Epidemiological update of cystic echinococcosis in livestock and assessment of practices related to its control in the Mediterranean area.

Cystic echinococcosis (CE), caused by the tapeworm Echinococcus granulosus, is a zoonotic parasitic disease that still represents a serious threat to human and animal health worldwide. The Mediterranean basin is recognized as one of the major hotspots of CE due to several factors, including the presence of diverse intermediate host species as well as socio-economic and cultural conditions of local communities. This study aims to take a closer look at epidemiological data on CE in the Mediterranean area and assess the knowledge attitudes and practices of shepherds towards this disease in four countries (Algeria, Greece, Italy and Tunisia), highly endemic for CE, with the final goal of identifying highly endemic risk areas and practices in use which might potentially allow the persistence of E. granulosus infection in these areas. To update the epidemiological scenario of CE in Mediterranean areas, a comprehensive review of peer-reviewed literature on CE prevalence data published during the 2017-2023 period was carried out and, through a geographical information system (GIS), a map displaying the current CE distribution in the Mediterranean area was generated. In addition, a questionnaire survey was conducted through in-depth interviews of the farmers to collect information on their management system as well as knowledge attitudes and practices towards CE. From the farmer-participatory survey some risky practices emerged including the non-regular deworming of dogs or the use of ineffective drugs or dosing, as well as the provision of uncooked animal viscera to dogs. Finally, lower levels of knowledge and awareness of the disease was observed among farmers from North Africa compared with those of European countries. In conclusion, the results obtained highlight that CE is still a very serious problem in Mediterranean areas and increased efforts are needed to promote awareness among farmers and to turn research results into policy in order to reduce the spread of this disease, according to the One Health perspective.

Impoverishment Effect of Hydatid Disease and Precision Medical Assistance Pattern of Government: Evidence from Yushu in China.

Hydatid disease is one of the 17 neglected tropical diseases recognized by WHO and causes a huge global disease burden. Hydatid disease poses a great threat to local medical poverty alleviation. In efforts to break the vicious circle of poverty, Hydatid disease has been widely concerned and discussed. In the practice of poverty alleviation in China, medical poverty alleviation is regarded as the double goal of getting rid of poverty and promoting the construction of a healthy China. On the basis of on-the-spot investigation in Yushu Prefecture, this paper conducts a follow up study on the poverty-causing effect of Hydatid disease and the precision medical assistance pattern of government using a field investigation method. The results show that Hydatid disease led to the increase of poverty in the population in Yushu Prefecture, precision medical assistance played an obvious role in treating Hydatid disease and poverty alleviation, the health service in the study area continues to improve and the medical backbone team further expanded. The main conclusion is that the three-level diagnosis and treatment framework can effectively reduce local poverty and improve people's living environment.

The economic evaluation of Cystic echinococcosis control strategies focused on zoonotic hosts: A scoping review.

BACKGROUND: Cystic echinococcosis (CE) is a zoonotic neglected tropical disease (zNTD) which imposes considerable financial burden to endemic countries. The 2021-2030 World Health Organization's roadmap on NTDs has proposed that intensified control be achieved in hyperendemic areas of 17 countries by 2030. Successful interventions for disease control, and the scale-up of programmes applying such interventions, rely on understanding the associated costs and relative return for investment. We conducted a scoping review of existing peer-reviewed literature on economic evaluations of CE control strategies focused on Echinococcus granulosus zoonotic hosts. METHODOLOGY/PRINCIPAL FINDINGS: Database searches of Scopus, PubMed, Web of Science, CABI Direct and JSTOR were conducted and comprehensively reviewed in March 2022, using predefined search criteria with no date, field or language restrictions. A total of 100 papers were initially identified and assessed for eligibility against strict inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Bibliography review of included manuscripts was used to identify additional literature. Full review of the final manuscript selection (n = 9) was performed and cost data for control interventions were extracted. CONCLUSIONS/SIGNIFICANCE: There are very little published data pertaining to the cost and cost effectiveness of CE control interventions targeting its zoonotic hosts. Data given for costs are often incomplete, thus we were unable to perform an economic analysis and cost effectiveness study, highlighting a pressing need for this information. There is much scope for future work in this area. More detailed information and disaggregated costings need to be collected and made available. This would increase the accuracy of any cost-effective analyses to be performed and allow for a greater understanding of the opportunity cost of healthcare decisions and resource allocation by stakeholders and policy makers for effective and cost-effective CE control.

