A cross-sectional study conducted in Bulgaria, Romania and Turkey has found that the true burden of cystic echinococcosis is poorly understood and that many cases remain asymptomatic, with no appropriate medical diagnosis and treatment. The study assessed the prevalence of the disease among rural populations in the three countries.
“This multicentre study provides, for the first time, the evidence of the number of people who are infected with echinococcosis that shows the real burden of this neglected parasitic infectious disease in WHO’s European Region,” said Dr Adriano Casulli, Director of WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (in humans and animals). “It is important to introduce new health policies to prioritize its control in endemic rural areas.”
Active abdominal cysts were found in participants from all three countries and across all age groups. Participants in whom cystic echinococcosis was diagnosed or suspected were referred to hospitals in the respective country for clinical management.
To improve surveillance, Dr Casulli added that international agencies need to work with the European Commission to prioritise new health policies for the notification of human and animal cystic echinococcosis in Europe.
“Accurate mapping and prevalence assessment using ultrasound screening with rigorous case definition is needed to comply with the WHO road map schedule for cystic echinococcosis elimination" said Dr Francesca Tamarozzi of the WHO Collaborating Centre for the Management of Clinical Cystic Echinococcosis, University of Pavia, Italy. “Our results should raise awareness among physicians in endemic areas and encourage improvement of case notification and cost-benefit analyses of public health interventions”.
The study, part of the HERACLES project, involved ultrasound-based examination. A total of 24 681 volunteers were recruited from 50 villages across rural areas of Bulgaria, Romania and Turkey over a period of 2 years.
While further data are needed on both the distribution and the prevalence of the disease in this area, the findings demonstrate an ongoing health burden in these communities and should be useful in planning and implementing cost–effective interventions.
Wider screening, particularly in high-risk rural areas, should be implemented along with disease awareness and education programmes. Informing populations about potential risk factors and practices maintaining the transmission of the infection (arising from hygiene habits, livestock and dog management) can help strengthen control and elimination programmes.
The disease
Cystic echinococcosis is a zoonotic disease (that is, a disease transmitted from animals to humans) caused by the larval stage of the tapeworm Echinococcus granulosus.
Infection results in the development of cysts, mostly in the liver and lungs. The disease is distributed worldwide but its burden is poorly known. The World Health Organization (WHO) has prioritized control of human cystic echinococcosis.
Cystic echinococcosis is a preventable disease and control programmes have been successful previously in other geographical areas.
Control programmes require intervention to interrupt the life cycle of the tapeworm between sheep and dogs, the main host species, to prevent transmission to humans and to improve human case detection and reporting.