BACKGROUND:Echinococcosis is a zoonotic parasitic disease that significantly endangers public health and hinders socioeconomic development. Sichuan Province is a mixed endemic area of cystic echinococcosis (CE) and alveolar echinococcosis (AE), and it has one of the most severe epidemics of echinococcosis in China. In 2012, the national epidemiological sampling survey of echinococcosis revealed that the prevalence rate of echinococcosis among the population in Sichuan Province was 1.08%, significantly higher than the national average (0.24%). In this study, the spatiotemporal distribution characteristics of newly diagnosed patients with echinococcosis in Sichuan Province from 2013 to 2024 were analyzed, providing a reference for identifying key areas of echinococcosis and developing targeted prevention and control strategies. METHODS:Data on the number of individuals screened for echinococcosis and the number of newly diagnosed patients in endemic counties were obtained from the annual reports of the Sichuan Provincial Echinococcosis Control Program between 2013 and 2024. The detection rate of newly diagnosed echinococcosis patients was calculated for each year. County-level electronic maps of Sichuan Province were downloaded from the National Geographic Information Public Service Platform. The spatial distribution map of the detection rate of newly diagnosed patients with echinococcosis in Sichuan Province was created using ArcGIS software, and global and local spatial autocorrelation analyses were conducted. Spatiotemporal scanning analysis of the detection rate of newly diagnosed echinococcosis patients in Sichuan Province was conducted using SaTScan software. RESULTS:From 2013 to 2024, the total detection rate of newly diagnosed patients with echinococcosis in the endemic areas of Sichuan Province was 55.77/100,000, with the detection rates of CE and AE being 36.71/100,000 and 19.88/100,000, respectively. The total detection rate of newly diagnosed patients with echinococcosis, as well as that of CE and AE, demonstrated a decreasing trend year by year (χ2 = 1,054.785, 925.936, 196.018; P < 0.001). The detection rate of CE was higher than that of AE between 2013 and 2021; however, this trend was reversed between 2022 and 2024. In terms of spatial distribution, areas with higher detection rates were primarily concentrated in the northwestern part of Sichuan Province, whereas areas with lower detection rates were mainly distributed in the southeastern part of the province. The global spatial autocorrelation analysis results revealed that the total detection rate of newly diagnosed echinococcosis patients exhibited spatial clustering in 2013-2016, 2018, 2020, and 2024. The detection rate of newly diagnosed CE patients exhibited spatial clustering in 2013, 2014, and 2022. The detection rate of newly diagnosed patients with AE exhibited spatial clustering in 2013-2018, 2020, and 2023. Local spatial autocorrelation analyses revealed that the "high-high" clustering areas of the total detection rates, CE and AE detection rates were concentrated in the northwestern and northern parts of the endemic areas, while the "low-low" clustering areas were concentrated in the southeastern parts of the endemic areas. Spatiotemporal scanning analysis revealed that the most important clusters of newly total diagnosed echinococcosis and CE patients in Sichuan Province were mainly located in Shiqu, Seda, Baiyu, Ganzi, Dege, Xinlong, Luhuo, Aba, and Rangtang counties. The most important clusters of patients with AE were mainly in Shiqu, Seda, Baiyu, Ganzi, Dege, and Rangtang counties. CONCLUSION:The results demonstrated that the detection rate of newly diagnosed patients with echinococcosis in Sichuan Province decreased annually between 2013 and 2024, exhibiting significant spatial clustering. The western Sichuan Qinghai Tibet Plateau region is a "hot spot" for echinococcosis in the Sichuan Province population. It is recommended that relevant departments develop precise prevention and control strategies for the current areas of clustering.