Assessment of echinococcosis control in Tibet Autonomous Region, China.

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.

Assessment of a 10-year dog deworming programme on the transmission of Echinococcus multilocularis in Tibetan communities in Sichuan Province, China.

Human alveolar echinococcosis (AE) is considered a neglected zoonotic disease by the World Health Organization (WHO). The causative pathogen, Echinococcus multilocularis, lives as an adult tapeworm in the intestinal tract of canines. AE was identified as an emerging public health issue in Tibetan communities of Shiqu County 20 years ago. On St. Lawrence Island, Alaska (USA), in the 1980s peri-domestic transmission of E. multilocularis was controlled by regular deworming of owned dogs over a 10-year period. In Tibetan communities, on the Tibetan Plateau, control of E. multilocularis transmission is challenging due to the continental setting, complex epidemiology, disease ecology, geography, and socio-cultural factors. However, a control programme based on deworming owned dogs using praziquental (PZQ) has been carried out since 2006. Assessment was conducted in townships where baseline data were available 10 years prior. Purging of dogs by oral administration of arecoline was used to measure E. multilocularis prevalence, trapping small mammals around communities was employed to assess the change in infection of pikas and voles, and analysis of human AE abdominal ultrasound-based data was used to understand the change in prevalence in the past decade. In all three evaluated townships, the E. multilocularis prevalence in owned dogs was significantly (P < 0.01) reduced from 7.23% (25/346) during 2000-2003 to 0.55% (1/181) in 2016. Human AE ultrasound-based prevalence (adjusted for age and sex) in five evaluated townships decreased significantly (P < 0.01) from 6.25% (200/3,198) during 2000-2002 to 3.67% (706/19,247) during 2015-2017. The 2016 prevalence of E. multilocularis metacestodes in small mammal intermediate hosts was not significantly different from the prevalence in 2008. The control programme was effective in reducing E. multilocularis infection in owned dogs and human AE prevalence, but did not significantly impact infection in wildlife intermediate hosts.

Identification of vulnerable populations and knowledge, attitude, and practice analysis of echinococcosis in Tibet Autonomous Region of China.

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.

The effects of dog management on Echinococcus spp. prevalence in villages on the eastern Tibetan Plateau, China.

BACKGROUND: The pastoral area of the eastern Tibetan Plateau is highly endemic for human echinococcosis. Domestic dogs are the main definitive host for the transmission of both Echinococcus granulosus (sensu lato) and E. multilocularis to humans. To control the infection risks, a national-level canine echinococcosis prevention and control programme has been implemented since 2015 in Shiqu County, Ganze Tibetan Autonomous Prefecture, Sichuan, China. The objective of this study was to evaluate its effect on Echinococcus spp. prevalence in dogs. METHODS: We surveyed 69 households with 84 owned dogs, for dog fecal samples and dog keeping information in the villages of Rizha and Eduoma. A total of 105 dog fecal samples (75 from owned dogs and 30 unknown dog fecal samples) were collected between 2015-2017 to determine Echinococcus spp. prevalence using copro-PCR. Eight variables based on household surveys were included into a logistic regression model for significant risk factors to canine echinococcosis prevalence in dogs. RESULTS: Between 2015-2017, the overall Echinococcus spp. copro-DNA prevalence decreased significantly in dogs from 51.2% (2015) to 20.0% (2017) in Rizha, and insignificantly from 11.5% (2016) to 4.3% (2017) in Eduoma. Echinococcus multilocularis was the most prevalent species continually copro-DNA detected during the entire study period, while E. granulosus was rare and not detected in 2017. Echinococcus shiquicus copro-DNA prevalence (a probable non-zoonotic wildlife species) was as high in dogs as that of E. multilocularis, although only detected in 2015 in Rizha. Unleashed dog feces were mainly collected in Rizha in 2015. Although 93.2% of owned dogs were leashed, and the monthly praziquantel dosing rate reached 97%, E. multilocularis infection could still be detected in 11.1% of owned dogs in 2017. Monthly deworming, leashing dogs 24 h per day, and the avoidance of dogs feeding on livestock viscera were significant measures to prevent canine echinococcosis infection in owned dogs. CONCLUSIONS: Carrying out a canine echinococcosis prevention and control programme can significantly decrease Echinococcus spp. prevalence. The potential contact between leashed dogs and wild small mammals is still a risk for re-infection of owned dogs with E. multilocularis. This study shows that the long-term application of regular dog treatment with praziquantel in the vast and remote echinococcosis endemic areas of the eastern Tibetan Plateau can reduce transmission in dogs but remains a challenging intervention.

