Preliminary study of the role of red foxes in Echinococcus multilocularis transmission in the urban area of Sapporo, Japan

Echinococcus species in wildlife

Transmission of Echinococcus spp. in life cycles that involve mainly wildlife is well recognized for those species with small mammals as intermediate hosts (e. g. E. multilocularis), as well as for E. felidis and the 'northern' genotypes of E. canadensis (G8 and G10). In contrast, the remaining taxa of E. granulosus sensu lato are best known for their domestic life cycles, and the numerous wild mammal species (mainly ungulates) that have been recorded with cystic echinococcosis in the past were mainly considered a result of spill-over from the dog-livestock transmission system. This view was challenged with the advent of molecular characterization, allowing discrimination of the metacestodes, although the contribution of wild mammals to various Echinococcus life cycles has remained uncertain for scarcity of wildlife studies. Numerous records of cysts in wild ungulates date back to the 20th century, but cannot with certainty be allocated to the Echinococcus species and genotypes that are recognized today. This means that our current knowledge is largely restricted to studies of the past two decades that kept adding gradually to our concepts of transmission in various geographic regions. In particular, new insights were gathered in the past years on E. granulosus s.l. in wildlife of sub-Saharan Africa, but also on transmission patterns of E. multilocularis in previously neglected regions, e. g. North America. Here, an update is provided on the current state of knowledge on wild mammals as hosts for all Echinococcus species, listing >150 species of wild hosts with references, as well as estimates on their epidemiological impact and our current gaps of knowledge.

Colonization of Warsaw by the red fox Vulpes vulpes in the years 1976-2019

The red fox is one of the most adaptable carnivores inhabiting cities. The aim of our study was to describe the process of Warsaw colonization by the red fox. We focused on: (1) the fox distribution in Warsaw on the basis of presence-absence data (2005-2012) over a grid of 1 × 1 km², (2) the process of settlement in 29 green areas (study periods 1976-1978, 2004-2012, and 2016-2019) in relation to habitat type, and (3) temporal and spatial patterns of the red fox incidents (1998-2015) reported by Warsaw citizens. We found out that: (1) the red fox penetrated the whole city (i.e. its presence was confirmed in all squares of the grid), (2) 21% of the green areas were colonized in 1976-1978 but 93% in 2016-2019. Forests and riparian habitats were occupied more frequently than parks and cemeteries in 1976-1978 with no difference in the further years; (3) the probability of the fox incidents increased over years, was higher in June-October, on working days, and around noon, and with the share of discontinuous urban fabric in the buffers around incident locations. Nevertheless, the incidents only partially reflect population abundance trends and activity patterns of the species, so should be treated cautiously.

Progress on the national echinococcosis control programme in China: analysis of humans and dogs population intervention during 2004-2014

Background

A national control program for echinococcosis has been in effect since 2005 in China. This program has applied a comprehensive strategy, and good control results have been achieved. Human echinococcosis prevalence rate decrease from 1.08% in 2004 to 0.24% in 2012. The objective of this study is focusing on assessment of the programme with two indices, including patient treatment and registered dogs deworming, in endemic areas of echincoccosis control over the period of 10 years (2004–2014) in China.

Methods

We established the database including demography at county and township levels with coverage for ten provinces and autonomous regions of China in this study. We using methods of epidemiological descriptive, instead the expectation-maximization for missing value filling for grouping available patients into those subjected to surgery and those receiving drug treatment after population screening and the dogs population after registered by deworming. We performed Microsoft Excel software and SPSS software on the results as percentages with the corresponding 95% confidence intervals (95% CIs). We also statistically analyzed the economics data on patient treatment and dogs deworming after the corresponding discount with annual bank interest rates (USD 1 = CNY 6.5, bank discount average changes of 2.3–3.3%).

Results

During 2004–2014, the grant total average rate of surgical patient (after surgical operation) treatment had increased with 32.4% and with 81.3% for medical treatment with albendazole. Meanwhile, it increased by 58.6% for the deworming of registered dog since 2007. The accumulated costs amounted to USD 27.03 million after discount for patients and registered dog treatment, which is 1/4 of the total accumulated financial inputs (USD 110.67 million from the Chinese Government). Since the implementation of the national program, it has increased 57 times with respect to the annual financial inputs (costs) and 368 times with respect to all accumulated financial inputs (costs).

Conclusions

This study showed that in endemic areas, patient diagnosis and management, dog management and treatment over this period helped reduce the parasite load to control the disease. More attention should be paid to controlling wild canines during the ongoing program period and sustainable follow-up evaluations are crucial for success and continued implementation of the national program.

A systematic review and meta-analysis on anthelmintic control programs for Echinococcus multilocularis in wild and domestic carnivores

Human alveolar echinococcosis (AE), caused by the tapeworm Echinococcus multilocularis, is one of the most dangerous zoonoses in the Northern hemisphere. In Europe, the parasite's life cycle is sylvatic, involving small rodents as intermediate hosts and red foxes as the major definitive hosts. Given the severity of this disease in humans and the high levels of environmental contamination with E. multilocularis in endemic areas, it seems crucial to implement control measures in order to prevent human AE. This systematic review identifies previous anthelmintic control programs targeting E. multilocularis in wild and domestic carnivores and evaluates the effectiveness of the different strategies implemented. A search through six databases identified 302 scientific papers for the period 1950–2015, of which only 17 were retained according to the inclusion criteria set. These 17 papers focused on control of E. multilocularis by baiting foxes in highly endemic areas of Europe or Japan, with the exception of one study focused on dogs in Alaska. The papers highlighted differences in baiting types, baiting frequency, choice of control areas and length of treatment period. Overall, these studies resulted in a sharp and statistically significant decrease in parasite prevalence, confirmed by the absence of overlap between confidence intervals for the pooled risk differences of control and treated areas. A monthly baiting frequency was proven to be highly effective at decreasing E. multilocularis prevalence in foxes, even in highly endemic areas and in a short period of time. Nevertheless, when foxes were not fully dewormed, the parasite showed a strong capacity to rapidly recover its initial prevalence.

