[Possibility of invasion of Echinococcus into Honshu with pet dogs from Hokkaido and overseas]

PURPOSE

The number of pet dogs moving with their owners to Honshu, the main island of Japan, from Hokkaido, and the number of dogs imported from overseas were examined, and the possibility of invasion of Echinococcus multilocularis and E. granulosus with these dogs was discussed.

METHODS

The number of pet dogs moving to Honshu-island from Hokkaido was examined with the movement notifications based on the Rabies Prevention Act in 29 prefectures during the period from 1996 to 2001. The number of pets was also examined by questionnaire targeting 3 aviation and 3 ferry companies. The number of dogs imported from overseas was examined with the Annual Reports of the Animal Quarantine Service of Japan, The sanitary conditions of hotels for pet owners were also examined with a questionnaire.

RESULTS

Approximately 140 pet dogs were found to have officially moved annually from Hokkaido to Honshu during the study period. However, the actual number might be two to three times this estimate, because many dogs moved without notification. Nearly ten thousand pet dogs were transported a year to and from Honshu and Hokkaido by planes and ferries. A value of three thousand would be expected if people from Hokkaido were accompanying their pets at the rate of the registered dogs per population, one animal per 23 Hokkaido residents. Up to 30 pet dogs infested with E. multilocularis would probably be included per year, according to the infestation rate of 1% in Hokkaido. The number of imported dogs from overseas was assessed at approximately 15 thousand a year, but these dogs were not obligated to receive animal quarantine with respect to echinococcal infestation in Japan. Hotels for pet owners were considered to be managed rather sanitarily, though certain administrative guidance is necessary to prevent hydatid disease infection of travelers and hotel workers. The authors consider that dogs from Hokkaido and also from echinococcosis endemic countries should undergo fecal examination for parasite eggs to prevent invasion of the parasite into Honshu.

CONCLUSION

The authors propose the fecal examination of the dogs from Hokkaido and also from overseas for preventing invasion of E. multilocularis and E. granulosus into Honshu, Japan.

Echinococcosis--an international public health challenge

This review aims to summarise some of the recent studies that have been undertaken on parasites of the genus Echinococcus and the diseases which they cause. Although the adult parasite, which inhabits the intestine of various carnivore species is not pathogenic, the larval or metacestode stages can be highly pathogenic, causing economic losses to livestock and various forms of echinococcosis in humans, some of which have a high fatality rate. There is growing evidence that there are at least 5 species of Echinococcus rather than the generally accepted 4 species. Within these species there are a number of genotypes or strains. This can have implications for surveillance and control. In some wealthy countries, cystic echinococcosis caused by Echinococcus granulosus has been successfully controlled or indeed eradicated. However, in most parts of the world it remains a serious threat to human health. In the former Soviet Union, the disease has rapidly increased in incidence after the end of communist administration. Human alveolar echinococcosis, caused by Echinococcus multilocularis, is more sporadic. However, in some Chinese communities there is a disturbingly high human prevalence and in Europe there has been an increase in the detection rate of E. multilocularis in animals in the last 10 years. Echinococcosis can present diagnostic challenges, particularly in the definitive host in areas of low endemicity. Much of the recent work relating to the use of coproantigen and PCR to overcome these difficulties is summarized. New ideas for controlling the parasite are becoming available and these include both the use of vaccination and the application of mathematical models to determine the most cost effective means of control. Effective measures that are affordable are vital if the parasite is to be controlled in poor countries.

Modelling the transmission dynamics of Echinococcus granulosus in sheep and cattle in Kazakhstan

Cystic echinococcosis, caused by Echinococcus granulosus, is an emerging disease in many parts of the world and, in particular, in eastern Europe and the former Soviet Union. This paper examines the abundance and prevalence of infection of E. granulosus in cattle and sheep in Kazakhstan. Observed data are fitted to a mathematical model in order to determine if the parasite population is partly regulated by intermediate host immunity and to define parameters in the model. Such data would be useful to develop simulation models for the control of this disease. Maximum likelihood techniques were used to define the parameters and their confidence limits in the model and the negative binomial distribution was used to define the error variance in the observed data. The results indicated that there are significant variations in the infection pressure to sheep depending on their location. In particular sheep from Almaty Oblast and from central and northern Kazakhstan appeared to have a greater exposure than sheep from Jambyl or South Kazakhstan Oblasts. The infection pressure to cattle was somewhat lower in comparison. In common with other similar studies, there was no evidence of parasite-induced immunity in sheep or cattle in Kazakhstan due to natural infection. The highest abundance and prevalence were seen in the oldest age classes of animals.