Disease burden of echinococcosis in Tibetan communities-A significant public health issue in an underdeveloped region of western China.

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.

Impact of disposing stray dogs on risk assessment and control of Echinococcosis in Inner Mongolia.

Echinococcosis has been recognized as one of the most important helminth zoonosis in China. Available models always consider dogs as the mainly definitive hosts. However, such models ignore the distinctions between domestic dogs and stray dogs. In this study, we propose a 10-dimensional dynamic model distinguishing stray dogs from domestic dogs to explore the special role of stray dogs and potential effects of disposing stray dogs on the transmission of Echinococcosis. The basic reproduction number R0, which measures the impact of both domestic dogs and stray dogs on the transmission, is determined to characterize the transmission dynamics. Global dynamic analysis of the model reveals that, without disposing the stray dogs, the Echinococcosis becomes endemic even the domestic dogs are controlled. Moreover, due to the difficulties in estimating the parameters involved in R0 with real data and the limitation of R0 in real-world applications, a new risk assessment tool called relative risk index Irisk is defined for the control of zoonotic diseases, and the studies of the risk assessment for Echinococcosis infection show that it is essential to distinguish stray dogs from domestic dogs in applications.

[Physiological characteristics of Echinococcus and their association with interventions against echinococcosis].

Alveolar and cystic echinococcosis are important zoonotic diseases caused by the dog/fox tapeworms of Echinococcus granulosus and E. multilocularis, which are distributed in almost whole the world. The diseases remarkably impact on the people's health and economic development of communities. Echinococcus tapeworms need two mammalian animals to complete their lifecycle. The worms undergo different developmental stages (adult, egg/oncosphere, cyst, and protoscolex). Each stage has its own distinct physiological characteristics. We summarize the characteristics and emphasize that some features that strongly impact on design of control program. Based on the lifecycle of these worms, two stages are infectious, one is egg the only stage for primarily infecting humans and intermediate host, and another stage is protoscolex, the only stage for infecting the definite hosts of the worms. Eggs are produced by the adult worms parasitized in the intestine of definite hosts. It takes 45 days for eggs becoming mature in dogs. With this feature of the tapeworm, New Zealand and Tasmania in Australia designed control program for deworming 8 times annually with an interval between deworms at 45 days. E. multilocularis takes 28-30 days in dog/fox producing mature eggs. Given that co-existence of E. granulosus and E. multilocularis in western China, a control measure so called "prepatent deworming control measure" has been used in these endemic areas with dosing worms in dogs every month. It normally takes 12-15 months for producing protosocleces in E. granulosus cysts in sheep. If meat markets attract most lambs, that is an effective measure for controlling cystic echinococcosis given that there are no protoscoleces produced from those lambs. In addition, Echinococcus has its own unique biological characteristics, such as sexual reproduction and asexual reproduction, single-cell layer structure of cyst, bidirectional development of protoscoleces induced by bile salts, and long term of infection causing host asymptomatic reaction make the parasites a models for addressing some biological and biomedical issues. And more, hydatid cyst fluid is the antigen resource for identifying diagnostic reagents; the specific gene expressed in oncospheres has been developed as an effective vaccine used for control program. With the development and application of high-throughput omics, including genomics, transcriptomics and proteomics, we can use the physiological characteristics of Echinococcus for searching diagnostic reagents, developing preventive vaccines and identify new drug targets.

