Echinococcosis is a neglected parasitic zoonotic disease that is distributed worldwide. Previous data has shown that China holds the highest disease burden of echinococcosis in the world, resulting in 22.97×105 disability adjusted life year (DALYs) lost annually (1). Echinococcosis is one of the epidemiological factors responsible for poverty in China. Since 2000, China’s central government (CG) has taken several actions to control echinococcosis in Western China. Since 2005, special funds by the CG have been allocated to echinococcosis research. Since 2007, echinococcosis has been listed as 1 of the 6 communicable diseases that exempts medical expenses. In 2010, the Action Plan for the Prevention and Control of Echinococcosis (2010‒2015) [APPCE (2010–2015)] was issued by the CG (2-3).
Ganzi Tibetan Autonomous Prefecture is located in western Sichuan Province with an average altitude of over 4,000 meters above sea level, and 97% of the population is Tibetan. Ganzi is an area with one of the highest disease burdens of endemic echinococcosis, and echinococcosis is prevalent in all 18 counties across Ganzi. In November 2015, China CDC established a work office to support the echinococcosis control program to reduce the associated morbidity and mortality. During 2016–2020, a series of control interventions has been implemented to control the echinococcosis transmission under the leadership of the work office: 1) an integrated control strategy has been implemented in 3 townships covering 1.53×105 square kilometers; 2) the morbidity rate has been reduced by 86.18%; 3) a total of 1,000 local professionals and technical staff have been trained for echinococcosis control; and 4) cultivation of health literacy has covered a population of 1.1 million. So far, echinococcosis remains highly prevalent in western China; the Ganzi work office might provide valuable experience to support the elimination of echinococcosis.
The promotion of echinococcosis control in the Tibet areas has been launched through the implementation of the CPCPPESC, GPSP (2016−2020). Under this pilot program, financial support, technical assistance, infrastructure construction, and capacity building were targeted for echinococcosis control in local areas in Ganzi. A total of 103 echinococcosis rehabilitation and treatment centers, livestock slaughtering centers, echinococcosis prevention and control laboratories, and safe water centers have been built in Shiqu County during the past 5 years, incurring a total cost of more than 1 billion CNY (8-11).
Based on the “pilot first” and “point-to-area” principle, the China CDC work office has played a critical role in implementing echinococcosis field control activities since initiation. Significant achievements in echinococcosis control realized in Ganzi were characterized by great reductions in the prevalence of echinococcosis in humans and domestic and wildlife hosts, remarkable improvements in awareness and behaviors pertaining to echinococcosis control, and significantly improved capacity building (Table 1).
Category Baseline data in 2014 End of 2020 Results of self-assessment in 2020 On-site technical evaluation results New patient detection rate in children aged 6–12 2.91% Below 1% 0% 0% Canine infection rate 6% Below 2% 0.86% 0.45%, 0.86%* Livestock infection rate 45% Below 25% 8.84% 8.84% Domestic dog registration rate 72% Above 85% 100% 100%, 100%* Canine deworming coverage 73% 90% 100% 100%, 100%* Treatment rate of diseased organs in slaughterhouse −† 100% 100% 100% Safe drinking water coverage in settlements 80% 100% 100% 100%, 100%* Rodent control rate in settlements and within 1 km radius −† 80% 80% 100% Awareness rate of prevention and control knowledge 30% Above 85% 98.13% 98.13% Standardized treatment rate of patients 50% Above 85% 93.15% 93.15%, 100%* Qualification rate of professional skills 60% 95% 99.85% 99.85%, 100%* * Assessment of village level.
† No data.
Table 1. Evaluation of pilot targets and indicators for comprehensive echinococcosis control in Shiqu County in 2020.
However, there were still some challenges for the elimination of this disease in local areas. First, financial support should be enhanced. Currently, operational funds for the China CDC work office mainly depend on the CPCPPESC, GPSP (2016−2020), and limited financial support was obtained from other sources. A large number of transportation fees were reported (accounting for 27.74% (1,387,100/5,000,000 CNY) of the budget) during the implementation of field control activities due to the special climate in high-altitude areas. In addition, the current workspace of the China CDC work office primarily relies on the Ganzi CDC. The harsh high-altitude natural environments require higher levels of protection during echinococcosis field control activities. All these programs require more financial support.
Second, the integrated control strategy should be intensified. Following the implementation of the 5-year pilot project of control, great achievements have been reached in echinococcosis control such as the reduction of morbidity to 0 in children aged 6−12 years among new patients. However, a risk factor of dog reinfection still exists, and it is difficult to construct shelters for stray dogs. Meanwhile, with the implementation of the National Ecological Protection Policy, increasing wildlife density could be a potential risk factor leading to echinococcosis transmission from wildlife to local human communities. Therefore, technical support is needed from stakeholders in animal husbandry, public security, and forestry administration. Consequently, a multidisciplinary collaboration mechanism needs to be built, and the integrated control strategy for echinococcosis should be reinforced (12-13).
Third, the translation of scientific research for echinococcosis into the clinic or field should be increased. During the operation of the 5-year pilot program, 20 national patents pertaining to echinococcosis were obtained. However, these patents are public welfare products, which lack the market collaboration mechanism to translate the patent into products. Currently, the work office is focused on epidemiological surveys of echinococcosis, assessing the risk of transmission of echinococcosis, and assessing the disease burden of echinococcosis; more attention should be given to the translation of the scientific research in the future. In addition, the work office requires the establishment of stronger collaborations with China CDC, most notably the field epidemiology training program, laboratory management, and continuing education management.
To respond to these challenges, the following suggestions are recommended. First, internal evaluations have proved the feasibility of the current operation model of the China CDC work office; therefore, we need to upgrade the current model, build a long-term mechanism, and continue to maintain a close collaboration with the expert team. Second, since echinococcosis is defined as a contributor to poverty, elimination of echinococcosis is critical to poverty alleviation. Therefore, poverty alleviation and echinococcosis control may be jointly performed to help the elimination program, build health services, and promote socioeconomic development. Third, the scientific research of echinococcosis needs to be translated into disease control products and services that are used to solve problems in the field. In addition, we need to make full use of national, intra-provincial, and extra-provincial experts in the prevention and control of echinococcosis to build a base of scientific innovation in the work office. Applied and operational studies are strongly recommended to attract market resources and funds for echinococcosis control programs. Finally, novel approaches to solve the problems of inconveniences in transportation and storage and laboratory testing of animal host samples are urgently required. Further epidemiological studies are required to investigate the transmission dynamics of wild animal echinococcosis in natural foci, to identify its risk factors, and to improve the integrated echinococcosis control in these target areas.
Acknowledgements: Participants of the national work office; National Health Commission of China; and China CDC.