Background Echinococcosis remains highly endemic in some nomadic communities on the Qinghai-Tibet Plateau, China, where alveolar echinococcosis (AE) and cystic echinococcosis (CE) exhibit notably high prevalence rates of 3.64% and 2.37%, respectively. Recent settlement expansion in the region has raised concerns, as smaller, remote settlements often lacked waste disposal and sewage systems, potentially facilitating echinococcosis transmission. The aim of this study is to investigate how settlement characteristics influence echinococcosis transmission. Findings The study was conducted from 2022–2024 in nomadic communities of Shiqu County in China. The overall prevalence rate of echinococcosis in 51 settlements was found to be 2.34% (321/13,701; 95% CI : 2.10–2.61), which included a prevalence rate of 1.62% (222/13,701; 95% CI : 1.42–1.85) for AE and a prevalence rate of 0.72% (99/13,701; 95% CI : 0.59–0.88) for CE. The prevalence rate of AE was significantly ( χ 2 = 49.57, P < 0.01) higher than that of CE. Settlements with a smaller population size (Z = -4.27, P < 0.01), a greater distance to the township center (Z = 2.66, P < 0.01) and a higher density of owned dogs (Z = 5.90, P < 0.01) were associated with higher prevalence rates of CE. These associations were also observed for AE prevalence, except for the density of owned dogs. Conclusions This study indicates that the transmission of AE was more active than that of CE in the nomadic communities. Smaller, remote settlements had higher prevalence rates for both CE and AE. The density of owned dogs was a significant risk factor for CE prevalence but not for AE prevalence. Targeted interventions are needed in these high-risk settlements. Future research should investigate how settlement characteristics interact with hygiene practices, the infection status of intermediate and definitive hosts, and their population dynamics to better understand combined effects on echinococcosis prevalence.

目的 总结四川省在棘球蚴病防控工作中机制和措施的创新实践,以期形成防治经验供政府决策参考.方法 通过文献和资料回顾性分析,逐条梳理和总结.结果 目前已形成了棘球蚴病防控的政府领导、多部门协作、全社会参与的良好形势;在棘球蚴病防治方面取得了重要进展,得益于在理念与机制创新、综合防控措施的落地生根、精准化施策和科学研究方面的持续用力.结论 棘球蚴病防治必须结合流行特点,采取综合施策,多部门协作的模式.

目的 了解甘孜州棘球蚴病流行地区石渠县、甘孜县和白玉县的患病情况,为制定棘球蚴病精准防控方案提供依据.方法 于2019-2021年分别对石渠县、甘孜县和白玉县的棘球蚴病患者及其家属进行调查,记录性别、年龄、职业、文化程度等信息,对患者及其家属进行腹部B超和血清学检查.采用卡方检验对率进行比较,检验水准为α=0.05.结果 在3县的35个乡镇开展研究,共纳入1209人进行腹部B超检查.检出阳性病人989名,其中多房棘球蚴病患者占60.71％,细粒棘球蚴病患者占26.87％;患者年龄介于6～92岁;女性患者占61.09％;牧民和文盲患者分别占77.15％、78.97％.结论 在棘球蚴病流行县,多房棘球蚴病患者占比较大,患者以女性、牧民为主,且文化程度较低,应对这部分人群密切检测,做到精准化防控.

国家"十三五"棘球蚴病防治规划确定的基本控制目标是到2020年70%的县人群患病率降低到1%以下及犬感染率降低到5%以下。2019年四川省有83%的县达到目标,超过国家目标任务要求。四川省棘球蚴病防治经过重点调查研究阶段、以卫生部门为主的防控试点阶段、部门协同防控初步阶段和政府主导攻坚达到基本控制阶段等4个阶段。四川省棘球蚴病从流行到基本控制,防治工作取得了显著成效,表明以"控制传染源为主、中间宿主防控与病人查治相结合"的综合防治策略十分有效。四川省的成功得益于"党政齐抓,全员共抓"、部门协作、科学防控及专业队伍的支撑,得益于不断探索新的策略措施,如季节性加强犬的驱虫和控制、定居点灭鼠等,以及创新患者筛查管理、健康教育、宿主监测等。未来要坚持行之有效的策略措施,并根据流行及防控的新情况及时优化策略措施,做到精准防控以进一步控制棘球蚴病的流行。