Knowledge, attitudes, and practices regarding cystic echinococcosis and sheep herding in Peru: a mixed-methods approach.

BACKGROUND: The parasitic disease, cystic echinococcosis (CE), is prevalent in low-income, livestock-raising communities and 2000 new people will be diagnosed this year in South America alone. The disease usually passes from livestock to dogs to humans, making it a zoonotic disease and part of the One Health Initiative. Control of CE has been infamously difficult; no endemic areas of South America have succeeded in maintaining sustainable eradication of the parasite. For the current study, we aimed to gain a better understanding of the knowledge, attitudes, and practices of rural sheep farmers and other community leaders regarding their sheep herding practices and perspectives about a control program for CE. We also hope to identify potential barriers and opportunities that could occur in a control program. The authors conducted Knowledge, Attitude and Practices (KAP) surveys and semi-structured interviews in rural communities in the highlands of Peru. The KAP surveys were administered to 51 local shepherds, and the semi-structured interviews were administered to 40 individuals, including shepherds, community leaders, and health care providers. RESULTS: We found that the shepherds already deworm their sheep at a median of 2 times per year (N = 49, range 2-4) and have a mean willingness-to-pay of U.S. $ 0.60 for dog dewormer medication (N = 20, range = 0.00- $2.00 USD). We were not able to learn the deworming agent or agents that were being used, for neither sheep nor dogs. Additionally, 90% of shepherds slaughter their own sheep (N = 49). We also learned that the main barriers to an effective control program include: lack of education about the cause and control options for CE, accessibility to the distant communities and sparse grazing pastures, and a lack of economic incentive. CONCLUSIONS: Findings suggest it may be feasible to develop an effective CE control program which can be used to create an improved protocol to control CE in the region.

Present status, actions taken and future considerations due to the findings of E. multilocularis in two Scandinavian countries.

When Echinococcus (E.) multilocularis was first detected in mainland Scandinavia in Denmark in 2000, surveillance was initiated/intensified in Sweden, mainland Norway and Finland. After 10 years of surveillance these countries all fulfilled the requirements of freedom from E. multilocularis as defined by the EU, i.e. a prevalence in final hosts <1% with 95% confidence level. However, in 2011 E. multilocularis was detected in Sweden for the first time and surveillance was increased in all four countries. Finland and mainland Norway are currently considered free from E. multilocularis, whereas the prevalence in foxes in Sweden and Denmark is approximately 0.1% and 1.0%, respectively. E. multilocularis has been found in foxes from three different areas in Denmark: Copenhagen (2000), Højer (2012-14) and Grindsted (2014). Unlike Sweden, Norway and Finland, human alveolar echinococcosis (AE) is not notifiable in Denmark, and the number of human cases is therefore unknown. In Sweden, E. multilocularis has been found in foxes in four counties, Västra Götaland, Södermanland, Dalarna (2011) and Småland (2014). E. multilocularis has also been found in an intermediate host in Södermanland (2014). Two cases of AE have been reported in humans (2012), both infected abroad. No cases of E. multilocularis or AE have been reported in Finland and Norway. Recommendations and future considerations are discussed further.

Echinococcus granulosus and other intestinal helminths: current status of prevalence and management in rural dogs of eastern Australia.