The fox baiting approach appears to be the most useful method for controlling the sylvatic life cycle of E. multilocularis, but it require a cost/benefit analysis before it is likely to be accepted by stakeholders.

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This systematic review evaluated the effectiveness of the control programmes of E. multilocularis.

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Differences in baiting types, baiting frequency, selection of control areas and treatment period were highlighted.

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A monthly baiting was proved to be efficient to decrease E. multilocularis prevalence in foxes.

Rural and urban distribution of wild and domestic carnivore stools in the context of Echinococcus multilocularis environmental exposure

In zoonotic infections, the relationships between animals and humans lead to parasitic disease with severity that ranges from mild symptoms to life-threatening conditions. In cities and their surrounding areas, this statement is truer with the overcrowding of the protagonists of the parasites' life cycle. The present study aims to investigate the distribution of a parasite, Echinococcus multilocularis, which is the causative agent of alveolar echinococcosis, using copro-sampling in historically endemic rural settlements of the eastern part of France and in newly endemic areas including urban parks and settlements surrounding Paris. Based on 2741 morphologically identified and geolocalized copro-samples, the density of fox faeces was generally higher in the surrounding settlements, except for one rural area where the faeces were at larger density downtown in the winter. Fox faeces are rare but present in urban parks. Dog faeces are concentrated in the park entrances and in the centre of the settlements. DNA was extracted for 1530 samples that were collected and identified from fox, dog, cat, stone marten and badger carnivore hosts. Echinococcus multilocularis diagnosis and host faecal tests were performed using real-time PCR. We failed to detect the parasite in the surroundings of Paris, but the parasite was found in the foxes, dogs and cats in the rural settlements and their surroundings in the historically endemic area. A spatial structuring of the carnivore stool distribution was highlighted in the present study with high densities of carnivore stools among human occupied areas within some potentially high-risk locations.

Natural larval Echinococcus multilocularis infection in a Norway rat, Rattus norvegicus, captured indoors in Hokkaido, Japan

Natural infection with larval Echinococcus multilocularis was recognized in one of eight Norway rats, Rattus norvegicus, caught indoors in 2009 in Ebetsu, Hokkaido, northern Japan. Cystic lesions were found in the right median and lateral lobes of the liver, with numerous alveolar cysts in the periphery of the lesions. Protoscolices were formed within large cysts. The laminated layers of the cysts were positive for PAS staining. Nested PCR using the primers specific for Taenia mitochondrial 12S rDNA yielded a 250-bp product, and the sequence of the PCR product matched that of E. multilocularis isolates from Hokkaido and Germany. This is the third natural alveolar hydatidosis in R. norvegicus in Japan.

Deworming of stray dogs and wild canines with praziquantel-laced baits delivered by an unmanned aerial vehicle in areas highly endemic for echinococcosis in China

BACKGROUND

Canines, the definitive hosts for the parasites causing alveolar (AE) and cystic echinococcosis (CE), are the main source of this infections playing the key role in the transmission. The ten-year mortality rate of AE is extremely high (94%) if the patients are not given sustained treatment. The aim of this field study is to explore the possibility of delivery of praziquantel-laced baits using unmanned aerial vehicles (UAVs) aimed at deworming wild canines in the endemic areas.

METHODS

UAVs were compared to manual bait delivery in the 1-km² test areas followed by testing of canine faeces using an Echinococcus coproantigen ELISA test in the ensuing year. The outcomes of the two approaches were compared with respect to time of delivery and overall cost.

FINDINGS

Compared to manual bait delivery, delivery by UAVs saved up to 67% of the overall cost. Three times more staff was needed for the former approach compared to the latter and, time wise, UAV bait delivery saved 350% compared to manual bait delivery on average. With regard to investment needed, the use of UAVs showed an efficiency 2.5 times better than manual bait delivery. Compared to the area served by UAVs, the average positive rate for the canine faecal samples was more than 38% higher in the area served manually.

CONCLUSION

The technique of bait delivery with praziquantel using UAVs for canine deworming has a strong potential with regard to savings of manpower, time and overall cost in areas highly endemic for echinococcosis.

Ecology and Life Cycle Patterns of Echinococcus Species

The genus Echinococcus is composed of eight generally recognized species and one genotypic cluster (Echinococcus canadensis cluster) that may in future be resolved into one to three species. For each species, we review existing information on transmission routes and life cycles in different geographical contexts and - where available - include basic biological information of parasites and hosts (e.g., susceptibility of host species). While some Echinococcus spp. are transmitted in life cycles that involve predominantly domestic animals (e.g., dog - livestock cycles), others are wildlife parasites that do or do not interact with domestic transmission. In many cases, life cycle patterns of the same parasite species differ according to geography. Simple life cycles contrast with transmission patterns that are highly complex, involving multihost systems that may include both domestic and wild mammals. Wildlife transmission may be primary or secondary, i.e., resulting from spillovers from domestic animals. For most of the species and regions, existing information does not yet permit a conclusive description of transmission systems. Such data, however, would be highly relevant, e.g., for anticipation of geographical changes of the presence and frequency of these parasites in a warming world, or for initiating evidence-based control strategies.

