Human alveolar echinococcosis caused by infection with Echinococcus multilocularis is one of the most potentially pathogenic helminthic zoonoses. Transmission occurs involving wildlife cycles typically between fox and small mammal intermediate hosts. A large focus of human alveolar echinococcosis was identified in the late 1980s in poor upland agricultural communities in south Gansu Province, China, and has been monitored until 2015. Observations suggest that over decades landscape and socio-ecological changes resulted in a cascade of factors that exacerbated and then interrupted parasite emergence, with probable elimination of peri-domestic transmission of E. multilocularis in this area, despite the relative proximity of large active transmission foci on the eastern Tibetan Plateau. This study case exemplifies how anthropogenic land use and behavioural changes can modify emergence events and the long-term transmission of endemic parasitic infections, and subsequently the importance of considering disease ecology transmission socio-ecosystems in order to understand parasite and disease distribution.