Abstract Background Echinococcosis is a global zoonotic parasitic disease caused by Echinococcus larvae. This disease is highly endemic in Sichuan Province, China. This study investigates the prevalence and spatial distribution characteristics of human echinococcosis at the township level in Sichuan Province, geared towards providing a future reference for the development of precise prevention and control strategies. Methods Human prevalence of echinococcosis was evaluated using the B-ultrasonography diagnostic method in Sichuan Province between 2016 and 2019. All data were collected, collated, and analyzed. A spatial distribution map was drawn to intuitively analyze the spatial distribution features. Eventually, the spatial autocorrelation was specified and local indicators of spatial association (LISA) clustering map was drawn to investigate the spatial aggregation of echinococcosis at the township level in Sichuan Province. Results The prevalence of echinococcosis in humans of Sichuan Province was 0.462%, among which the occurrence of cystic echinococcosis (CE) was 0.221%, while that of alveolar echinococcosis (AE) was 0.244%. Based on the results of the spatial distribution map, a predominance of echinococcosis in humans decreased gradually from west to east and from north to south. The Global Moran’s I index was 0.77 (Z = 32.07, P < 0.05), indicating that the prevalence of echinococcosis in humans was spatially clustered, exhibiting a significant spatial positive correlation. Further, the findings of local spatial autocorrelation analysis revealed that the “high–high” concentration areas were primarily located in some townships in the northwest of Sichuan Province. However, the “low–low” concentration areas were predominantly located in some townships in the southeast of Sichuan Province. Conclusions Our findings demonstrated that the prevalence of echinococcosis in humans of Sichuan Province follows a downward trend, suggesting that the current prevention and control work has achieved substantial outcomes. Nevertheless, the prevalence in humans at the township level is widely distributed and differs significantly, with a clear clustering in space. Therefore, precise prevention and control strategies should be formulated for clusters, specifically strengthening the “high–high” clusters at the township level. Graphic Abstract

目的探索适用于预测四川省新发现棘球蚴病患者检出率的模型,为制定"十四五"棘球蚴病防治规划和策略提供科学依据。方法收集四川省2007—2020年每年新发现棘球蚴病患者检出率数据,分别建立ARMA时间序列模型和灰色系统GM （1,1）模型,对2021—2023年新发现棘球蚴病患者的检出情况进行预测,同时采用判定系数、平均绝对误差和均方误差等指标比较2种模型的拟合和预测效果。结果ARMA模型分析结果显示,2017—2020年检出率拟合值和实际值的误差分别为12.44、 26.04和33.30,预测2021、 2022和2023年四川省新发现棘球蚴病患者检出率分别为50.14/10万、 50.04/10万和49.99/10万;GM （1,1）模型分析结果显示,2017—2020年检出率拟合值和实际值的误差分别为6.51、 2.94和-1.20,预测2021、 2022和2023年四川省新发现棘球蚴病患者检出率分别为20.55/10万、 17.65/10万和15.77/10万。对两种模型进行拟合效果评价结果显示,GM （1,1）模型的预测效果优于ARMA模型。结论可采用GM （1,1）模型预测四川省未来新发现棘球蚴病患者检出率变化趋势,预测的检出率呈现出下降趋势,但仍有新病例检出,需继续加强棘球蚴病的综合防治,巩固防治成果。