Peroral Echinococcus multilocularis egg inoculation in Myodes glareolus, Mesocricetus auratus and Mus musculus (CD-1 IGS and C57BL/6j)

Echinococcus multilocularis transmission predominantly occurs in Europe between the red fox (Vulpes vulpes) and various species of rodent intermediate hosts. We infected 3 species of rodent, Myodes glareolus (n = 47), Mesocricetus auratus (n = 11) and outbred Mus musculus (CD-1 IGS) (n = 9) with an E. multilocularis egg suspension that contained 100 eggs with viable oncospheres and performed post mortem examination 6, 8 (M. glareolus) and 10 weeks post inoculation (wpi). C57BL/6j mice (n = 4) were used as positive controls as they have been shown to exhibit macroscopic liver lesions 4 wpi. To the best of our knowledge, this is the first study to experimentally assess susceptibility in the ostensibly competent host M. glareolus. Lesions were only detected in 2 of 47 M. glareolus (4.3%) at 8 and 10 wpi and although both contained protoscolices (1675 at 8 wpi and 88 at 12 wpi) the low percentage of infected animals brings into question their role as transmitters of the parasite. Significant differences were observed between inbred and outbred mice with E. multilocularis infection in the former demonstrating increased establishment (p ≤ 0.0001) and growth (p ≤ 0.0001). No lesions were found in all 11 M. auratus.

Wilderness in the 'city' revisited: different urbes shape transmission of Echinococcus multilocularis by altering predator and prey communities

The urbanization of Echinococcus multilocularis, the agent of alveolar echinococcosis (AE), is a public health concern worldwide. Here we propose to consider 'urban' habitats under a broad ecological perspective and discuss the effects of human settlements (urbes) on host communities and the process of parasite urbanization. We argue that interactions between landscape features (i.e., landscape composition and configuration) and host communities can shape the heterogeneity of transmission gradients observed within and across different types of human settlement. Due to unique ecological characteristics and public health management priorities, we envisage urban landscapes as a model system to further increase our understanding of host-parasite interactions shaping the circulation of E. multilocularis.

Feeding ecology informs parasite epidemiology: prey selection modulates encounter rate with Echinococcus multilocularis in urban coyotes

We investigated the role of urban coyote feeding ecology in the transmission of Echinococcus multilocularis, the causative agent of Alveolar Echinococcosis in humans. As coyotes can play a main role in the maintenance of this zoonotic parasite within North American urban settings, such study can ultimately aid disease risk management. Between June 2012 and June 2013, we collected 251 coyote feces and conducted trapping of small mammals (n = 971) in five parks in the city of Calgary, Alberta, Canada. We investigated E. multilocularis epidemiology by assessing seasonal variations of coyote diet and the selective consumption of different rodent intermediate host species. Furthermore, accounting for small mammal digestibility and coyote defecation rates we estimated the number of small mammal preys ingested by coyote and consequently, coyote encounter rates with the parasite. Dominant food items included small mammals, fruit and vegetation, although hare and deer were seasonally relevant. The lowest frequency of occurrence per scat of small mammals was recorded in winter (39.4%), when consumption of deer was highest (36.4%). However, highest encounter rates (number of infected hosts predated/season) with E. multilocularis (95% CI: 1.0-22.4), combined with the lack of predation on non-competent small mammal species, suggest that winter is the critical season for transmission and control of this parasite. Within the small mammal assemblage, voles (Microtus pennsylvanicus and Myodes gapperi) were the selected preys of urban coyotes and likely played a key role for the maintenance of the urban sylvatic life-cycle of E. multilocularis in Calgary.

Where to deliver baits for deworming urban red foxes for Echinococcus multilocularis control: new protocol for micro-habitat modeling of fox denning requirements

BACKGROUND

Deworming wild foxes by baiting with the anthelmintic praziquantel is being established as a preventive technique against environmental contamination with Echinococcus multilocularis eggs. Improvement of the cost-benefit performance of baiting treatment is required urgently to raise and maintain the efficacy of deworming. We established a spatial model of den site selection by urban red foxes, the definitive host, to specify the optimal micro-habitats for delivering baits in a new modeling approach modified for urban fox populations.

METHODS

The model was established for two cities (Obihiro and Sapporo) in Hokkaido, Japan, in which a sylvatic cycle of E. multilocularis is maintained. The two cities have different degrees of urbanization. The modeling process was designed to detect the best combination of key environmental factors and spatial scale that foxes pay attention to most (here named 'heeding range') when they select den sites. All possible models were generated using logistic regression analysis, with "presence" or "absence" of fox den as the objective variable, and nine landscape categories customized for urban environments as predictor variables to detect the best subset of predictors. This procedure was conducted for each of ten sizes of concentric circles from dens and control points to detect the best circle size. Out of all models generated, the most parsimonious model was selected using Akaike's Information Criterion (AIC) inspection.

RESULTS

Our models suggest that fox dens in Obihiro are located at the center of a circle with 500 m radius including low percentages of wide roads, narrow roads, and occupied buildings, but high percentages of green covered areas; the dens in Sapporo within 300 m radius with low percentages of wide roads, occupied buildings, but high percentages of riverbeds and green covered areas. The variation of the models suggests the necessity of accumulating models for various types of cities in order to reveal the patterns of the model.

CONCLUSIONS

Our denning models indicating suitable sites for delivering baits will improve the cost-benefit performance of the campaign. Our modeling protocol is suitable for the urban landscapes, and for extracting the heeding range when they select the den sites.

