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Vol. 2 No. 1 Jan. 3, 2020 Vol. 2 No. 1 Jan. 3, 2020 Preplanned Studies National Alveolar Echinococcosis Distribution — China, 2012–2016 01 Analysis of Early Essential Newborn Care Capacities of Rural Health Facilities — Four Provinces in Western China, 2016 08 Co-Administration of Multiple Childhood Vaccines — Guangdong Province, 2019 13 Notifiable Infectious Diseases Reports Reported Cases and Deaths of National Notifiable Infectious Diseases — China, November, 2019 16 China CDC Weekly Editorial Board Editor-in-Chief George F. Gao Deputy Editor-in-Chief Liming Li Gabriel M Leung Zijian Feng Executive Editor Feng Tan Members of the Editorial Board Xiangsheng Chen Xiaoyou Chen Zhuo Chen (USA) Xianbin Cong Gangqiang Ding Xiaoping Dong Mengjie Han Guangxue He Xi Jin Biao Kan Haidong Kan Qun Li Tao Li Zhongjie Li Min Liu Qiyong Liu Jinxing Lu Huiming Luo Huilai Ma Jiaqi Ma Jun Ma Daxin Ni Lance Rodewald (USA) RJ Simonds (USA) Ruitai Shao Yiming Shao Xiaoming Shi Yuelong Shu Xu Su Chengye Sun Dianjun Sun Hongqiang Sun Quanfu Sun Xin Sun Jinling Tang Kanglin Wan Huaqing Wang Linhong Wang Guizhen Wu Jing Wu Weiping Wu Xifeng Wu (USA) Zunyou Wu Fujie Xu (USA) Wenbo Xu Hong Yan Hongyan Yao Zundong Yin Hongjie Yu Shicheng Yu Xuejie Yu (USA) Jianzhong Zhan Liubo Zhang Rong Zhang Tiemei Zhang Wenhua Zhao Yanlin Zhao Zhijie Zheng (USA) Maigeng Zhou Xiaonong Zhou Baoping Zhu (USA) Advisory Board Director of the Advisory Board Xinhua Li Vice-Director of the Advisory Board Yu Wang Jianjun Liu Members of the Advisory Board Chen Fu Gauden Galea (Malta) Dongfeng Gu Qing Gu Yan Guo Ailan Li Jiafa Liu Peilong Liu Yuanli Liu (USA) Roberta Ness (USA) Guang Ning Minghui Ren Chen Wang Hua Wang Kean Wang Xiaoqi Wang Zijun Wang Fan Wu Xianping Wu Jianguo Xu Gonghuan Yang Tilahun Yilma (USA) Guang Zeng Xiaopeng Zeng Yonghui Zhang Editorial Office Directing Editor Feng Tan Managing Editors Lijie Zhang Qian Zhu Scientific Editors Ning Wang Ruotao Wang Editors Weihong Chen Yu Chen Peter Hao (USA) Xudong Li Jingxin Li Qing Yue Ying Zhang Cover Photo: Alveolar Echinococcosis Epidemiological Survey in Dalong Village, Shigatse, Tibet Autonomous Region, China, 2016. (Photographer: Shangdong Provincial Medical Team for Tibet) China CDC Weekly Preplanned Studies National Alveolar Echinococcosis Distribution — China, 2012−2016 Canjun Zheng1,&; Chuizhao Xue2,&; Shuai Han2,&; Zhongjie Li1; Hu Wang3; Liying Wang2; Ying Wang2; Qian Wang4; Yu Feng5; Yanyan Hou6; Xiao Ma7; Junying Ma7; Xiumin Han8; Gongsang Quzhen9; Xiaofeng Jiang10; Weidong Guo10; Xianglin Wu11; Yaming Yang12; Lei Cao13; Fanka Li14; Weiqi Chen15; Xinliu Yan12; Shicheng Yu16; Meihua Fu2; Qing Yu2; Ning Xiao2; Jiangping Cao2; Jun Yan17; Weiping Wu2,#; Xiao-nong Zhou2,# detected cases during this study were treated with Summary drugs or surgery. In addition, counties where AE was What is already known about this topic? detected carried out deworming for dogs and wild Both alveolar echinococcosis (AE) and cystic animals, rat extermination around villages, and large- echinococcosis are endemic in China, among which scale health education initiatives. alveolar echinococcosis has a very high mortality rate. The E. multilocularis life cycle takes place primarily What is added by this report? between wild canids (e.g. foxes, wolves, dogs, etc.) as The survey results showed the prevalence and scope of definitive hosts and their prey (e.g. rodents) as AE in China and identified high-risk groups including intermediate hosts. Humans can become accidentally children, monks, herdsmen and illiterate people. At the infected while consuming parasite eggs that are same time, all the cases found in the survey (more than excreted in the feces of the definitive hosts, but 90% of the patients did not go to the hospital for otherwise does not transmit infections as part of the diagnosis and treatment before survey) were promptly natural cycle. AE can infect the liver in humans and diagnosed and treated. resemble a cancer-like malignant growth and is What are the implications for public health primarily endemic in the northern hemisphere practice? including Asia, Europe, and North America. The This study provides information for the development resulting growth in the liver is characterized by slow of a plan for AE prevention and control and for the development of metacestode stage and a prolonged implementation of interventions targeted to high-risk duration of infection. Early stages are often absent of populations. noticeable symptoms, but if left untreated, AE may lead to death in 90% of cases within 10−15 years of Alveolar echinococcosis (AE) is a potentially lethal, diagnosis (1). zoonotic, parasitic disease caused by the larvae of AE cases have been reported continuously by Echinococcus multilocularis (E. multilocularis) and is hospitals in Western China. However, AE endemic designated by the WHO as neglected tropical disease. areas in Western China, especially Qinghai-Tibet To