Modelling the transmission dynamics of Echinococcus granulosus in dogs in rural Kazakhstan

Cystic echinococcosis, caused by Echinococcus granulosus, is an emerging disease in many parts of the world and, in particular, in eastern Europe and the former Soviet Union. This paper examines the abundance of infection of E. granulosus in the definitive host in southern Kazakhstan. Observed data are fitted to a mathematical model in order to decide if the parasite population is partly regulated by definitive host immunity and to define parameters in the model. Such data would be useful to develop simulation models for the control of this disease. Maximum likelihood techniques were used to define the parameters and their confidence limits in the model and the negative binomial distribution was used to define the error variance in the observed data. The results indicated that there were 2 distinct populations of dogs in rural Kazakhstan which had significantly different exposures to E. granulosus. Farm dogs, which are closely associated with livestock husbandry, particularly sheep rearing, had a relatively high mean abundance of 631 parasites per dog and a prevalence rate of approximately 23%. The best fit to the model indicated that there was significant herd immunity in the dog at this infection pressure. In contrast, village dogs which were more likely to be kept as pets had a much lower mean abundance of parasites of only 27 parasites per dog and a lower prevalence of 5-8%. With this village population of dogs, the best fit indicated negligible herd immunity.

Overview of the epidemiological situation on echinococcosis in the Mediterranean region

Cystic echinococcosis due to its considerable morbidity rates, in the populations of the Mediterranean region, give rise to high economic losses both in the public health sector and the animal production industry. Medium to high infection rates in man are recorded in most of the Mediterranean countries. Public awareness of hydatid disease is rather low in most of these countries. Difficulties in early diagnosis, the prevalent occurrence in rural areas with weak systems of health care, the favourable conditions created by man, as well as the climatic and ecological ones, are factors contributing to the prevalence of the infection. Small, ill-equipped and unsupervised slaughter-houses, illegal slaughtering, high population of stray dogs, etc., are known to be the main sources of infection. Echinococcus granulosus is the species present in nearly all countries of the regions while E. multilocularis infection is limited to a few of them. Accurate data on the incidence of human hydatid disease in the region are not available as it is notifiable in only a few countries.

The use of mathematical models to simulate control options for echinococcosis

In many parts of the world Echinococcus granulosus is a widespread infection in sheep and dogs with a consequential spill over into the human population. In the past, mathematical models have been derived to define the transmission dynamics of this parasite, principally in the sheep-dog life cycle. These models have characterized the cycles of infection as lacking in density dependent constraints in both the definitive or intermediate hosts. This suggested that there was little, if any, induced host immunity by the parasite in either host in natural infections. However, recent evidence from both Tunisia and Kazakhstan, where young dogs are the most heavily parasitised, suggests the possibility of significant definitive host immunity. This may have an effect on the control effort needed to destabilize the parasite. A preliminary computer simulation model (based on an Excel spreadsheet) to attempt to predict the results of a control programme has been written. This demonstrates that there could be significantly different results if there is indeed protective immunity in the dog than in the absence of immunity. In the former the parasite needs a greater control effort to push the parasite towards extinction than in the latter. The computer simulation is based on a mathematical model of the parasite's life cycle and is flexible so that different values of parameters can be used in different situations where the transmission of the parasite may be at different levels. Because of the flexibility of the computer simulation it is anticipated that this programme can be applied in most situations, although initial parameters for a particular location or strain of the parasite will have to be first predetermined with base line field surveys and possibly experimental infections. The programme also has an additional flexibility to enable simulations if some parameters cannot be accurately estimated through Monte-Carlo techniques. In the latter situation, worst and best case scenarios can be estimated and likely frequency distributions of the unknown parameters can be included in the model.

Interactions between landscape changes and host communities can regulate Echinococcus multilocularis transmission

An area close to the Qinghai-Tibet plateau region and subject to intensive deforestation contains a large focus of human alveolar echinococcosis while sporadic human cases occur in the Doubs region of eastern France. The current review analyses and compares epidemiological and ecological results obtained in both regions. Analysis of rodent species assemblages within quantified rural landscapes in central China and eastern France shows a significant association between host species for the pathogenic helminth Echinococcus multilocularis, with prevalences of human alveolar echinococcosis and with land area under shrubland or grassland. This suggests that at the regional scale landscape can affect human disease distribution through interaction with small mammal communities and their population dynamics. Lidicker's ROMPA hypothesis helps to explain this association and provides a novel explanation of how landscape changes may result in increased risk of a rodent-borne zoonotic disease.