Echinococcosis in wild carnivorous species: epidemiology, genotypic diversity, and implications for veterinary public health

Echinococcosis is a zoonosis caused by helminths of the genus Echinococcus. The infection, one of the 17 neglected tropical diseases listed by the World Health Organization, has a cosmopolitan distribution and can be transmitted through a variety of domestic, synanthropic, and sylvatic cycles. Wildlife has been increasingly regarded as a relevant source of infection to humans, as demonstrated by the fact that a significant proportion of human emerging infectious diseases have a wildlife origin. Based on available epidemiological and molecular evidence, of the nine Echinococcus species currently recognized as valid taxa, E. canadensis G8-G10, E. felidis, E. multilocularis, E. oligarthrus, E. shiquicus, and E. vogeli are primarily transmitted in the wild. E. canadensis G6-G7, E. equinus, E. granulosus s.s., and E. ortleppi are considered to be transmitted mainly through domestic cycles. We summarize here current knowledge on the global epidemiology, geographical distribution and genotype frequency of Echinococcus spp. in wild carnivorous species. Topics addressed include the significance of the wildlife/livestock/human interface, the sympatric occurrence of different Echinococcus species in a given epidemiological scenario, and the role of wildlife as natural reservoir of disease to human and domestic animal populations. We have also discussed the impact that human activity and intervention may cause in the transmission dynamics of echinococcosis, including the human population expansion an encroachment on shrinking natural habitats, the increasing urbanization of wildlife carnivorous species and the related establishment of synanthropic cycles of Echinococcus spp., the land use (e.g. deforestation and agricultural practices), and the unsupervised international trade and translocation of wildlife animals. Following the 'One Health' approach, we have also emphasized that successful veterinary public health interventions in the field of echinococcosis requires an holistic approach to integrate current knowledge on human medicine, veterinary medicine and environmental sciences.

Canine echinococcosis: global epidemiology and genotypic diversity

Canine echinococcosis is a potential zoonotic infection caused by the adult form of several cestode species belonging to the genus Echinococcus, of which E. granulosus sensu lato and E. multilocularis are the most epidemiologically relevant. Dogs infected with E. granulosus and E. multilocularis are widely regarded as the main source of infection for human cystic and alveolar echinococcosis, diseases that cause substantial morbidity and socio-economic burden in several regions of the world. Following our previous review on the global situation of cystic echinococcosis in livestock species (Cardona and Carmena. Vet. Parasitol. 2013;192:10-32), we summarize here current knowledge on the global epidemiology, geographical distribution and molecular diversity of Echinococcus spp. infection in dogs. We address relevant topics including the implications of the increasing urbanization of wildlife species such as foxes, coyotes, and dingoes in the establishment of urban cycles of Echinococcus spp., or the rising concerns regarding the role of unsupervised translocation of infected dogs in spreading the infection to Echinococcus-free areas. The involvement of wildlife species as natural reservoirs of disease to domestic animals and humans and the epidemiological significance of the sympatric occurrence of different Echinococcus species in the same geographical region are also debated. Data presented are expected to be useful for policy makers, educational and health authorities responsible for designing and implementing effective measures for disease control and prevention.

Environmental changes impacting Echinococcus transmission: research to support predictive surveillance and control

Echinococcosis, resulting from infection with tapeworms Echinococcus granulosus and E. multilocularis, has a global distribution with 2-3 million people affected and 200,000 new cases diagnosed annually. Costs of treatment for humans and economic losses to the livestock industry have been estimated to exceed $2 billion. These figures are likely to be an underestimation given the challenges with its early detection and the lack of mandatory official reporting policies in most countries. Despite this global burden, echinococcosis remains a neglected zoonosis. The importance of environmental factors in influencing the transmission intensity and distribution of Echinococcus spp. is increasingly being recognized. With the advent of climate change and the influence of global population expansion, food insecurity and land-use changes, questions about the potential impact of changing temperature, rainfall patterns, increasing urbanization, deforestation, grassland degradation and overgrazing on zoonotic disease transmission are being raised. This study is the first to comprehensively review how climate change and anthropogenic environmental factors contribute to the transmission of echinococcosis mediated by changes in animal population dynamics, spatial overlap of competent hosts and the creation of improved conditions for egg survival. We advocate rigorous scientific research to establish the causal link between specific environmental variables and echinococcosis in humans and the incorporation of environmental, animal and human data collection within a sentinel site surveillance network that will complement satellite remote-sensing information. Identifying the environmental determinants of transmission risk to humans will be vital for the design of more accurate predictive models to guide cost-effective pre-emptive public health action against echinococcosis.

The impact of globalisation on the distribution of Echinococcus multilocularis

In the past three decades, Echinococcus multilocularis, the cause of human alveolar echinococcosis, has been reported in several new countries both in definitive hosts (canids) as well as in people. Unless treated, infection with this cestode in people is fatal. In previously endemic countries throughout the Northern Hemisphere, geographic ranges and human and animal prevalence levels seem to be increasing. Anthropogenic influences, including increased globalisation of animals and animal products, and altered human/animal interfaces are thought to play a vital role in the global emergence of this pathogenic cestode. Molecular epidemiological techniques are a useful tool for detecting and tracing introductions, and differentiating these from range expansions.

Coprological survey of alimentary tract parasites in dogs from Zambia and evaluation of a coproantigen assay for canine echinococcosis

Faecal samples were collected from the rectum of 540 domestic dogs from four districts (Lusaka, Katete, Petauke and Luangwa) in Zambia between 2005 and 2006 and prevalences of canine alimentary tract parasites were determined by coprological examination. Thirteen different ova and parasites including strongyle (43.3%), Spirocerca lupi (18.7%), taeniid (13.1%), Toxocara canis (7.6%), Sarcocystis sp.* (7.5%), Isospora sp.* (5.7%), Physaloptera sp.* (4.6%), Capillaria sp.* (2.8%), Dipylidium caninum (2.2%), Mesocestoides sp.* (2.0%), Ascaris sp.* (1.7%), Trichuris vulpis* (0.4%) and Schistosoma mansoni* (0.4%) were detected, Ascaris and Schistosoma probably originating from coprophagy. The species with asterisks and later-described Taenia multiceps are for the first time reported from dogs in Zambia. A coproantigen enzyme-linked immunosorbent assay (CoproAg-ELISA) developed for Echinococcus spp. revealed 43 positive dogs and 37 of these harboured taeniid eggs. From 63 of the 71 taeniid egg-positive samples, eggs and DNA thereof were isolated and subjected to a multiplex polymerase chain reaction for differentiating E. granulosus sensu lato, E. multilocularis and Taenia spp. Amplicons indicative for Taenia spp. were obtained from 60 samples. Sequencing of amplicons spanning part of the mitochondrial cytochrome c oxidase subunit 1 gene, which was possible with 38 samples, revealed 35 infections with T. hydatigena and 3 with T. multiceps. Therefore, the CoproAg-ELISA showed some positives, but concrete evidence for the existence of canine E. granulosus infection could not be established. Comparison of the results of the CoproAg-ELISA and Taenia species identification indicated that the CoproAg-ELISA cross-reacts with patent infections of T. hydatigena (57%) and T. multiceps (33%).

