to spatial distribution analysis, the prevalence of human echinococcosis was found to be clustered, with the specific clustering areas being identified. The cystic echinococcosis primary cluster covered 88 townships, while that of alveolar echinococcosis’s covered 38 townships. Conclusions This study shows spatial distributions of echinococcosis with different epidemic degrees in 692 townships of TAR and high-risk cluster areas at the township level. Our findings indicate that strengthening the echinococcosis prevention and control strategies in TAR should directed at townships with a high prevalence and high-risk clustering areas. Graphical Abstract

Echinococcosis is a serious zoonotic parasitic disease transmitted from canines to humans and livestock. Periodic deworming is recommended by the WHO/OIE as a highly effective measure against echinococcosis. However, manual deworming involves significant challenges, particularly in remote areas with scarce resources. The insufficient awareness delivering praziquantel (PZQ) baits for dogs leads to low compliance rate. The aim of this study was therefore to develop a novel smart collar for dogs to address these challenges. We developed a smart Internet of Things (IoT)-based deworming collar which can deliver PZQ baits for dogs automatically, regularly, quantitatively with predominant characteristics of being waterproof, anti-collision, cold-proof and long life battery. Its performance was tested in two remote locations on the Tibetan Plateau. A cross-sectional survey was conducted to evaluate the compliance of the dog owners. Further, a randomized controlled study was performed to evaluate the difference between smart-collar deworming and manual deworming. The collar’s effectiveness was further assessed on the basis of Generalized Estimation Equations (GEE). The testing and evaluation was done for 10 smart deworming collars in factory laboratory, 18 collars attached for 18 dogs in Seni district, Tibet Autonomous Region, China, and 523 collars attached for 523 dogs in Hezuo city, Gansu province, China. The anti-collision, waterproof, and coldproof proportion of the smart collars were 100.0%, 99.5%, and 100.0%, respectively. When compared to manual deworming, the dogs’ risk of infection with Echinococcus on smart-collar deworming is down to 0.182 times (95% CI: 0.049, 0.684) in Seni district and 0.355 (95%CI: 0.178, 0.706) in Hezuo city, the smart collar has a significant protective effect. The owners’ overall compliance rate to attach the smart collars for their dogs was 89%. The smart deworming collar could effectively reduce the dogs’ risk of infection with Echinococcus in dogs, significantly increase the deworming frequency and coverage and rapidly remove worm biomass in dogs. Thus, it may be a promising alternative to manual deworming, particularly in remote areas on the Tibetan Plateau., Author summary Echinococcosis remains a critical but neglected zoonotic parasitic disease transmitted between canines and livestock or wild rodents. Dogs play a key role in Echinococcus granulosus sensu lato (s.l.) and E. multilocularis transmission, dual infection also occurs in dogs in co-endemic regions in China. The initial egg-production phase occurs over a span of 34–58 days (E. granulosus) or 28–35 days (E. multilocularis) following infection. The free-living eggs, voided with faeces of the definitive host, can withstand extreme weather conditions and remain viable for 240 days (E. granulosus) or 41 months (E. multilocularis) in the environment. Removal or reduction of the worm biomass in dogs will have the greatest and fastest effect in terms of reducing active transmission. In China, although significant efforts have been expended to achieve monthly manual deworming, the actual frequency and coverage thereof remain low; therefore, Echinococcus spp. is still highly prevalent among dogs. Moreover, echinococcosis transmission is still rampant, as the heavy disease burden suggests. We propose a novel, smart, Internet of Things (IoT)-based deworming tool that can deliver PZQ baits to dogs regularly and automatically. It could increase the deworming frequency and coverage significantly, reduce the risk of infection by down to 0.182–0.355 times, and prevent canine infections by removing the worm biomass in dogs rapidly. This deworming collar could also potentially prevent the transmission of echinococcosis from dogs to humans and livestock completely. It may be an excellent alternative to existing manual deworming methods, and the difficulties associated with performing deworming in remote areas with scarce resources can be overcome. Since the discovery of PZQ as the most effective antiworm drug, few breakthroughs have been achieved in terms of novel tools and technologies for the control of echinococcosis. Over the last 50 years, echinococcosis control measures have lagged to keep up with the World Health Organization (WHO) roadmap for the elimination of the disease owing to the practical difficulties in remote areas with scarce resources as well as the lack of promotion of new technologies. We expect the proposed smart deworming collar to herald the development of more innovative technologies for controlling echinococcosis by accelerating the elimination of the disease.