OBJECTIVES: Ascertain the prevalence of intestinal helminths in rural dogs from eastern Australia and Tasmania. Identify farm management practices contributing to the perpetuation and transmission of Echinococcus granulosus. METHODS: Helminth infection in dogs was determined microscopically through faecal flotation. Infection with E. granulosus was determined via faecal antigen-capture ELISA and coproPCR. Taeniid eggs were identified using molecular methods. Data on dog management and owner understanding of hydatid disease were collected via questionnaire. RESULTS: Faeces were collected from 1425 Australian rural dogs (1119 mainland; 306 Tasmania). Eggs of hookworms were most prevalent, up to 40.2%, followed by whipworms (Trichuris vulpis), up to 21.2%. Roundworms (Toxocara canis and Toxascaris leonine) were least common, up to 6.1%. Taeniid eggs were found in 11 dogs (5 Taenia pisiformis; 2 T. serialis; 4 T. hydatigena); 2 of the T. hydatigena-infected dogs were also E. granulosus coproantigen-positive. Of the 45 dogs found to be E. granulosus coproantigen-positive, 24 were in Tasmania, 16 in NSW, 3 in Victoria and 2 in Queensland. Three Tasmanian coproantigen ELISA-positive dogs were also coproPCR-positive. The most common dog ration was commercial dry food, but half the owners fed raw meat to their dogs and some fed offal of lambs (8.9%) or mutton (7.8%). More than half (69%) of owners weighed their dogs before deworming. Few dewormed their dogs often enough to ensure they remained cestode-free and owners hunting wildlife usually left carcases where they were shot. CONCLUSIONS: E. granulosus is still present in Australian rural dogs, including Tasmania, but at low levels. Owner behaviour perpetuates transmission of cestodes.

Control of Echinococcus multilocularis: strategies, feasibility and cost-benefit analyses.

Echinococcus multilocularis, the zoonotic agent of human alveolar echinococcosis, has considerably extended its range and became more prevalent in many parts of the endemic areas. Accordingly, there is an increasing demand for measures to prevent human infections. Rising public awareness of this zoonosis and individual protective actions should be part of every prevention program. Considering the high reproduction of E. multilocularis in domestic dogs which live in close contact to humans, a monthly deworming scheme for domestic dogs with access to rodents is likely to be of high importance. This holds true if only low prevalences in domestic dogs are recorded, as high densities of these pets can easily outweigh low infections rates. Thus, in central Europe their estimated contribution to environmental contamination with E. multilocularis eggs ranges between 4% and 19%. The estimated contribution of domestic cats is insignificant (<0.3%) due to low parasite reproduction in this species. Control of the parasite by reducing its main wildlife hosts (foxes, vole species) is barely achievable on a larger scale and is generally not well accepted due to ecological considerations and animal welfare concerns. In general, the frequency of the parasite sharply decreases when anthelmintic baits are regularly distributed to foxes. However, eradication of the parasite is unlikely and long-term baiting campaigns are actually the most effective tool to significantly lower the infection pressure with parasite eggs. Regarding the long latency of 5-15 years of alveolar echinococcosis, however, such measures can only be cost effective if they are pursued for several decades and concentrate on restricted areas which are most relevant for the transmission of alveolar echinococcosis such as highly endemic areas in densely populated zones. Thus, the implementation of this approach strongly depends on factors such as public attitude, available financial resources and priority setting of political decision-makers.

[Assessment of health education against echinococcosis in Tibetan region of Sichuan Province, China].

OBJECTIVE: To find an effective strategy of implementing health education in Tibetan Regions so as to make echinococcosis control sustainable at a large scale. METHODS: During July to November of 2008, surveys were conducted on health education requirements among various populations in the form of questionnaire and group discussion in endemic areas of echinococcosis in three counties of the Ganzi Tibetan Autonomous Prefecture, Sichuan. Based on the obtained results, health education materials suitable for different populations were designed. The materials were applied for conducting health education in field at Tagong Township, Kangding of Ganzi in October, 2009. By the survey in May, 2010, the improved effect on knowledge and behavior change was compared before and after (6 months later) health education in order to assess the usefulness of these materials. Simultaneously, Xinduqiao Township of Kangding was selected as control. This town is neighboring to the study area with similar natural and demographic conditions, in which no health education activities related to the study was implemented. RESULTS: Various populations showed their interested requirements for health education materials and ways. Based on the information collected, a series of materials were designed and applied for health education activities in field. The results indicated that, compared with the data before health education, improvement of the knowledge and behaviors against echinococcosis among students and local residents showed significant increase (P < 0.05), but only one knowledge point about the importance of washing hands before meal among students showed no significant difference (P > 0.05) in spite of the rates increasing from 88.6% (78/88) before health education to 95.5% (84/88) after education. The local officers and monks also showed to some extent improvement on behavior manners. The rate of correct treatment of livestock viscera increased from 37.1% (13/35) and 30.3% (10/33) before the education to 82.9% (29/35) and 78.8% (26/33) (P < 0.01), while the rate of not feeding stray dogs among monks was 6.4% (3/47) before and 10.6% (5/47) (P > 0.05) after the education. The knowledge-increasing and behavior-improving rates on playing dogs among the students, residents and monks increased by 182% and 193%, 42.8% and 54.3%, 6.4% and 14.9%, respectively. There was no considerable change in the control township. CONCLUSION: The materials designed for health education are acceptable by most populations. The improvement rate of knowledge and behaviors is considerable among the groups. Use of the materials receives expected effect on health education and health promotion.