Fox defecation behaviour in relation to spatial distribution of voles in an urbanised area: An increasing risk of transmission of Echinococcus multilocularis?

Urbanisation of alveolar echinococcosis is a new phenomenon that has been highlighted during the last few decades. It has thus become necessary to understand the dynamics of transmission of Echinococcus multilocularis in urbanised areas. Spatial heterogeneity of infection by E. multilocularis has been explained as the result of a multifactorial dependence of the transmission in which the factors depend on the scale of the investigation. The aim of this study was to assess, in an urbanised area, the effect of such environmental factors as season, habitat type and the level of urbanisation, on the availability of two major intermediate hosts (Microtus spp. and Arvicola terrestris), the distribution of red fox faeces and the distribution of E. multilocularis as determined by detection of coproantigens in faeces. Results of the study revealed higher densities of Microtus spp. in rural than in peri-urban areas. Moreover this species was highly aggregated in urban wasteland. Arvicola terrestris densities did not appear to be linked to the level of urbanisation or to the type of habitat studied. Distribution of faeces was positively linked to distance walked and to Microtus spp. and A. terrestris distributions whatever the level of urbanisation. Such a distribution pattern could enhance the transmission cycle in urban areas. The Copro-ELISA test results on faeces collected in the field revealed that ODs were significantly negatively correlated with the abundance of A. terrestris. The larger population densities of Microtus spp. found in urban wastelands and the well known predominance of Microtus spp. in the red fox diet in the region suggest that Microtus spp. may play a key role in urban transmission of the parasite in the study area.

Multiplex PCR system for identifying the carnivore origins of faeces for an epidemiological study on Echinococcus multilocularis in Hokkaido, Japan

A multiplex PCR system was developed to identify the carnivore origins of faeces collected in Hokkaido, Japan, for epidemiological studies on Echinococcus multilocularis. Primers were designed against the D-loop region of mitochondrial DNA. Two separate primer mixtures (mix 1, specific forward primers to fox, raccoon dog and dog, and a universal reverse primer [prH]; and mix 2, specific forward primers to cat, raccoon and weasels and prH) were used so that the PCR products (160 bp, fox and cat; 240 bp, raccoon dog and raccoon; and 330 bp, dog and weasel) were distinguished by size. The multiplex PCR exhibited no cross-reactivity between carnivore species and did not amplify DNA from rodent prey. When 270 field-collected faeces were examined, 250 showed single PCR products belonging to specific target sizes, suggesting successful carnivore identification for 92.6% of samples. Taeniid eggs were detected in 11.1% of samples and coproantigen in 30.4%; whereas the prevalences of taeniid eggs and coproantigen were 12.9% and 34.0% in fox faeces, and 0% and 26.3% in cat faeces, respectively. These results suggest that the prevalence in different target animals can be evaluated individually and precisely using multiplex PCR system.

Echinococcus multilocularis infection in pet dogs in Japan

A survey of Echinococcus multilocularis infections in pet dogs in Japan from 1997 to 2007 was conducted by testing for coproantigen reactivity, fecal taeniid eggs, and egg DNA. In Hokkaido, the only island where E. multilocularis is endemic in Japan, 18 of 4768 dogs (0.4%) excreted taeniid eggs that were positive for E. multilocularis DNA by polymerase chain reaction (PCR). Most of the dogs testing positive for egg DNA were kept free-range, but three dogs had been kept inside their owners' houses. In addition, 15 dogs were suspected to be infected based on the results of a coproantigen test. One dog, which was transported from Hokkaido to Honshu, the main island of Japan, was excreting taeniid eggs that were positive for E. multilocularis DNA by PCR. These results suggest the importance of proper pet management in disease prevention, even for dogs kept indoors, and they point out a possible means by which the parasite may be introduced into non-endemic areas through transport of infected dogs.

Monitoring of environmental contamination by Echinococcus multilocularis in an urban fringe forest park in Hokkaido, Japan

OBJECTIVES

The aim of this study was to determine the prevalence of Echinococcus multilocularis environmental contamination in an urban fringe-the Nopporo forest park of Sapporo city, Hokkaido, Japan. A secondary aim was to determine possible transmission risks areas by associating percentage occurrence of E. multilocularis-positive faeces with the different land-use classes.

METHODS

Wild fox faeces collected from the environment were examined by intravital methods, such as the taeniid egg sucrose floatation technique, E. multilocularis coproantigen enzyme-linked immunosorbent analysis and DNA test of taeniid eggs by PCR. Geospatial maps produced by the Global Positioning System and Landsat data were analysed using geographic information system software to determine the association between percentage occurrences of E. multilocularis-positive fox faeces and land-use classes.

RESULTS

Our findings showed high prevalence rates in both E. multilocularis egg and coproantigen-positive faeces (16 and 49%, respectively) in the investigated urban fringe forest park. Data revealed that percentage occurrence of E. multilocularis-positive fox faeces was associated with land-use classes, such as forest and open field (P < 0.05).

CONCLUSIONS

We conclude that Nopporo forest park in the urban fringe of Sapporo city, Hokkaido is a reservoir with a high prevalence of zoonotic infective agents for alveolar echinococcosis. Our findings suggest that interface habitats between forests or woodlands and open fields are indispensable for continued maintenance of the life-cycle of E. multilocularis and, as such, constitute high risk areas for echinococcosis transmission.

