Selenium deficiency is widely accepted as a fundamental cause of Keshan disease (KD). In the present study, the selenium levels of hair and food samples of KD in some endemic areas were measured; the prevalence and incidence of KD for the year 2007 in these areas were surveyed. The results for KD surveillance from 2003 to 2007 were analyzed. The selenium level was measured fluorometrically. In 2007, a total of 19,280 residents were surveyed in 15 provinces. The prevalence and incidence of KD were 3.0% and 4.9‰, respectively. In KD and control subjects, the mean levels of hair selenium were respectively 0.3223 mg/kg and 0.4466 mg/kg. The mean level of staple food selenium was 0.0227 ± 0.0144 mg/kg. During the 5 years, the selenium content in hair was always kept at a normal level within inhabitants of KD-endemic areas, but that in staple food was always kept at a lower level. These results indicate that the pathogenic factor has not been drastically eliminated even with the increasing selenium level of internal environment and is still continually damaging public health of KD in endemic areas. Since KD is still a serious threat to public health in its endemic areas, it is of great importance to pay attention to the prevention and control of this disease.