Echinococcosis: disease, detection and transmission

Echinococcosis is one of the world's most geographically widespread parasitic zoonoses, with transmission occurring in tropical, temperate and arctic biomes. Most human infections are due to Echinococcus granulosus transmitted between domestic dogs and livestock, but this cosmopolitan species also cycles between wild carnivores (principally canids) and wild ungulates. The other species with significant zoonotic potential is E. multilocularis that occurs naturally in fox definitive hosts and small mammal intermediate hosts. These two species cause human cystic or alveolar echinococcosis respectively, which may be considered serious public health problems in several regions including developed countries. This review provides an introductory overview to the Supplement and summarises the biology and epidemiology of these two related cestodes with an emphasis on applied aspects relating to detection, diagnosis and surveillance in animal and human populations, and includes aspects of transmission ecology, and also considers aspects of community epidemiology and potential for control.

Multi-scale spatial analysis of human alveolar echinococcosis risk in China

Risk factors for the transmission of Echinococcus multilocularis to humans operate at a range of spatial scales. Over a large area, such as China, regional scale risk is correlated with variation in climatic conditions because of its effect on the spatial distribution of landscapes that can support E. multilocularis transmission in wildlife hosts and the probability of egg survival. At a local scale of a few kilometres, or tens of kilometres, transmission risk is related to the spatial proximity of human populations and landscapes with active transmission. At the patch scale, when considering individual villages or households, human behavioural factors are important and for individuals genetic and immunological factors play a role. Satellite remote sensing can provide landscape information at a range of spatial scales and provide a spatial framework within which to examine transmission patterns. This paper reviews the application of remotely sensed data and spatial data analysis to develop a better understanding of disease transmission and shows how such data have been used to examine human alveolar echinococcosis infection patterns, at a range of spatial scales, in an endemic area in central China.

Several strains of Echinococcus granulosus infect livestock and humans in Argentina

Mitochondrial cytochrome oxidase subunit 1 (CO1) sequencing, Southern blot of a repetitive DNA element and single strand conformation polymorphism of the 5' non-transcribed region of the cytosolic malate dehydrogenase (MDH) gene were used to determine the extent and distribution of Echinococcus granulosus genetic variation in Argentina. Five distinct strains of E. granulosus were shown to exist in the country. The common sheep, Tasmanian sheep, cattle and camel strains were identified in humans. Unlike the situation found in other countries, where the common sheep strain is the major source of human contamination, the Tasmanian sheep and camel strains produced a significant number of human infections in some regions of Argentina. This is the first report of cattle strain in humans in South America. Goats could be the natural intermediate host of the camel strain, which was not identified in humans from other regions so far. More than one genotype was identified in the same geographic area. These findings may have important consequences for human health and the control of hydatid disease. Within-strain differences were also observed, showing the potential of variation of E. granulosus.

Several strains of Echinococcus granulosus infect livestock and humans in Argentina

Mitochondrial cytochrome oxidase subunit 1 (CO1) sequencing, Southern blot of a repetitive DNA element and single strand conformation polymorphism of the 5' non-transcribed region of the cytosolic malate dehydrogenase (MDH) gene were used to determine the extent and distribution of Echinococcus granulosus genetic variation in Argentina. Five distinct strains of E. granulosus were shown to exist in the country. The common sheep, Tasmanian sheep, cattle and camel strains were identified in humans. Unlike the situation found in other countries, where the common sheep strain is the major source of human contamination, the Tasmanian sheep and camel strains produced a significant number of human infections in some regions of Argentina. This is the first report of cattle strain in humans in South America. Goats could be the natural intermediate host of the camel strain, which was not identified in humans from other regions so far. More than one genotype was identified in the same geographic area. These findings may have important consequences for human health and the control of hydatid disease. Within-strain differences were also observed, showing the potential of variation of E. granulosus.