Echinococcus multilocularis in Belgium: prevalence in red foxes (Vulpes vulpes) and in different species of potential intermediate hosts

Echinococcus multilocularis causes a rare but potentially lethal zoonotic infection in humans. This tapeworm is known to be endemic in foxes in several countries of Western and Central Europe. In Western Europe, the common vole (Microtus arvalis) and the water vole (Arvicola terrestris) are considered to be the most important intermediate host species of this cestode whereas the red fox is by far the most important final host. The purpose of this study was to provide data on the prevalences in Wallonia (Southern part of Belgium) both in the red fox and in different potential intermediate hosts. A total of 990 red foxes were examined between January 2003 and December 2004 for the presence of E. multilocularis. The average prevalence was 24.55% (22.38-27.87). Out of 1249 rodents or insectivores belonging to the species Apodemus sylvaticus, Arvicola terrestris, Clethrionomys glareolus, Microtus arvalis, Microtus agrestris and Sorex araneus, only one M. arvalis (out of 914-0.11% (0.003-0.61) and one C. glareolus (out of 23-4.3% (0.1-21.9) were found to be infected. However, the muskrat (Ondatra zibethicus) seems to be a good intermediate host as 11.18% (9.72-12.76) of the animals (n=1718) were found to be infected. A positive correlation was found between the prevalences in foxes and in muskrats in each of the different geological regions. This study indicates that the muskrat is highly sensitive to this zoonotic tapeworm and could perhaps represent a good bioindicator when studying the epidemiology of this parasitic infection in Belgium and in other countries where the muskrat is present.

Collaborative control initiatives targeting zoonotic agents of alveolar echinococcosis in the northern hemisphere

Alveolar echinococcosis is one of the most important lethal zoonotic helminth infections in the northern hemisphere. Currently, the threat to public health is increasing, as evidenced by the rising prevalence rate of alveolar echinococcosis, as well as the invasion of urban areas by infected wild foxes. This threat is further increased due to the involvement of pet dogs, and probably cats, as emerging sources of infection. These increased threats to public health also have associated economic risks; therefore, there is a need for effective and sustainable methods of control. In this paper, initiatives to control alveolar echinococcosis by targeting its definitive hosts through anthelmintic baiting campaigns initiated by local residents who used local resources for bait production, distribution and collection of fecal samples for diagnosis are described. Further, when such distribution programs are coupled with the use of GIS-based maps, the optimum distribution of bait was obtained. These programs have also included the use of intravital diagnostic analyses of infection rates, which have been overseen by the Forum on Environment and Animals (FEA), and also allowed a nationwide monitoring of echinococcosis in difinitive hosts. In addition, a government initiative requiring mandatory reporting of echinococcosis in dogs to health authorities was recently initiated in Japan. Overall, the results of this study have shown that use of collaborative control initiatives targeting zoonotic agents of alveolar echinococcosis can be an effective method for reducing the threat of lethal echinococcosis in the northern hemisphere.

The immunodiagnosis of Echinococcus multilocularis infection

Alveolar echinococcosis (AE) is a severe zoonotic disease caused by the metacestode stage of Echinococcus multilocularis. The infection can have fatal consequences in humans if treatment is not provided, so early diagnosis is fundamental for initiating treatment and reducing morbidity and mortality. In addition, detection of the parasite in the definitive host plays a central role in epidemiological studies and surveillance programmes for control of AE. This review presents an overview of the present situation regarding the immunodiagnosis of E. multilocularis infection. Special attention is given to the description of the native, partially purified and recombinant antigens available currently for immunodiagnostic purposes. Recent advances in the primary serodiagnosis and follow-up of AE patients are highlighted, including the detection of specific cytokine profiles. Progress in the immunodiagnosis of intestinal E. multilocularis infection in definitive hosts, particularly the detection of excretory-secretory and integument products of the worm in faeces (copro-antigens) by ELISA, is also discussed.

Helminths of red foxes (Vulpes vulpes) in Denmark

An epidemiological study of helminths in 1040 red foxes collected from various localities in Denmark during 1997-2002, revealed 21 helminth species at autopsy, including nine nematode species: Capillaria plica (prevalence 80.5%), Capillaria aerophila (74.1%), Crenosoma vulpis (17.4%), Angiostrongylus vasorum (48.6% from Northern Zealand (endemic area)), Toxocara canis (59.4%), Toxascaris leonina (0.6%), Uncinaria stenocephala (68.6%), Ancylostoma caninum (0.6%), and Trichuris vulpis (0.5%); seven cestodes: Mesocestoides sp. (35.6%), a number of Taeniid species (Taenia pisiformis, T. hydatigena, T. taeniaeformis, T. crassiceps, and unidentified Taenia spp.) (22.8%), and Echinococcus multilocularis (0.3%); four trematodes: Alaria alata (15.4%), Cryptocotyle lingua (23.8%), Pseudamphystomum truncatum (3.6% from Northern Zealand), and Echinochasmus perfoliatus (2.4% from Northern Zealand); one acanthocephalan: Polymorphus sp. (1.2%). Significant difference in prevalence was found for T. canis and A. vasorum according to host sex, and for T. canis, U. stenocephala, Mesocestoides sp., Taenia spp., A. alata, A. vasorum, and Capillaria spp. according to age groups (adult, young or cub). Prevalence and average worm intensity for each helminth species varied considerably according to geographical locality, season, and year. Aggregated distribution was found for several helminth species. The two species E. multilocularis and E. perfoliatus are first records for Denmark.

