Abstract
We analyzed databases spanning 50 years, which included retrospective alveolar echinococcosis (AE) case finding studies and databases of the 3 major centers for treatment of AE in Switzerland. A total of 494 cases were recorded. Annual incidence of AE per 100,000 population increased from 0.12-0.15 during 1956-1992 and a mean of 0.10 during 1993-2000 to a mean of 0.26 during 2001-2005. Because the clinical stage of the disease did not change between observation periods, this increase cannot be explained by improved diagnosis. Swiss hunting statistics suggested that the fox population increased 4-fold from 1980 through 1995 and has persisted at these higher levels. Because the period between infection and development of clinical disease is long, the increase in the fox population and high Echinococcus multilocularis prevalence rates in foxes in rural and urban areas may have resulted in an emerging epidemic of AE 10-15 years later.
Highlights
We analyzed databases spanning 50 years, which included retrospective alveolar echinococcosis (AE) casefinding studies and databases of the 3 major centers for treatment of AE in Switzerland
Human alveolar echinococcosis (AE), a hepatic disorder that resembles liver cancer, is a highly aggressive and lethal zoonotic infection caused by the larval stage of the fox tapeworm, Echinococcus multilocularis [1]
A reasonable explanation for this finding may be the urbanization of the E. multilocularis cycle, which has resulted in an increase in the number and proportion of infected urban foxes in areas with high human populations, thereby increasing the infection risk for the human population [7]
Summary
We analyzed databases spanning 50 years, which included retrospective alveolar echinococcosis (AE) casefinding studies and databases of the 3 major centers for treatment of AE in Switzerland. Because the period between infection and development of clinical disease is long, the increase in the fox population and high Echinococcus multilocularis prevalence rates in foxes in rural and urban areas may have resulted in an emerging epidemic of AE 10–15 years later. Domestic dogs are highly susceptible definitive hosts [4]; in some areas, such as Alaska [5], People’s Republic of China [6], and Europe [7], they can play an additional or even the dominant role as an infection source for humans. The documented area of E. multilocularis endemicity in Europe has recently increased [3,7,8] Whether this increase results from a true extension of the geographic range or increased detection in populations of wildlife not previously investigated is still unclear [1]. The reasons for the increase in the fox populations have been attributed to ecologic factors, the successful vaccination campaign against fox rabies, and the increase in anthropogenic food supplies [7,10]
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