Societal Drivers of Human Echinococcosis in China | Parasites & Vectors

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general situation

There were 4323 cases, including 1811 males and 2512 females, with a sex ratio of 1:1.39, accounting for 41.89% and 58.11% of cases, respectively. The youngest patient was 2 years old and the oldest 95 years old, with a mean age of 42 years. The Qinghai-Tibet Plateau hosted 3286 cases, while 1037 cases were found in the area outside the Qinghai-Tibet Plateau (Table 2). CE represented 3194 cases and AE was responsible for 1064 cases (Table 2). There were 65 cases of coinfection with CE and AE. In the analysis, CE cases included confirmed CE cases and co-infections with CE and AE. Similarly, AE cases included confirmed AE cases and co-infections with CE and AE.

Table 2 Echinococcosis cases in the non-Qinghai-Tibet Plateau

Identifying common risk factors for CE and AE

The cluster analysis was performed on cases on the Qinghai-Tibet Plateau and on cases outside the Qinghai-Tibet Plateau, respectively. Each ring was constructed from the inside out based on proportion, gender, age, education and occupation (Fig. 1).

Fig. 1

Cluster results of vulnerable populations in Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau

Cluster analysis of populations at risk in the Qinghai-Tibet Plateau

The range of k-clusters was defined as 2-7 [19, 20]. After determining the best k-value, the instances from the Qinghai-Tibet Plateau were grouped with k= 4 as the optimal number of clusters (Fig. 1a). The first cluster comprised 1672 cases, which were mainly made up of women in age group 2, ie 21-64 years, and illiterates (Fig. 1a). The second cluster included 730 cases, mostly women under the age of 21 and with only primary education (Fig. 1a). The third cluster consisted of 675 people, mostly women in age group 2 (21-64 years), who had primary education and worked with shepherds. The last cluster included 209 people, mostly males in age group 2 (21-64 years) with a low level of education (primary school) and a religious profession.

Cluster analysis of populations at risk in the non-Qinghai-Tibet Plateau

Four clusters were also found in the non-Qinghai-Tibet Plateau (Fig. 1b). The first included 353 cases, mostly women and farmers in age group 2 (21-64 years) with primary school education. The second cluster included 296 people, mostly male farmers in age group 2 with elementary and middle school education. The 286 people who formed the third cluster were mostly elderly women aged 3 years (≥ 65 years), uneducated and farm women. The last cluster included 102 cases, mostly involving males in age group 2 (21-64 years), who were educated in middle school and high school and had a variety of occupations.

Clustering by lifestyle

Cluster analysis of CE cases

There were 3259 CE cases (including co-infection of CE and AE). Four clusters were found (Fig. 2a). The first included 1062 people, mostly females in age group 2 (21-64), living in a winter settlement and a nomadic summer lifestyle, with dogs nearby and feral dogs in the surrounding areas. The second cluster included 506 cases, also mostly females in age group 2 (21-64), living in a permanent residence with no dogs nearby but with feral dogs in the area. The third group included 982 individuals and corresponded to age group 2 females living in permanent settlements with nearby dogs and feral dogs in the area. The last group included 709 individuals, again mostly females but from age class 3 (≥ 65 years) who also lived in permanent settlements, with both domestic dogs nearby and feral dogs in the area.

Fig. 2
figure 2

Clustering results for susceptible populations in CE and AE cases

Cluster analysis AE cases

There were 1129 AE cases (including co-infection of CE and AE). Only three clusters were identified in AE (Fig. 2b). The first cluster included 290 cases, mostly females in age group 1 (

Lifestyle and human hydatid disease

Lifestyle patterns of human echinococcosis cases of Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau were analyzed based on the following parameters: lifestyle patterns (permanent or nomadic), sources of drinking water, situation of neighborhood domestic dogs, and presence of wild dogs in the area .