Towards the control of Echinococcus multilocularis in the definitive host in Japan

Echinococcus multilocularis is distributed all over Hokkaido, the northern island of Japan. The prevalence in foxes has been around 40% in the last decade. Three trials of anthelmintic bait distribution have been conducted in Hokkaido to reduce the prevalence in foxes. In those trials, bait distribution was done along roads in the study area using cars and/or around fox breeding dens by hand. Changes in the prevalence in foxes were evaluated either by necropsy of captured foxes or by coproantigen and egg detection of faeces collected in field. All of the trials showed bait distribution was effective for the reduction of the prevalence in foxes; however, it was also suggested that a frequent and continuous baiting program is necessary for effective and stable control of the prevalence in foxes. As observed in some cities in Europe, urban foxes infected with the parasite were also recognized in Sapporo. A survey of pet dogs showed that 0.4% of surveyed dogs were determined infected. In addition, a dog which was transported from Hokkaido to the main island of Japan was found excreting E. multilocularis eggs. The results raised the public recognition of canine infections, which in turn lead to the modification of a Japanese law for infectious diseases and to the enforcement of a national reporting system of dogs infected with E. multilocularis by veterinarians.

Coproantigens in taeniasis and echinococcosis

The application of modern immunodiagnostic or molecular diagnostic techniques has improved the diagnosis of the taeniid cestode infections, echinococcosis and taeniasis. One particularly promising approach is the detection of parasite-specific antigens in faeces (coproantigens). This approach has been applied to both Echinoccocus and Taenia species and it has gained increasingly widespread use. Taeniid coproantigen tests are based on either monoclonal or polyclonal antibodies raised against adult tapeworm antigens. These tests have the following common characteristics; they are largely genus-specific, specificity is high (>95%), parasite antigen can be detected in faeces weeks prior to patency, levels of coproantigen are independent of egg output, coproantigen is stable for days at a range of temperatures (-80 degrees C to 35 degrees C), for several months in formalin-fixed faecal samples, and coproantigen levels drop rapidly (1-5 days) following successful treatment. In the genus Taenia, most work has been done on Taenia solium and coproantigen tests have reliably detected many more tapeworm carriers than microscopy. For Echinococcus species, there is a broad positive correlation between test sensitivity and worm burden with a reliable threshold level for the test of >50 worms. Characterisation of taeniid coproantigens in order to further improve the tests is ongoing. Studies indicate taeniid coproantigens to include high molecular weight (>150 kDa), heavily glycosylated molecules with carbohydrate moieties contributing substantially to the levels of antigen detected in faeces. Application of the existing coproantigen tests in epidemiological and control programmes for Echinococcus and Taenia species infection has begun to contribute to an improved understanding of transmission and of surveillance of these important zoonotic cestodes.

Modified Sugar Centrifugal Flotation Technique for Recovering Echinococcus multilocularis Eggs From Soil

Among soil-transmitted parasitic diseases, alveolar hydatidosis due to the ingestion of Echinococcus multilocularis eggs is becoming a serious problem in Hokkaido, the northern most island of Japan. Dissemination of the infection far from the endemic areas can occur if motor vehicles transmit soil contaminated with eggs. No appropriate and validated method for recovering the taeniid eggs from soil is available. A modified sugar centrifugal flotation technique, using a sucrose solution of specific gravity 1.27 and 0.05% Tween-80, was evaluated as a method to successfully recover eggs from soil. Contamination levels as low as 10 eggs per gram could be detected. This method may be useful to determine the prevalence of E. multilocularis, its transmission, and the potential for by monitoring soil contamination with eggs.

Wilderness in the city: the urbanization of Echinococcus multilocularis

A distinct increase in fox populations, particularly in urban areas, has been observed in Europe. This is of particular concern in endemic regions of the small fox tapeworm Echinococcus multilocularis, the aetiological agent of human alveolar echinococcosis. Novel tools have facilitated the investigation of the ecology of urban foxes and have demonstrated the urban wildlife cycle of E. multilocularis. Such studies are essential for estimating the risk of transmission to humans and to determine the basics for the development of control strategies.

Epidemiology of alveolar echinococcosis with particular reference to China and Europe

Human alveolar echinococcosis (AE), caused by the metacestode of the fox tapeworm Echinococcus multilocularis, is the most pathogenic zoonosis in temperate and arctic regions of the northern hemisphere. Prospective collection of human cases in some areas and mass screenings using ultrasound imaging and confirmation with serological techniques have markedly improved our knowledge of the epidemiology of the disease in humans during the past two decades. Transmission occurs when eggs of the tapeworm, excreted by the final hosts (usually foxes but also dogs, wolves and cats), are ingested accidentally by humans or during normal feeding by a variety of rodents and small lagomorphs. However, the species of host animals differ according to regional changes in mammalian fauna. This review mostly focuses on epidemiology of alveolar echinococcosis in those parts of the world where new and more accurate epidemiological data are now available, i.e. China and Europe, as well as on new epidemiological trends that can be suspected from recent case reports and/or from recent changes in animal epidemiology of E. multilocularis infection. The People's Republic of China (PRC) is a newly recognized focus on AE in Asia. Human AE cases were firstly recognized in Xinjiang Uygur Autonomous Region and Qinghai Provinces at the end of 1950s and infected animals were first reported from Ningxia in central China and northeast of Inner Mongolia in the 1980s. E. multilocularis (and human cases of AE) appears to occur in three areas: (1) Northeastern China (northeast focus): including Inner Mongolia Autonomous region and Heliongjiang Province (2) Central China (central focus): including Gansu Province, Ningxia Hui Autonomous Region, Sichuan Province, Qinghai Province and Tibet Autonomous Region and (3) Northwestern China: including Xinjiang Uygur Autonomous Region, bordered with Mongolia, Russia, Kazakhstan and Kyrgyzstan. The highest prevalence of the disease, up to 15 per cent of the population in some villages, is reached in China. In Europe, data from the European Echinococcosis Registry (EurEchinoReg: 1982-2000) show 53 autochthonous cases of AE in Austria, 3 in Belgium, 235 in France, 126 in Germany, 1 in Greece, and 112 in Switzerland, and 15 'imported' cases, especially from central Asia; 14 cases were collected in Poland, a country not previously considered endemic for AE. Improved diagnostic technology, as well as a real increase in the infection rate and an extension to new areas, can explain that more than 500 cases have been reported for these 2 decades while less than 900 cases were published for the previous 7 decades. New epidemiological trends are related to an unprecedented increase in the fox population in Europe, to the unexpected development of urban foxes in Japan and in Europe, and to changes in the environmental situation in many countries worldwide due to climatic or anthropic factors which might influence the host-predator relationship in the animal reservoir and/or the behavioural characteristics of the populations in the endemic areas.