An intact laminated layer is important for the establishment of secondary Echinococcus multilocularis infection

Echinococcus multilocularis causes alveolar echinococcosis primarily in rodents, but also in humans where it represents one of the most lethal helmintic infections. We used a susceptible mouse (C57BL/6) model to demonstrate failure in controlling secondary infection with the E. multilocularis metacestode, even when performed at the lowest possible infection dose. This was achieved by intraperitoneal or intrahepatic inoculation of a single parasite vesicle. In secondary infections, the primary physical barrier between the parasite and the host is constituted by the acellular laminated layer (LL), which is predominantly composed of high-molecular-weight glycans and surrounds the entire metacestode. Only those metacestode structures which exhibited an intact LL were successful in establishing infection, whereas metacestodes which were punctured - thus exhibiting an opened LL and thereby an accessible germinal layer - were no longer infective. Conversely, both types of vesicle survived in vivo maintenance, as assessed by RT-PCR based upon II/3 gene expression. In consequence, the encapsulating LL appears to be one of the key factors that mediates survival and successful proliferation of the parasite metacestode in vivo.

Combined eco-epidemiological and molecular biology approaches to assess Echinococcus granulosus transmission to humans in Mauritania: occurrence of the 'camel' strain and human cystic echinococcosis

Mauritania lies between West-Central Africa where human cystic echinococcosis (CE) is considered extremely rare and West Maghreb where CE accounts for a real public health problem. Until 1992, Mauritania was considered as human CE-free even through CE seemed well known in livestock. In 1992, the introduction of ultrasonography led to the diagnosis of the first human CE cases. In 1997, a veterinary study revealed that dogs living around Nouakchott were commonly infected by Echinococcus granulosus. To assess E. granulosus transmission and to identify the most relevant animal reservoir responsible for human CE emerging in Mauritania, a simultaneous eco-epidemiological and molecular biology approach was performed. The fieldwork included sample collection and investigation of relationship between intermediate hosts, definitive hosts and humans. Typing of E. granulosus strains was performed using comparison of polymerase chain reaction (PCR)-amplified DNA sequences with one nuclear (BG 1/3) and 2 mitochondrial (COI, NDI) targets. Results show that the 'camel' strain is actually infectious to humans and circulates between intermediate hosts including camels and cattle. It is suggested that preventive measures at slaughtering places could reduce human contamination.

Combined eco-epidemiological and molecular biology approaches to assess Echinococcus granulosus transmission to humans in Mauritania: occurrence of the 'camel' strain and human cystic echinococcosis

Mauritania lies between West-Central Africa where human cystic echinococcosis (CE) is considered extremely rare and West Maghreb where CE accounts for a real public health problem. Until 1992, Mauritania was considered as human CE-free even through CE seemed well known in livestock. In 1992, the introduction of ultrasonography led to the diagnosis of the first human CE cases. In 1997, a veterinary study revealed that dogs living around Nouakchott were commonly infected by Echinococcus granulosus. To assess E. granulosus transmission and to identify the most relevant animal reservoir responsible for human CE emerging in Mauritania, a simultaneous eco-epidemiological and molecular biology approach was performed. The fieldwork included sample collection and investigation of relationship between intermediate hosts, definitive hosts and humans. Typing of E. granulosus strains was performed using comparison of polymerase chain reaction (PCR)-amplified DNA sequences with one nuclear (BG 1/3) and 2 mitochondrial (COI, NDI) targets. Results show that the 'camel' strain is actually infectious to humans and circulates between intermediate hosts including camels and cattle. It is suggested that preventive measures at slaughtering places could reduce human contamination.

Spatial and temporal aspects of urban transmission of Echinococcus multilocularis

High prevalences of Echinococcus multilocularis have been reported from foxes of the city of Zurich, Switzerland. In order to characterize transmission in urban areas, a coproantigen ELISA was evaluated for diagnosing the infection in fox faecal samples collected in the environment. In addition, trapped rodents were investigated for the presence of metacestodes. Faecal samples could reliably be classified as being of fox origin by assessing physical properties as shown by the different parasite spectra of putative fox and dog faecal specimens. From the total of 604 tested putative fox faecal samples 156 (25.8%) were positive in the ELISA with a distinct increase in the proportion of positive samples from the urban to the periurban zone. Furthermore, samples collected in the border zone had significantly more coproantigen-positive results during winter. Prevalence of E. multilocularis in rodents was 9.1% (81/889) for Arvicola terrestris (with 3.5% of the animals harbouring between 14 and 244400 protoscoleces) and 2.4% (2/83) for Clethrionomys glareolus. E. multilocularis-infected A. terrestris were found in 9 of 10 trapping sites in the border zone. The high infection pressure in the periphery of urban areas might pose a risk for infection with E. multilocularis for both domestic carnivores as well as for urban inhabitants. Interventions into the cycle aiming at reducing the infection pressure should therefore focus on these areas.