目的 了解降低流浪犬密度对小型哺乳类动物棘球蚴感染情况的影响.方法 于2016年4月-2020年6月,采取聘请专业捕犬人员或由公安部门搜捕流浪犬等办法在石渠县全县范围内全年搜捕流浪犬并进行集中管理(实施安乐死).2015-2020年,每年1次从石渠县境内的国营牧场驾车至尼呷镇(乡) (行驶距离130.5 km),沿公路观察两侧视野范围内的流浪犬,记录沿途流浪犬数量.按流浪犬数量(只)/行驶距离(km)计算流浪犬密度.分别于2016年7月、2020年7-8月,于石渠县俄多玛、温波、宜牛、虾扎、尼呷、蒙宜、格孟等乡(镇)捕捉小型哺乳类动物,现场剖检获取脏器带回实验室,取疑似棘球蚴病灶组织提取基因组DNA,PCR扩增细胞色素c氧化酶亚基1(cox1),测序并在GenBank中进行BLAST比对以明确棘球绦虫虫种.根据PCR检测及测序比对结果计算小型哺乳类动物棘球蚴感染率.率的95％置信区间采用Clopper&Pearson精确法进行计算,感染率的比较采用卡方检验或Fisher确切概率法进行分析.结果 2016年4月-2020年6月,石渠县全县累计搜捕并集中管理流浪犬41446只,每年集中管理流浪犬数量分别为26570、4377、5656、4100、743只.2015-2020年,石渠县的流浪犬密度分别为0.80、0.04、0.06、0.04、0.05和0.05只/km.2016年7月,共捕获小型哺乳类动物261只,其中鼠兔192只,田鼠69只.PCR检测结果显示,棘球蚴阳性14只,其中田鼠8只,鼠兔6只;田鼠多房棘球蚴感染率为11.6％ (8/69,95％CI:5.1％～21.6％);鼠兔多房棘球蚴感染率和石渠棘球蚴感染率均为1.6％ (3/192,95％CI:0.3％～4.5％).2020年7-8月,共捕获小型哺乳类动物270只,其中田鼠223只,鼠兔47只,PCR检测结果显示,田鼠多房棘球蚴感染率为0.5％(1/223,95％CI:0～2.5％);鼠兔未检测到棘球蚴感染.2020年石渠县田鼠多房棘球蚴感染率较2016年显著下降(P＜0.01),鼠兔多房棘球蚴感染率及石渠棘球蚴感染率均有所下降,但差异无统计学意义(P＞0.05).结论 在流浪犬具有重要流行病学意义的多房棘球蚴病流行区,控制流浪犬可显著降低田鼠多房棘球蚴感染率.

目的 了解四川省非流行县棘球蚴病报告病例的人群分布情况及流行病学特点.方法 收集2015-2019年四川省非流行县(市、区)常住人口中棘球蚴病报告病例的基本信息、病例类型及流行病学史,用WPS Excel 2019软件创建数据库,并对流行情况进行分析.结果 收集2015-2019年四川省148个非流行县棘球蚴病报告病例共计165例,分布于14个市(州)的57个县(区).2016年报告病例数最多,为40例,随后逐年减少.病例数以成都市最多,为61例(占37.0％).来自乡(镇)的报告病例数为114例(占69.1％).各年龄组人群均有发病,41 ～60岁年龄组报告病例数占比最高,为52.7％ (87/165).男性103例,女性62例,男女性别比为1.7:1.职业分布以农民和工人报告病例数较多,分别为58例和28例,占52.1％ (86/165).报告病例中细粒棘球蚴病和多房棘球蚴病病例数分别为55例(占33.3％)和34例(占20.6％),未分型76例.在追踪到的119例病例中,62.2％ (74/119)有棘球蚴病流行区到访史;其中29例到访过四川本省流行县,到访四川省外流行区最多的地区为新疆(20例)和西藏(15例).结论 2015-2019年四川省非流行县棘球蚴病报告病例主要来自成都市、乡(镇)、男性、41～60岁年龄组、农民等人群,大部分有新疆、西藏等棘球蚴病流行区到访史.