Molecular tools for studies on the transmission biology ofEchinococcus multilocularis

Two novel approaches for diagnosis of intestinalEchinococcus multilocularisinfection, the detection ofE. multilocularis-specific coproantigens in ELISA and of copro-DNA by PCR, have been successfully implemented. These methods have proven their value for thepost mortemand theintra vitamdiagnosis ofE. multilocularisin definitive hosts. They have also made novel approaches possible to study the transmission biology of the parasite as they allow detection of the infection in faecal samples collected in the environment. Coproantigen detection is the diagnostic method of choice as it is sensitive, fast and cheap. Studies on faecal samples collected in the field revealed that coproantigen detection did reflect the different prevalences in fox populations as assessed from foxes at necropsy and also the effect of deworming efforts in foxes as achieved by long-term distribution of praziquantel-containing baits. The use of PCR for routine diagnostic or large-scale purposes is hampered by the fact that DNA extraction from faecal material is a very laborious task. Therefore, PCR is rationally used for confirmatory purposes of copro-antigen-positive samples. As taeniid eggs cannot further be differentiated morphologically, PCR is the method of choice to identifyE. multilocularisinfections in faecal or environmental samples containing taeniid eggs. In intermediate rodent hosts, PCR is routinely used in epidemiological studies for identifyingE. multilocularisfrom liver lesions which are often very small, atypical or calcified.

Perspective on control options forEchinococcus multiloculariswith particular reference to Japan

Following a brief introduction of recent advances in molecular and immunological technology for detection of persons and animals infected withEchinococcus multilocularisand an overview of the current situation of alveolar echinococcosis (AE) in Japan, perspectives on control options are discussed with reference to different epidemiological situations. AE is considered the most serious parasitic zoonosis in temperate and arctic regions of the northern hemisphere. The number of human cases differs drastically among regions. While high numbers of patients are apparently associated with highE. multilocularisprevalence in domestic dogs, e.g. in parts of Alaska and western China, the number of cases is moderate or low in areas where the parasite is mainly transmitted by wild canid species (e.g. in central Europe or temperate North America). However, the severity of the disease, the absence of curative treatment for most cases, the high cost of long-term chemotherapy and the anxiety caused for the population in highly endemic areas call for the development of preventive strategies even in regions where human AE is rare. Furthermore, in view of (1) drastically increasing numbers and infection rates of foxes involved in transmission ofE. multilocularis, and (2) increasingly close contact between humans and foxes e.g. in Europe and Japan, there is considerable concern that AE incidences may in future increase in these regions. Control options depend on a variety of factors including the species of canid principally responsible for transmission and the socio-economic situation in the region. Where domestic dogs (stray or owned) are the principal hosts forE. multilocularis, control options can include those applicable toE. granulosus, i.e. reduction of the number of stray dogs, registration and regular preventive chemotherapy of owned dogs, and information campaigns for the population promoting low-risk behaviour for man and dogs. WhereE. multilocularisis mainly transmitted by wild canids, the situation is far more difficult with preventive strategies still being in trial stage. Integrated control measures could include prevention information campaigns, restricting access of pet animals (dogs and cats) to rodents, chemotherapy of foxes on local or regional scales, and strategies to minimize contacts between people and foxes.

Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern

Echinococcosis in humans is a zoonotic infection caused by larval stages (metacestodes) of cestode species of the genus Echinococcus. Cystic echinococcosis (CE) is caused by Echinococcus granulosus, alveolar echinococcosis (AE) is caused by E. multilocularis, and polycystic forms are caused by either E. vogeli or E. oligarthrus. In untreated cases, AE has a high mortality rate. Although control is essentially feasible, CE remains a considerable health problem in many regions of the northern and southern hemispheres. AE is restricted to the northern hemisphere regions of North America and Eurasia. Recent studies have shown that E. multilocularis, the causative agent of AE, is more widely distributed than previously thought. There are also some hints of an increasing significance of polycystic forms of the disease, which are restricted to Central and South America. Various aspects of human echinococcosis are discussed in this review, including data on the infectivity of genetic variants of E. granulosus to humans, the increasing invasion of cities in Europe and Japan by red foxes, the main definitive hosts of E. multilocularis, and the first demonstration of urban cycles of the parasite. Examples of emergence or reemergence of CE are presented, and the question of potential spreading of E. multilocularis is critically assessed. Furthermore, information is presented on new and improved tools for diagnosing the infection in final hosts (dogs, foxes, and cats) by coproantigen or DNA detection and the application of molecular techniques to epidemiological studies. In the clinical field, the available methods for diagnosing human CE and AE are described and the treatment options are summarized. The development of new chemotherapeutic options for all forms of human echinococcosis remains an urgent requirement. A new option for the control of E. granulosus in the intermediate host population (mainly sheep and cattle) is vaccination. Attempts are made to reduce the prevalence of E. multilocualaris in fox populations by regular baiting with an anthelmintic (praziquantel). Recent data have shown that this control option may be used in restricted areas, for example in cities, with the aim of reducing the infection risk for humans.