Background The echinococcosis is prevalent in 10 provinces /autonomous region in western and northern China. Epidemiological survey of echinococcosis in China in 2012 showed the average prevalence of four counties in Tibet Autonomous Region (TAR) is 4.23%, much higher than the average prevalence in China (0.24%). It is important to understand the transmission risks and the prevalence of echinococcosis in human and animals in TAR. Methods A stratified and proportionate sampling method was used to select samples in TAR. The selected residents were examined by B-ultrasonography diagnostic, and the faeces of dogs were tested for the canine coproantigen against Echinococcus spp. using enzyme-linked immunosorbent assay. The internal organs of slaughtered domestic animals were examined by visual examination and palpation. The awareness of the prevention and control of echinococcosis among of residents and students was investigated using questionnaire. All data were inputted using double entry in the Epi Info database, with error correction by double-entry comparison, the statistical analysis of all data was processed using SPSS 21.0, and the map was mapped using ArcGIS 10.1, the data was tested by Chi-square test and Cochran-Armitage trend test. Results A total of 80 384 people, 7564 faeces of dogs, and 2103 internal organs of slaughtered domestic animals were examined. The prevalence of echinococcosis in humans in TAR was 1.66%, the positive rate in females (1.92%) was significantly higher than that in males (1.41%), (χ2 = 30.31, P

Background Echinococcosis is highly endemic in western and northern China. Tibet Autonomous Region (TAR) is the most serious prevalent area. Linzhi is located in southeastern part of TAR. Dogs are the primary infection source for the transmission of echinococcosis to humans. A control and prevention campaign based on dog management has been implemented in the past three years. This study aims to evaluate the effects of dog management on the infection rate of dogs. Methods Data of dog population, registration and de-worming of seven counties/district in Linzhi between 2017 and 2019 were obtained from the annual prevention and control report. Domestic dog fecal samples were collected from each endemic town of seven counties/district in Linzhi in 2019 to determine the infection of domestic dogs using coproantigen enzyme-linked immunosorbent assay (ELISA). Data analysis was processed using SPSS statistics to compare dog infection rate between 2016 and 2019 by chi-square test, and maps were mapped using ArcGIS. Results In Linzhi, domestic dog population has decreased from 17 407 in 2017 to 12 663 in 2019, while the registration rate has increased from 75.9% in 2017 to 98.6% in 2019. Similarly, stray dog population has decreased from 14 336 in 2017 to 11 837 in 2019, while sheltered rate has increased from 84.6% in 2017 to 96.6% in 2019. Dog de-worming frequency has increased from 4 times per annum in 2017 to 12 times in 2019, indicating that approximately every dog was dewormed monthly. A total of 2715 dog fecal samples were collected for coproantigen ELISA assay. The dog infection rate was 2.8% (77/2715) in 2019, which was significantly lower than 7.3% (45/618) in 2016 (P Conclusions Increased dog registration, decreased dog population, and increased dog de-worming frequency contributed to significantly decrease the dog infection rate in Linzhi. Control and prevention campaign based on dog management could significantly decrease dog infection with Echinococcus spp. in echinococcosis endemic areas.

Background Echinococcosis is highly endemic in western and northern China, Tibet Autonomous Region （TAR）is one of the most serious prevalent areas where the prevalence of echinococcosis in 2016 was 1.66% in humans and dog infection rate was 7.30%. Linzhi is located in southeastern part of TAR where the prevalence of echinococcosis in 2016 was 1.55% in humans and in dog infection rate was 7.28%.Dogs are the main infection source for the transmission of echinococcosis to humans. A control and prevention campaignbased on dog management has been conductedin the past three years. This study is toevaluate the effects of dog management on infection rate of dogs.Methods Data of dog population, registration and de-worming of 7 counties/district in Linzhi from 2017 to 2019 were collected. Domestic dog fecal samples were collected from each endemic town of7 counties/district in Linzhiin 2019 to determine the infection of dogsusing coproantigen ELISA. Data analysis was processed using SPSS statistics to compare dog infection rate between 2016 and 2019 by chi-square test, and maps were mapped using ArcGIS.Results In Linzhi, domestic dog population decreased from 17407 in 2017, 16512 in 2018, to 12663 in 2019, whilethe registration rate increased from 75.92% in 2017, 95.48% in 2018, to 98.64% in 2019. Similarly, stray dog populationdecreased from 14336 in 2017, 13067 in 2018, to 11837 in 2019, while sheltered rateincreased from 84.63% in 2017, 92.32% in 2018, to 96.63% in 2019.Dog de-worming frequency increased from 4 times per annum in 2017 to 12 times in 2019, indicating almost every dog was dewormed monthly. A total of 2715 dog fecal samples were collected for coproantigen ELISA assay. The dog infection rate was 2.84% (77/2715) in 2019, which was significantly lower than7.28% (45/618) in 2016 (P＜0.05).Conclusion Increased dog registration, decreased dog population and increased dog de-worming frequency contributed to significantly decreased dog infection rate in Linzhi, TAR. Control and prevention campaign based on dog management can significantly decrease dog infection with Echinococcus spp in echinococcosis endemic areas.

