Cystic Echinococcosis in Spain: Current Situation and Relevance for Other Endemic Areas in Europe

Francisco A Rojo-Vazquez,Rufino Alamo-Sanz,Javier Pardo-Lledias,Miguel Cordero-Sanchez,Ana Hernandez-Gonzalez,Marcelo Francos-Von Hunefeld,Enrico Brunetti,Mar Siles-Lucas,Simon Brooker

doi:10.1371/journal.pntd.0000893

Abstract

Cystic echinococcosis (CE) remains an important health problem in many regions of the world, both where no control measures have been implemented, and where control programs have been incompletely successful with ensuing re-emergence of the disease. In Spain, official data on CE show an increase in the proportion of intermediate hosts with CE during the last few years, and autochthonous pediatric patients have been reported, a sign of active local transmission of disease. A similar picture emerges from data reported to the European Food Safety Authority by other European countries. Nevertheless, several crucial aspects related to CE that would help better understand and control the disease have not been tackled appropriately, in particular the emergence of infection in specific geographical areas. In this respect, while some data are missing, other data are conflicting because they come from different databases. We review the current situation of CE in Spain compared with areas in which similar problems in the CE field exist, and offer recommendations on how to overcome those limitations. Specifically, we believe that the introduction of national registries for CE with online data entry, following the example set by the European Registry for Alveolar Echinococcosis, would help streamline data collection on CE by eliminating the need for evaluating and integrating data from multiple regions, by avoiding duplication of data from patients who access several different health facilities over time, and by providing much needed clinical and epidemiological data that are currently accessible only to clinicians.

Highlights

Echinococcus granulosus is a cestode whose larval stage causes cystic echinococcosis (CE) in livestock, wild animals, and humans
Cystic echinococcosis (CE) is acquired by ingesting eggs, originating from the faeces of definitive hosts, that harbour the adult E. granulosus worms in their small intestine (Figure 1)
CE has a renewed importance in Europe [5]. This has been recognized by the European authorities through directive 2003/99/EC, in which CE is a disease to be reported to the European Food Safety Authority (EFSA)

Summary

Introduction

Echinococcus granulosus is a cestode whose larval stage causes cystic echinococcosis (CE) in livestock, wild animals, and humans. Where the importance of CE has been recognized, control programs have been implemented, leading to a drastic reduction in its prevalence This has caused the discontinuation of control measures and the exclusion of CE from the list of notifiable diseases. CE has a renewed importance in Europe [5] This has been recognized by the European authorities through directive 2003/99/EC, in which CE is a disease to be reported to the European Food Safety Authority (EFSA). This re-emergence should raise our awareness of crucial and incompletely elucidated aspects of this disease. We present the latest data about CE in Spain and the suggestions from an expert panel about issues that have not been addressed, with a look at other countries that share the problem

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Conclusions