为提高棘球蚴病人群筛查质量和患者管理水平,四川省基于服务器/客户端模式,设计筛查、首诊、随访及远程会诊等4个模块,以人脸生物学识别为基础,建立了棘球蚴病全民筛查管理系统,通过人脸识别技术实现了受检者信息固化、远程超声会诊,并通过系统对数据实现快速录入、便捷查询统计和有效管理.本系统的开发,满足了卫生部门对棘球蚴病筛查及患者信息的管理需求,实现了专家对基层医务人员远程技术指导和对棘球蚴病患者的远程辅助诊断.

目的 了解棘球蚴病防治项目实施对四川省棘球蚴病患者治疗费用的影响,为制定棘球蚴病救助政策提供参考.方法 收集2016-2020年四川省4所三甲医院棘球蚴病外科治疗病例的资料,包括患者的基本信息、病灶分型、住院天数、手术费用、医保补助、国家项目补助等资料信息.采用SPSS 18.0统计学软件进行统计分析.结果 收集的504例病例资料中,男女性别比为1∶1.2,细粒棘球蚴病(114例)和多房棘球蚴病(175例)分型比为1∶1.5,平均年龄(38.6±14.5)岁.手术部位以肝脏为主90％ (414/460).手术方式以肝部分切除为主24.7％ (90/365),合并其他手术的病例82例,肝移植病例33例.住院时间天数中位数为15 d.2016年与2020年相比中位数住院总费用由41234元上升为66356元,呈逐年上升趋势(P＜0.01).不同医院、年度、手术年龄、住院时间、棘球蚴病分型及手术方式对住院总费用有影响(P＜0.05).补助数据完整的237例患者中,住院费用总额为16833040元,住院费用中位数为51172元,国家棘球蚴病项目补助金总额为4645709元,中位数22000元,补助＞ 20000元者占51.9％;医疗保险和棘球蚴病项目救助后,需自付医疗费用的病例192例,合计金额2710793元,中位数5888元,自付0～5000者最多(58.2％),其中47人零支付.结论 国家棘球蚴病救治项目很大程度上减轻了患者的医疗费用负担.

OBJECTIVE:To investigate the effectiveness of a new health education pathway for echinococcosis control among primary school students in regions highly prevalent for echinococcosis in China. METHODS:Six primary schools were randomly selected from echinococcosis hyper-endemic regions, with 13 classes assigned to the intervention group and 9 to the control group, and all students in these 21 classes were recruited as the study subjects. Echinococcosis health education was performed through the pathway of assessing the current status-strengthening the building of teaching resources-focusing on practices in the intervention group, while routine health education was given in the control group. A questionnaire survey was performed to assess the score of echinococcosis control knowledge (including theoretical knowledge score and mean daily practical capability score) before and after the health education interventions to evaluate the effectiveness of this new health education pathway for echinococcosis control. RESULTS:The mean score of echinococcosis control knowledge was 68.86 ± 18.70 points at baseline, with the mean theoretical knowledge score of 40.97 ± 10.75 points, and the mean daily practical capability score of 27.89 ± 12.50 points. Clustering analysis showed three types of populations, including "unsatisfactory", "learn and apply creatively", and "rote learning", which accounted for 24.62% (240/975), 45.74% (446/975) and 29.64% (289/975), respectively. The mean score of echinococcosis control knowledge was 81.08 ± 18.15 points in the intervention group during the final assessment, with the mean theoretical knowledge score of 43.65 ± 9.40 points, and the mean daily practical capability score of 37.43 ± 12.22 points, and both were significantly higher relative to baseline (t = -4.201 and -15.202, both P values < 0.01). The mean score of echinococcosis control knowledge was comparable between at baseline (70.55 ± 19.46 points) and final assessment (71.74 ± 19.37 points) in the control group (t = -0.87, P > 0.05). CONCLUSIONS:The awareness of echinococcosis control knowledge is fair among primary school students in echinococcosis hyper-endemic regions; however, the capability of combining theoretical learning and practices requires to be improved. The health education mode based on the pathway of assessing the current status-strengthening the building of teaching resources-focusing on practices seems to remarkably improve the understanding of echinococcosis control knowledge among primary school students in echinococcosis hyper-endemic regions.