What is already known about this topic? Both alveolar echinococcosis (AE) and cystic echinococcosis are endemic in China, among which alveolar echinococcosis has a very high mortality rate. What is added by this report? The survey results showed the prevalence and scope of AE in China and identified high-risk groups including children, monks, herdsmen and illiterate people. At the same time, all the cases found in the survey (more than 90% of the patients did not go to the hospital for diagnosis and treatment before survey) were promptly diagnosed and treated. What are the implications for public health practice? This study provides information for the development of a plan for AE prevention and control and for the implementation of interventions targeted to high-risk populations.

Echinococcosis, caused by genus Echinococcus, is the most pathogenic zoonotic parasitic disease in the world. In Tibet of the People’s Republic of China, echinococcosis refers principally to two types of severe zoonosis, cystic echinococcosis (CE) and alveolar echinococcosis (AE), which place a serious burden on public health and economy in the local community. However, research on the spatial epidemiology of echinococcosis remains inadequate in Tibet, China. Based on the recorded human echinococcosis data, maps of the spatial distribution of human CE and AE prevalence in Tibet were produced at city level and county level respectively, which show that the prevalence of echinococcosis in northern and western Tibet was much higher than that in other regions. We employ a geographical detector to explore the influencing factors for causing CE and AE while sorting information on the maps of disease prevalence and environment factors (e.g. terrain, population, and yak population). The results of our analysis showed that biological factors have the most impact on the prevalence of echinococcosis, of which the yak population contributes the most for CE, while the dog population contributes the most for AE. In addition, the interaction between various factors, as we found out, might further explain the disease prevalence, which indicated that the echinococcosis prevalence is not simply affected by one single factor, but by multiple factors that are correlated with each other complicatedly. Our results will provide an important reference for the evaluation of the echinococcosis risk, control projects, and prevention programs in Tibet., Author summary Echinococcosis, a worldwide zoonosis caused by genus Echinococcus, is highly endemic in Tibet of China. CE and AE as two main types of Echinococcosis are causing serious health burdens, thereby attracting more attention to public health in Tibet. This work provides detailed geographical information about CE and AE prevalence based on the recorded human echinococcosis data from CDC. A geographical detector was employed to explore the potential environmental factors that influence these diseases and to quantify the specific contribution of each factor as well as discovering the interaction between factors. The results showed that biological factors have the most impact on the prevalence of echinococcosis, of which the yak population contributes most to CE while the dog population makes the most contribution to AE. Besides, the interactive results greatly improved the explanation of the two diseases, indicating that the echinococcosis prevalence is not simply affected by one factor, but by various interrelated factors. Such research can be beneficial to the evaluation, control projects, and prevention programs of the echinococcosis risk in Tibet.

Multilingual abstracts in the five official working languages of the United Nations. (PDF 204 kb)

Cystic echinococcosis (CE), which is caused by Echinococcus granulosus, is a worldwide helminthozoonosis that is highly endemic in the Tibet Autonomous Region of China and has important public health and economic impacts. However, the spatial epidemiological characteristics of CE in Tibet are still unclear. Based on recorded human CE cases and the use of a geographic information system, the spatial distribution patterns of CE prevalence at three different scales were analyzed. In addition, a spatial agglomeration map of CE prevalence was generated based on cold/hot spot analysis. By combining maps of environmental and biological covariates with information about known human CE cases, the links between CE prevalence and relevant covariates were explored, revealing that the annual average precipitation, elevation, water accessibility and animal population (dog and yak) were associated with the prevalence of CE at the significance level of P