Willingness to pay for compulsory deworming of pets entering Sweden to prevent introduction of Echinoccoccus multilocularis.

To investigate if the Swedish entry rules for pets to prevent the introduction of Echinococcus multilocularis (EM) are proportional (i.e. that their costs do not exceed the value of their benefits), a dichotomous-choice contingent valuation study was conducted. The study was performed before the first case of EM was detected in Sweden in February 2011. About 5000, randomly selected, Swedish citizens were invited to participate and 2192 of them (44%) accepted to do so. Missing information on whether or not one would accept to pay for keeping the rules for 143 respondents resulted in 2049 observations (41%) available for the estimation of willingness to pay (WTP), and missing information on personal characteristics for another 274 respondents reduced the number of observations available for sensitivity analysis to 1775 (36%). Annual expected WTP for keeping the rules ranged between € 54.3 and € 99.0 depending on assumptions about compensations demanded by respondents not willing to pay. The estimates are conservative since only answers from respondents that were absolutely certain they would pay the suggested bid were regarded as yes-responses. That WTP is positive implies that Swedish citizens perceived the benefits of the rules to be larger than their costs.

A pilot study for control of hyperendemic cystic hydatid disease in China.

BACKGROUND: Cystic hydatid disease (CHD) is a global parasitic zoonosis caused by the dog tapeworm, Echinococcus granulosus. The disease is hyperendemic in western China because of poor economic development; limited community knowledge of CHD; widespread, small-scale household animal production; home killing of livestock; and the feeding of dogs with uncooked offal. METHODOLOGY/PRINCIPAL FINDINGS: A control program focusing on monthly praziquantel (PZQ) treatment of all registered dogs and culling unwanted and stray dogs has been designed to control CHD in hyperendemic areas in China. A pilot field control project in two counties (Hutubi and Wensu) in Xinjiang, China showed that after 4 years of treatment, the prevalence of dogs with E. granulosus was reduced from 14.7% and 18.6%, respectively, to 0%, and this caused a 90%-100% decrease of CHD in sheep born after commencement of the control program. CONCLUSIONS/SIGNIFICANCE: The strategy aimed at preventing eggs being released from dogs into the environment by treating animals before adult tapeworms are patent can decrease E. granulosus transmission and considerably reduce hyperendemic CHD. Monthly treatment of dogs with PZQ and culling unwanted and stray dogs have been shown to be an efficient, highly cost-effective and practicable measure for implementation in rural communities. As a result, the Chinese Ministry of Health has launched an extensive CHD control program in 117 counties in western China using this control strategy.

Echinococcosis: costs, losses and social consequences of a neglected zoonosis.

The socio-economic impact of echinococcosis, with special reference to cystic echinococcosis (CE) caused by Echinococcus granulosus, is reviewed. The following items are discussed: socio-economic consequences in humans; economic consequences in livestock; costs and benefits of control programmes; economic evaluation of control programmes; social reasons favouring the life cycle of CE; social, political and economic situations hindering the control of echinococcosis. Many consequences are difficult to evaluate from an economic point of view. However, many evaluations have shown that CE is an important (often neglected) public health and economic problem, especially in endemic areas, and that the socio-economic evaluation of its consequences and of control actions proves indispensable to best use available resources and possibly tailor control strategies.