目的 观察阿苯达唑(ABZ)和毗喹酮(PQT)交替联合用药及ABZ单药治疗藏族牧民棘球蚴病的效果和不良反应,为药物治疗棘球蚴病提供参考依据.方法 采用B超检查结合血清学检测对四川省阿坝州若尔盖县和壤塘县牧民进行棘球蚴病筛查,确诊患者纳入治疗和观察.将病例随机分为ABZ+PTQ交替联合用药治疗组(ABZ+PQT组)和ABZ单药治疗组(对照组,ABZ组).ABZ+PQT组患者ABZ片剂15 mg/(kg,d),分2次服用,连服25 d,随后改服PQT片剂40 mg/(kg,d),顿服,连服5d,依次交替服药,3个月为一个疗程,疗程中间不停药.ABZ组患者ABZ片剂15 mg/(kg,d),分2次服用,连续服药3个月,停药1周后开始下个疗程.两组患者的治疗时间均为2年.治疗期间,两组患者每半年进行一次影像学疗效评估、血清抗棘球蚴IgG抗体检测和肝功能指标监测.通过问卷调查和主要肝功能指标监测了解不良反应.结果 纳入治疗随访观察的临床诊断棘球蚴病病例共97例.ABZ+PQT组共55例病例,其中细粒棘球蚴病(CE) 31例、多房棘球蚴病(AE) 24例;ABZ组共42例病例,其中CE 22例、AE 20例.通过2年的治疗和随访观察,ABZ+PQT组对CE的治愈率为19.4％ (6/31),有效率为58.1％ (18/31);对AE的治愈率为12.5％ (3/24),有效率为50.0％ (12/24).ABZ组对CE的治愈率为9.1％ (2/22),有效率为18.2％ (4/22);对AE的治愈率为5.0％ (1/20),有效率为20.0％(4/20).两组在抗棘球蚴IgG抗体滴度变化差异不显著.血清抗棘球蚴IgG抗体检测结果显示,治疗前,ABZ+PQT组血清抗体吸光度(A450值)为0.39±0.06,服药3个月后上升至0.45±0.05,此后基本维持在相同水平,但在治疗12月后下降至0.38±0.07,后保持稳态;ABZ组血清抗体A450值变化趋势与ABZ+PQT组相似,服药前为0.41±0.07,服药3个月后升至0.43±0.08,治疗12个月时降为0.39±0.07,后基本平稳;不同疗程时间对血清抗体A 450值的影响有统计学意义(P＜0.05).治疗期间总不良反应发生率为23.7％ (23/97),其中ABZ+PQT组有8例(占34.8％),ABZ组有15例(占65.2％),主要是胃肠不适等轻度不良反应;重度不良反应主要为肝功能受损,服药3个月时,6例(ABZ+PQT治疗组1例,ABZ治疗组5例)丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)都升高,此后随访逐渐下降至正常.结论 ABZ+PQT组对CE和AE的治疗有效率高于ABZ组;ABZ+PQT组产生的药物不良反应明显低于ABZ组;血清抗棘球蚴IgG抗体变化不能反映病灶进展情况.