Cystic echinococcosis and the Mediterranean Region: a long-lasting association

Cystic echinococcosis (CE) is an important zoonosis in Italy and in the whole Mediterranean Region, as confirmed by the work by Ettore Biocca, whose contributions to the subject are reported in a summarised annex to the bibliography. The contribution to the understanding and control of CE are presented, with special emphasis on the socio-economic impact, on factors affecting the maintenance of CE in the Mediterranean Region, on the epidemiological situation and control measures, on the present status of epidemiological surveillance, on the control problems in normal and emergency situations, on health education and training. Also, the justifications of combined control programmes are discussed, which may be applied only in situations of peace and well-being.

[Echinococcus multilocularis: the prevalence of the fox tapeworm with possible serious consequences for humans]

The prevalence of the fox tapeworm in foxes (final host) and muskrats (one of the intermediate hosts) in the Netherlands and Europe has been discussed. The tapeworm was found in 9.4% of the investigated foxes from the province of Groningen and in 0.2% of the muskrats from the same region. Also in the province of Limburg positive foxes were found, but no positive muskrats. Possible ways of infection for humans are described together with methods for prevention. It is concluded that at this moment risks for humans to become infected are minimal, but vigilance and monitoring of foxes and muskrats remains needed.

Control of Echinococcus granulosus in Uruguay: evaluation of different treatment intervals for dogs

This study attempted control of transmission of Echinococcus granulosus from dogs to sheep in different areas in the Department of Florida, Uruguay, by treating dogs with praziquantel at intervals of 6, 12 and 16 weeks. The 6-week interval was based on the prepatent period of infection with E. granulosus, the 12- and 16-week intervals were based on the rate of reinfection with tapeworms in dogs in the area. Dogs had become reinfected with E. granulosus between 2 and 4 months after treatment, whereas they became reinfected with the Taenia spp. tapeworms within 2 months of treatment. One year after the start of treatments sentinel lambs were born and grazed the farms in the three treatment areas. Approximately, 15 months later when the sentinel lambs were killed and examined for parasites the six weekly treatments had stopped the transmission of E. granulosus to the sentinel lambs. Treatment of dogs at 12- and 16-week intervals failed to stop transmission of E. granulosus but both the numbers of farms and the numbers of sheep infected with E. granulosus were lower where dogs received 12 weekly treatments compared with dogs receiving 16 weekly treatments and a fourth area where dogs had received no treatments (chi(2)P=0.002). Lambs continued to become infected with the Taenia spp. tapeworms in all the areas. Control was complicated by large changes in the dog population. From a starting population of 1164 dogs in the three treated areas, 832 new dogs, most of these adult hunting dogs, entered the population and 793 dogs were lost from the population.

A case-control study of the risk factors for cystic echinococcosis among the children of Rio Negro province, Argentina

In 1984 the prevalence of cystic echinococcosis (CE) in Rio Negro province in central Argentina reached alarming levels, with almost 6% of children aged 7-13 years infected with the causative agent, Echinococcus granulosus. Although the control activities developed between 1980-2000 have now lowered the prevalence of infection in this age-group to 1.1%, transmission of E. granulosus has clearly not ceased. The aim of the present study was to identify possible flaws in the control programme and the risk factors associated with CE. The 24 cases and 66 controls used were identified during a survey of the 1,070 schoolchildren attending 12 schools in Ingeniero Jacobacci, Rio Negro province. In interviews based around a standardized questionnaire, the adult female with responsibility for each subject (usually the mother but sometimes a grandmother or guardian) was asked 70 questions about the child and his or her immediate family, their contact with dogs and relevant environmentmental factors, and their level of contact with the control programme. Univariate and multivariate analyses were used to determine odds ratios (OR) and their 95% confidence intervals (CI). The main risk factors found to be significantly associated with CE were having a family member with the disease (OR = 3.11; CI = 0.92-10.47), spending the first years of life surrounded by a large number of dogs (OR = 2.11; CI = 1.2-3.5), and having a father who slaughtered sheep at his workplace (OR = 1.14; CI = 1.04-1.24). Obtaining drinking water from a tap (OR = 0.28; CI = 0.08-1.01) also remained in the final model, as a protective factor.