Echinococcus granulosus infection and options for control of cystic echinococcosis in Tibetan communities of Western Sichuan Province, China.

BACKGROUND: Human cystic echinococcosis (CE) is highly endemic in the Tibetan regions of Sichuan where most families keep guard dogs and where there are considerable numbers of ownerless/stray dogs. Strong Buddhist beliefs do not allow for elimination of stray dogs, and many strays are actually fed and adopted by households or monasteries. On account of the high altitude (3900-5000 m), pasturage is the major agricultural activity in this area. The harsh mountainous climate often leads to many grazing animals dying on the pasture at the end of a hard winter. The skin and some meat are taken, and the rest of the animal is left for scavenging birds and animals. The poor sanitation and hygiene, the Buddhist doctrine of allowing old livestock to die naturally, plus the unrestricted disposal of animal viscera post-slaughter may be responsible for the high prevalence of human CE in this setting.

METHODS AND FINDINGS: As part of a large collaborative control program for CE in Ganzi County, situated in the west of Sichuan Province, surveillance for Echinococcus infection in domestic dogs using a coproantigen method and necropsy of unwanted dogs was carried out prior to (in 2000) and after (in 2005) dog anthelminthic treatment (5 mg/kg oral praziquantal at 6 month intervals) to determine the efficacy of the treatment for control. The prevalence of E. granulosus only in dogs by necropsy was 27% and 22%, and prevalence of both Echinococcus spp. by necropsy was 63% and 38%; prevalence of both Echinococcus spp. by coproantigen analysis was 50% and 17%. Necropsy of sheep/goats (age <1 to 12 years) (prevalence of E. granulosus in 1-6-year-old animals was 38% and in 10-12-year-old animals was 70%) and yaks (age 4 years) (prevalence of E. granulosus was 38%) was undertaken to determine the baseline transmission pressure. Protoscoleces were only found in very old sheep/goats and yaks. Necropsy of dogs in the Datangma district indicated that there was no apparent significant change in the overall prevalence of E. granulosus in unwanted dogs after 5 years of 6-month praziquantel treatment. However, this was likely due to the number of dogs available for necropsy being too small to reflect the real situation prevailing. There was a highly significant decrease in Echinococcus prevalence after the 5-year treatment program shown by coproantigen-ELISA. This indicated a decreasing but continuing risk for re-infection of domestic and stray dogs. Genotyping of E. granulosus samples obtained from necropsied sheep/goats and yaks and from locally infected humans at surgery was carried out to determine the strain of parasite responsible for human infection. DNA genotyping indicated that only the sheep strain (G1) of E. granulosus was present in the study area.

CONCLUSIONS: Considerable re-infection rates of E. granulosus among dogs indicated a high infection pressure from infected livestock in this region, most likely from older animals dying on the pasture. A combination of livestock vaccination with the Eg95 vaccine, which is effective against the sheep strain of E. granulosus, and dog anthelmintic treatment, thus targeting two critical points of the parasite life-cycle, would avoid the conflicts of religion or local culture and could achieve the goal of hydatid control in the long term.