Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey

a cross-sectional, ultrasound-based, population study from the HERACLES project

Francesca Tamarozzi, Okan Akhan, Carmen Michaela Cretu, Kamenna Vutova, Devrim Akinci, Rossitza Chipeva, Turkmen Ciftci, Corina Manuela Constantin, Massimo Fabiani, Branimir Golemanov, Denisa Janta, Patricia Mihailescu, Marin Muhtarov, Serra Orsten, Marius Petrutescu, Patrizio Pezzotti, Alexandru Cosmin Popa, Loredana Gabriela Popa, Mircea Ioan Popa, Valeri Velev & 3 others Mar Siles-Lucas, Enrico Brunetti, Adriano Casulli

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.

METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.

FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.

INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.

FUNDING: European Union Seventh Framework Programme.

Original languageEnglish
Pages (from-to)769-778
Number of pages10
JournalThe Lancet Infectious Diseases
Volume18
Issue number7
DOIs
Publication statusPublished - Jul 2018

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Bulgaria
Romania
Echinococcosis
Turkey
Population
Eastern Europe
Zoonoses
Rural Population
European Union
Cysts
Volunteers
Primary Health Care
Costs and Cost Analysis

Keywords

  • Abdomen/diagnostic imaging
  • Animals
  • Bulgaria/epidemiology
  • Cross-Sectional Studies
  • Echinococcosis/diagnostic imaging
  • Female
  • Humans
  • Incidence
  • Male
  • Population Surveillance
  • Prevalence
  • Romania/epidemiology
  • Rural Population/statistics & numerical data
  • Turkey/epidemiology
  • Ultrasonography
  • Zoonoses/epidemiology

Cite this

Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey : a cross-sectional, ultrasound-based, population study from the HERACLES project. / Tamarozzi, Francesca; Akhan, Okan; