Echinococcosis/hydatidosis: a severe threat in Mediterranean countries.

Echinococcosis/hydatidosis is one of the most important parasitic zoonotic diseases in the world. Both cystic hydatidosis (CE) caused by Echinococcus granulosus and alveolar echinococcosis (AE) caused by E. multilocularis have been reported in several countries of the Mediterranean region (MR). E. granulosus has always been present in the MR and is the most common species. This parasite depends on the dog-sheep cycle and is actively transmitted in all pastoral regions where sheep, cattle and camelids predominate. E. multilocularis occurs only sporadically in limited areas of France, Serbia and Montenegro, Turkey, Tunisia and Morocco. However recent evidence indicates that it is spreading into other regions of the Mediterranean. Due to the lack of well-documented data, and to the fact that CE is not a notifiable disease in the majority of M countries, the precise incidence and prevalence of CE in humans and animals are not known. Published data suggests that prevalence is rather high in North Africa, Turkey, Greece, and in several regions of Italy and Spain. CE is an increasing public health and socio-economic concern due to the considerable morbidity rates that give rise to high economic losses both in the public health sector and in the livestock industry. Hospitalisation for human CE lasts from 2 weeks to more than 1 month in case of surgery. A number of factors contribute to the increase of prevalence and to the spreading of CE in the MR. These include the diversity of livestock production systems (predominantly extensive, traditional animal husbandry), small, ill-equipped and unsupervised slaughter-houses, illegal and family slaughtering, low public awareness of hydatid diseases, and the high population of stray dogs. Cyprus is the only country where an eradication programme has been successfully implemented. There have been, however, important developments in the last decade in CE epidemiology, in the diagnosis of canine infection, in strain characterisation and in immune strategies against CE in animals. This scientific progress, together with effective health education programmes, will likely improve control programmes and reduce the time required to achieve significant decreases in prevalence or eradication.