Human and animal cystic echinococcosis in Tataouine governorate: hypoendemic area in a hyperendemic country, myth or reality?

Cystic echinococcosis (Echinococcus granulosus sensu lato infection) in Tunisia, a One Health perspective for a future control programme

The emergence of pandemics with dramatic consequences for human health has obscured endemic diseases that continue to pose a problem for human and animal health in several regions of the world. Among these diseases, cystic echinococcosis, a zoonotic parasitic infection caused by a group of cestodes, Echinococcus granulosus sensu lato, remains a real human and animal health problem in several regions of the world, including the Mediterranean Basin. Despite the implementation of a number of governmental control programmes using several tools (dog treatment, meat inspection, etc.), this infection is still highly prevalent in North Africa. Here we present a review of the epidemiology of cystic echinococcosis in Tunisia, an analysis of the constraints limiting the effectiveness of the control programmes implemented, and finally argue for the use of the One Health framework to improve the effectiveness of future programmes.

Knowledge, awareness and practice regarding cystic echinococcosis in Algeria: A cross-sectional survey among the general population

Cystic echinococcosis (CE) is a parasitic zoonotic disease with a widespread occurrence, particularly in developing countries. Known as a neglected disease, it is highly prevalent in Algeria with a significant public health concern and substantial financial losses. The objectives of this study was to explore knowledge and awareness and practice of the Algerian population regarding this disease. A cross-sectional online-based survey was conducted between July 15 and September 25, 2022 using a self-administered questionnaire targeting all Algerian people of more than 18 years of age. Out of the total respondents, 87.7% have ever heard of CE with livestock rearing connection (OR:2.550, CI 95% OR: 1.108-5.870) and educational level (OR:3.826, CI 95% OR: 1.599-9.156) as the main factors associated with the level of awareness. Regarding their knowledge, results showed dispersing notions about the disease. The majority (84.8%) were aware of the zonnotic nature of the disease while only 49.6% knew that CE is caused by parasitic disease. Also, 83.3% were knowledgeable of the role of contaminated offal in the contamination of dogs which are considered as the main source of contamination of humans (65.19%). Regarding their practices, even home slaughtering was common (92.96%), some positive attitudes were prevalent where most of the participants declared washing vegetable before consumption (97.41%) and washing their hands after touching a dog (91.11%). Also, 68.29% among the dog owners declared that deworming their pets. This study has revealed that despite the high level of awareness and some positive attitudes, the level of knowledge about CE among the Algerian public has shown some gaps related to the epidemiology of the disease. These results could be helpful for the awareness campaigns programmers in their missions through focusing their efforts on raising the level of knowledge for the items that have shown a lack of understand which will be of great importance in the strategy of CE elimination.

Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections

BACKGROUND

Echinococcosis is a neglected zoonosis of increasing public health concern worldwide. According to the World Health Organization, 19,300 lives and 871,000 disability-adjusted life-years are lost globally each year because of cystic echinococcosis. Annual costs associated with cystic echinococcosis were estimated at US$ 3 billion because of treatment of cases and losses in the livestock industry.

METHODS

We performed the random-effects model of meta-analysis using 51-year (1970-2021) data available from AJOL, Google Scholar, PubMed, Science Direct, Scopus and Web of Science. We also applied the Joanna Briggs Institute critical appraisal instrument for studies reporting prevalence data, the Cochran's Q-test, Egger's regression test and the single study deletion technique to respectively examine within-study bias, heterogeneity, across-study bias and sensitivity.

RESULTS

Thirty-nine eligible studies on human cystic echinococcosis (HCE) from 13 countries across the five African sub-regions showed an overall prevalence of 1.7% (95% CI 1.1, 2.6) with a statistically significant (P < 0.001) sub-group range of 0.0% (95% CI 0.0, 14.1) to 11.0% (95% CI 7.6, 15.7). Highest prevalences were observed in Eastern Africa (2.7%; 95% CI 1.4, 5.4) by sub-region and Sudan (49.6%; 95% 41.2, 58.1) by country. Another set of 42 studies on Echinococcus granulosus infections (EGI) in dogs from 14 countries across the five African sub-regions revealed an overall prevalence of 16.9% (95% CI 12.7, 22.3) with a significant (P < 0.001) variation of 0.4 (95% CI 0.0, 5.9) to 35.8% (95% CI 25.4, 47.8) across sub-groups. Highest prevalences of E. granulosus were observed in North Africa (25.6%; 95% CI 20.4, 31.6) by sub-region and Libya (9.2%; 95% CI 5.7, 13.9) by country.

CONCLUSION

Human cystic echinococcosis and EGI are respectively prevalent among Africans and African dogs. We recommend a holistic control approach that targets humans, livestock, dogs and the environment, which all play roles in disease transmission. This approach should involve strategic use of anthelminthics in animals, standardized veterinary meat inspection in abattoirs, control of stray dogs to reduce environmental contamination and proper environmental sanitation. Mass screening of humans in hyper-endemic regions will also encourage early detection and treatment.