目的 了解2016-2019年四川省监测点棘球蚴病疫情的动态变化,为下一步防控工作提供参考.方法 2016-2019年,每年采用B超检查四川省监测点范围内2周岁以上常住人口棘球蚴病患病情况,采集监测点范围内家犬、流浪犬粪样,ELISA检测犬粪棘球绦虫抗原情况,采用触检、剖检法检查监测县牲畜、啮齿目动物内脏,判定其感染情况.结果 35个监测点人群监测结果显示,2016-2019年棘球蚴病新患者检出率呈逐年降低,由2016年的0.15％ (72/48976)降至2019年的0.02％ (13/81725) (P＜ 0.05).新检出患者共115例,其中80.87％ (93/115)来自于甘孜州;多房棘球蚴病患者占59.13％ (68/115),细粒棘球蚴病患者占38.26％ (44/115),肝外棘球蚴病患者占2.61％ (3/115).2016-2019年家犬和流浪犬的粪棘球绦虫抗原阳性率分别为1.19％ (28/2348)、2.35％ (52/2212)、3.43％ (69/2010)、0.95％ (35/3668)和2.87％ (13/453)、2.00％ (8/400)、4.69％ (15/320)、0.80％ (5/624),不同年份间阳性率差异均有统计学意义(P＜0.05),2019年较2016年分别下降了20％、72％;中间宿主牲畜感染检出率分别为4.45％ (146/3283)、1.53％ (50/3273)、2.93％ (75/2564)、2.18％ (89/4078),啮齿目动物感染检出率分别为1.71％ (123/7204)、2.48％ (185/7470)、1.19％ (67/5613)、1.47％ (154/10477),不同年份间感染检出率差异均有统计学意义(P＜0.05),2019年较2016年分别下降了51％、14％.结论 2016-2019年四川省棘球蚴病患者检出率、犬粪棘球绦虫抗原阳性率和中间宿主感染检出率总体呈下降趋势,犬粪棘球绦虫抗原阳性率和中间宿主感染检出率仍存在波动.

目的 了解四川省365例新型冠状病毒肺炎患者中治愈出院者住院时长及其影响因素.方法 收集四川省新冠肺炎确诊病例中365名治愈出院病人的人口学相关信息、临床资料及流行病学调查资料等,采用(均数±标准差)和中位数(四分位数)描述计量资料,组间比较使用独立样本t检验和单因素方差分析.多因素分析使用多水平线性模型,检验水准为α=0.05(双侧).结果 365例出院病人的住院平均时间为16.2天,中位时间为16天,最长时间为34天,最短时间为3天;住院时长在高级水平(不同的收治机构)上存在聚集性(VPC=0.33,P＜0.05);住院时长在不同机构类型、病例来源、临床严重程度以及发病时间中存在差异(P＜0.05),且发病时间与病例来源存在一定的交互效应.结论 随着疫情发展,四川省新冠肺炎确诊病例的住院时长呈现逐渐缩短的趋势,传染病专科医院的住院时长更短,重症病例的住院时长比轻症者更长.

Echinococcus granulosus sensu stricto (s.s.), Echinococcus multilocularis and Echinococcus canadensis are the common causes of human echinococcosis in China. An accurate species identification tool for human echinococcosis is needed as the treatments and prognosis are different among species. The present work demonstrates a method for the simultaneous detection of these three Echinococcus species based on multiplex polymerase chain reaction (mPCR). Specific primers of this mPCR were designed based on the mitochondrial genes and determined by extensive tests. The method can successfully detect either separated or mixed target species, and generate expected amplicons of distinct size for each species. Sensitivity of the method was tested by serially diluted DNA, showing a detection threshold as less as 0.32 pg for both E. granulosus s.s. and E. canadensis, and 1.6 pg for E. multilocularis. Specificity assessed against 18 other parasites was found to be 100% except weakly cross-react with E. shiquicus. The assay was additionally applied to 69 echinococcosis patients and 38 healthy persons, confirming the high reliability of the method. Thus, the mPCR described here has high application potential for clinical identification purposes, and can further provide a useful tool for evaluation of serology and imaging method.