Lifestyle clustering analysis of cases in the Qinghai-Tibet Plateau

There were 2251 cases of CE in the Qinghai-Tibet Plateau (including co-infection of CE and AE). We used k= 3 as the best clustering number for clustering CE cases in the Qinghai-Tibet Plateau (Fig. 3). There were 1152 cases in the first category, concentrated in groups whose lifestyle was winter residence and summer nomadism, the drinking water purity was Level 2, neighbors had dogs, and there were feral dogs in the area. In the 997 cases in the second category, the way of life in the settlement, the drinking water purity levels 2 and 3 as well as domestic and wild dogs in the immediate vicinity played a role. There were 102 cases in the third category, mostly concentrated in groups where the lifestyle was sedentary, drinking water cleanliness was Level 1, neighbors had no domestic dogs, and the surrounding area had no feral dogs. For AE, there were 1076 AE cases in the Qinghai-Tibet Plateau (including co-infection of CE and AE). There were 458 cases in the first category, concentrated in groups whose lifestyle was winter dwelling and summer nomadism, potable water purity was Level 2, and neighbors had dogs and feral dogs in the area. Nomadic lifestyle, level 2 and 3 drinking water purity, and the presence of domestic and wild dogs in the area were factors in the 376 cases in the second category. There were 242 cases in the third category, concentrated in lifestyle groups: Settlement, Level 1 drinking water purity, neighbors with dogs, and feral dogs in the area.

Fig. 3
figure 3

Results of Lifestyle Clustering in Cases for CE and AE in the Qinghai-Tibet Plateau

Lifestyle clustering analysis of cases outside the Qinghai-Tibet Plateau

There were 1008 CE cases in non-Qinghai-Tibet Plateau (including co-infection of CE and AE). The results of clustering cases for CE in non-Qinghai-Tibet Plateau with k= 3 as the optimum number of accumulations are shown in Fig. 4. In the first group, there were 510 cases, concentrated in the population that had a settlement lifestyle, Level 1 cleanliness of drinking water, neighbors with dogs, and no feral dogs in the environment. In the second category, there were 406 cases concentrated in groups with sedentary lifestyles, Level 1 drinking water cleanliness, neighbors with dogs, and feral dogs in the area. There were 92 cases in the third group, concentrated in groups with sedentary lifestyles, Level 3 drinking water cleanliness, neighbors with dogs, and no feral dogs in the area. For AE, there were 53 AE cases in the non-Qinghai-Tibet Plateau (including co-infection of CE and AE). In the first group, there were 20 cases, concentrated in the sedentary population, Level 2 drinking water cleanliness, neighbors with dogs, and feral dogs in the area. In the second category, there were 13 cases concentrated in groups with sedentary lifestyles, level 3 drinking water cleanliness, neighbors with dogs, and feral dogs in the area. There were 13 cases in the third group, concentrated in groups with sedentary lifestyles, Level 1 drinking water cleanliness, neighbors with dogs, and no feral dogs in the area. Seven cases of the fourth category mainly focused on the population, whose lifestyle consisted of winter residence and summer nomadism, the purity of drinking water was secondary water, dogs from neighbors and feral dogs in the area.

Fig. 4
figure 4

Results of Lifestyle Clustering in Cases of CE and AE in the Non-Qinghai-Tibet Plateau

Comparison of behavioral patterns in Qinghai-Tibet Plateau and non-Qinghai-Tibet Plateau cases

Summer nomadism and permanent winter settlements were more common in the cases of the Qinghai-Tibet Plateau than those outside the Qinghai-Tibet Plateau. The proportion of purity grades 2 and 3 in the selection of the drinking water source was higher in the Qinghai-Tibet Plateau cases than in the non-Qinghai-Tibet Plateau cases; in the case of the latter, the proportion of cleanliness level 1 was higher. As indicated in Table 3, the presence of neighborhood domestic dogs and neighborhood wild dogs was higher on the Qinghai-Tibet Plateau than on the non-Qinghai-Tibet Plateau. On the Qinghai-Tibet Plateau, the families of 1,202 cases (36.6%) chose not to slaughter livestock. Among families, a total of 1101 (33.5%) cases chose to slaughter cattle at home. Only the families of 146 cases (4.4%) chose to slaughter animals in centralized facilities, while the families of 837 (25.5%) cases sporadically randomly slaughtered livestock. A total of 276 people outside the Qinghai-Tibet Plateau (26.6%) did not slaughter livestock. As indicated in Table 3, the families of 551 subjects (53.1%) chose to slaughter livestock at home, and the families of 133 (12.8%) cases were involved in intensive slaughter.

Table 3 Lifestyle comparison of cases in the Qinghai-Tibet Plateau and cases outside of the Qinghai-Tibet Plateau
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