comprehensively understand the prevalence and Plateau, often have cases that have not been diagnosed scope of AE in China, China CDC organized the and reported to hospitals, potentially due to factors relevant provincial and county-level centers for disease such as poor economic conditions, inconvenient control and prevention to conduct the epidemiological transportation, and poor access to health services. In survey on echinococcosis in 409 counties in 9 addition, undiagnosed cases frequently result in fatal provincial-level administrative divisions from 2012 to outcomes, so reported hospital cases alone have 2016. In total, 1,208,944 people were examined by B- difficulty capturing the full situation of the epidemic in ultrasonography and estimated an overall prevalence in China. the population of the 6 provincial-level administrative With the support of the National Health divisions to be 0.27% (95% CI*: 0.25%−0.30%). Commission of the People’s Republic of China, China Using results from this survey, a national plan to CDC organized the relevant provincial and county- address echinococcosis has been formulated, and all level CDCs to conduct an epidemiological survey on * CI=Confidence Interval. Chinese Center for Disease Control and Prevention CCDC Weekly / Vol. 2 / No. 1 1 China CDC Weekly echinococcosis from 2012 to 2016. Based on the population in the layer to the total population of the conditions for transmission of echinococcosis in each region). All data were inputted using double entry in county and the presence of reported cases of local the Epi Info 3.5.4 (US CDC) database, with error echinococcosis infection in the Infectious Disease correction using double-entry comparison. Statistical Reporting System of the China CDC, China CDC analysis was processed using SPSS 21.0 (IBM, New determined that 409 counties in 9 provincial-level York, USA). administrative divisions across the country would be From 2012 to 2016, 1,208,944 people were investigated. examined by B-ultrasonography in 409 counties A stratified and proportionate sampling method was among 9 provincial-level administrative divisions adopted. In the criteria-meeting counties of Sichuan, including Qinghai, Sichuan, Gansu, Yunnan, and Gansu, Qinghai provinces, and Xinjiang, Ningxia, and Shaanxi provinces, and Ningxia, Xinjiang, Tibet, and Tibet autonomous regions, all villages were classified Inner Mongolia autonomous regions; 52.39% were by the mode of production of their local residents into male and 47.61% were female. No cases of AE were four categories.† The number of villages, sampled detected in Inner Mongolia, Yunnan, and Shaanxi. In randomly in each layer, was determined based on the 99 counties of the remaining 6 provincial-level proportion of the population in each layer of the administrative divisions, 1,243 cases of alveolar county’s population,§ and 16 villages were sampled in echinococcosis were diagnosed. each county.¶ The overall prevalence in the population at risk in 6 An investigation team composed of epidemiologists endemic provincial-level administrative divisions was and B-ultrasound doctors conducted B-ultrasound 0.27% (95% CI: 0.25%–0.30%), of which the screening on survey subjects, recorded basic prevalence rate in the population at risk in information for each subject and lesion information for Qinghai province was the highest 0.73% (95% CI: each case, and then diagnosed and classified cases 0.64%–0.81%). At the county level, the prevalence of according to China’s “Diagnostic Criteria for 8 counties among 99 AE endemic counties nationwide exceeded 1 and were distributed in Qinghai, Echinococcosis” (WS 257–2006). Before the field % Sichuan, and Tibet, and the highest of which was Dari survey, all investigators involved in the survey were County in Qinghai with a prevalence of 10.95% (95% trained for B-ultrasonography diagnosis and the use of CI: 9.95%–11.95%) (Figure 1, Table 1). Epi Info software. The same survey plan was used in Among 9,007,094 people at risk in 99 AE-endemic each county, and all the cases diagnosed in the field counties, 94,687 men and 106,636 women ranging survey were reviewed by B-ultrasonography experts at from 1 to 99 years old were examined by B- the provincial level. ultrasonography, of which 524 and 719 cases of AE The positive rate of AE in humans was defined as were diagnosed, respectively. The positive rate of AE the number of diagnosed patients out of the total among males was 0.55% (524/94,687, 95% CI: number of people examined. The prevalence of the 0.51%–0.60%), and lower than that among females, population was calculated according to the following 0.67% (719/106,636, 95% CI: 0.63%–0.72%), and equation: njwj the difference in positive rate between men and women p = 9 = 9 pjwj 2 Nj was statistically significant (χperson = 11.71, p<0.01). j= j= The youngest case of AE was 3 years old, and the where “p” is the prevalence of the population in the oldest was 82 years old.
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