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Background: In China the highest prevalence of echinococcosis is in Tibet Autonomous Region (TAR). The government has issued documents and implemented comprehensive prevention and control measures focusing on controlling the source of infection of echinococcosis. It was very important to understand the implementation and effect of infectious source control measures. The purpose of this study was to examine the implementation of measures to control infectious source (domestic and stray dogs) in TAR and to assess their effectiveness. Methods: We collected data on domestic dog registration and deworming and stray dog sheltering in 74 counties/districts in the TAR from 2017 to 2019. Fecal samples from domestic dogs were collected from randomly selected towns to determine Echinococcus infection in dogs using coproantigen ELISA. We analyzed the data to compare the canine rate of infection between 2016 and 2019. The data analysis was performed by SPSS statistical to compare dog infection rate in 2016 and 2019 by chi-square test, and ArcGIS was used for mapping. Results: From 2017 to 2019, 84 stray dog shelters were built in TAR, and accumulatively 446,660 stray or infected dogs were arrested, sheltered, or disposed of. The number of domestic dogs went downward, with an increased registration management rate of 78.4% (2017), 88.8% (2018), and 99.0% (2019). Dogs were dewormed 5 times in 2017, 12 times in 2018, and 12 times in 2019. The dog infection rate was 1.7% (252/14,584) in 2019, significantly lower than 7.3% (552/7564) from the survey of echinococcosis prevalence in Tibet in 2016 (P < 0.05). Conclusion: Between 2017 and 2019, the number of stray dogs and infection rate of Echinococcus spp. in domestic dogs decreased significantly, indicating that dogs were effectively controlled as a source of infection in TAR and reflecting a significant decrease in the risk of echinococcosis transmission. [ABSTRACT FROM AUTHOR]

Background: Molecular markers are essential to identify Echinococcus species and genotypes in areas with multiple Echinococcus species to understand their epidemiology and pathology. Tibet Autonomous Region (TAR) is one of the areas worst hit by echinococcosis. However, molecular epidemiology is still missing among echinococcosis patients in TAR. This research explored the Echinococcus species and genotypes infecting humans in TAR and the population diversity and the possible origin of G1 in TAR. Methods: Cyst samples were collected in one echinococcosis-designated hospital in TAR. Echinococcus species and genotypes were identified through a maximum-likelihood approach with near-complete/complete mtDNA using IQ-TREE. Phylogenetic networks were built with PopART, and the phylogeographical diffusion pattern was identified using a Bayesian discrete phylogeographic method. Results: Using phylogenetic trees made with near-complete/complete mtDNA obtained from 92 cysts from TAR patients, the Echinococcus species and genotypes infecting humans in TAR were identified as Echinococcus granulosus (s.s.) G1 (81, 88.04%), accounting for the majority, followed by G6 of the E. canadensis cluster (6, 6.52%), E. granulosus (s.s.) G3 (3, 3.26%), and E. multilocularis (2, 2.17%). An expansion trend and a possible recent bottleneck event were confirmed among the G1 samples in TAR. Adding the other near-complete mtDNA of G1 samples globally from the literature, we identified the possible phylogeographic origin of the G1 samples in TAR as Turkey. Conclusions: Using near-complete/complete mtDNA sequences of Echinococcus spp. obtained from echinococcosis patients, a variety of Echinococcus species and genotypes infecting humans throughout TAR were identified. As far as we know, this is the first comprehensive molecular investigation of Echinococcus species and genotypes infecting humans throughout TAR. We identified, for the first time to our knowledge, the possible origin of the G1 in TAR. We also enriched the long mtDNA database of Echinococcus spp. and added two complete E. multilocularis mtDNA sequences from human patients. These findings will improve our knowledge of echinococcosis, help to refine the targeted echinococcosis control measures, and serve as a valuable baseline for monitoring the Echinococcus species and genotypes mutations and trends of the Echinococcus spp. population in TAR. [ABSTRACT FROM AUTHOR]

Echinococcosis is one of the 17 neglected tropical diseases recognized by the World Health Organization and causes a huge global disease burden. The Tibet Autonomous Region (Tibet) of China is the most epidemic area of echinococcosis worldwide. Echinococcosis poses an enormous threat to local public health and economic development. Identifying vulnerable populations and analyzing people's knowledge, attitudes, and practices (KAP) with respect to echinococcosis is necessary to prevent and control echinococcosis. Based on reported cases and questionnaire responses, we first used a k-prototypes clustering algorithm to identify vulnerable populations according to human demographics (including gender, age, education level, and occupation). We then used a KAP analysis to evaluate the Tibetan people's understanding of echinococcosis. The results identified three types of vulnerable population. Vulnerable population I comprised illiterate middle-aged and older women engaged in agriculture and animal husbandry. Vulnerable population II comprised illiterate middle-aged male herdsmen. Vulnerable population III comprised young male farmers with a low education level. The KAP analysis indicated that the pass rate for all participants was 72.6%, 6.4%, 95.0%, and 75.8% for KAP, K, A, and P, respectively. The pass rates were significantly different among different age and gender groups. Based on these results, it is necessary to improve public health education and professional training, and to implement effective control and management measures targeting typical hosts of echinococcosis. This study provides a direct reference for the prevention and control of echinococcosis in Tibet. • Vulnerable people of echinococcosis is first studied using K-prototypes clustering. • Three types of vulnerable populations of echinococcosis were identified. • A KAP analysis of echinococcosis is first made to evaluate Tibetan's understanding. • Tibetan people need to raise awareness and improve actions against echinococcosis. • Improving public health education and controlling typical hosts is suggested. [ABSTRACT FROM AUTHOR]