为了解石渠县棘球绦虫终末宿主和中间宿主动物活动特点,于2018年6月和8月采用红外感应触发相机在石渠县俄多玛乡日扎村居民定居点附近选取8户家庭观察人与拴养犬之间的互动情况,以及拴养犬与其他动物之间的互动情况.选取4个观察点观察小型哺乳类动物活动规律.红外相机固定在距离地面100 cm左右的电线杆或围栏上,观察记录6 m以内人或动物的有效活动情况.在放置有红外相机并记录到有高原鼠兔和青海松田鼠活动的范围内采集动物样品,进行物种的分类鉴定.对所采集动物样品的细胞色素b基因(Cyt b)进行PCR扩增,并进行双向测序,在GenBank中通过Blastn进行序列比对.结果 显示,8户牧民家庭仅有3户共计277 min的视频得到有效记录,每户仅1条拴养犬,均为藏犬,拴养犬距离户主居住点平均在28 m左右,且拴养犬均在户主庭院围栏外,平均每天喂食1次,未发现人或野犬与拴养犬有接触性动作.在高原鼠兔观察点捕获的动物经鉴定为高原鼠兔,其地面活动开始时间为6:46,结束时间为20:41;活动高峰期出现在9:00、12:00、15:00和19:00左右.在青海松田鼠观察点捕获的动物经鉴定为青海松田鼠,其地面活动开始时间为8:06,结束时间为20:09,其中19:00左右活动最为频繁.人与拴养犬的互动以喂食为主,犬被喂食次数少,增加了其捕食小型哺乳类动物的可能性;高原鼠兔活动开始时间早于青海松田鼠,高原鼠兔全天活动更为频繁.

Echinococcosis is considered by the World Health Organization (WHO) to be a neglected zoonotic disease in the world. Some Tibetan communities were found to be highly endemic for echinococcosis just 20 years ago. Until recently, we were able to understand the overall disease burden of echinococcosis in Tibetan communities after prevalence data being available from nationwide investigations from 2012 to 2016. Data were abstracted from 9 publications regarding to echinococcosis prevalence between 2016-2018; from 10 data bases on echinococcosis prevalence for 151 Tibetan counties; and statistics of population, Gross Domestic Product (GDP) and health staff from 44 local statistic bureaus and government websites at provincial, prefecture and county level, and 2 books of provincial yearly statistics. These data were used to estimate the Disability Adjusted Life Years (DALYs) due to cystic echinococcosis (CE) and alveolar echinococcosis (AE). The distribution of DALYs was presented geographically and economically. The echinococcosis DALYs in the Tibetan communities were estimated to be 126,159 (95%UI 122,415-137,675) annually using the method recommended by WHO. AE DALYs were estimated to be 105,829 (95%UI 101,969-117,090), which were more than CE DALYs of 20,330 (95%UI 19,690-21,581). Echinococcosis affects people more in underdeveloped areas. There was a tendency that a higher echinococcosis DALYs were usually correlated a higher altitude. Health services are also poorly provided in terms of number of health staff of 5.05 per 1000 population in comparison with the national average of 5.8 per 1000 population. The data suggest that the echinococcosis burden in the center region of Qinghai-Tibet plateau is higher than that of other regions, and consequently more control and health services should be provided to the region.

目的 了解四川省石渠县肝包虫病患者B超影像的变化过程及趋势,分析变化规律,提高对包虫病的超声影像识别能力,了解阿苯达唑大规模社区治疗情况.方法 通过现场超声检查及血清学检测,对患者进行跟踪随访;通过Excel建立2个队列数据库,分别比较病灶1年及2年后的影像变化特点;以Fisher确切概率法,对病灶退化率进行比较.结果 共计随访606例,获得618个病灶的清晰图像;1年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到16.42％ (P ＜0.05),其他各型之间退化率差异无统计学意义(P＞0.05);2年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到45.45％(P ＜0.05),其他各型之间退化率差异无统计学意义(P＞0.05).结论 本研究中涉及的病灶变化可推测为自然转归,表明阿苯达唑大规模社区治疗依从性差;CE3是囊型包虫病中最不稳定的类型,易退化为CF4;CE3、CE4的囊壁可直接被肝组织吸收;泡型包虫病中似血管瘤型不稳定,发展为伪囊型.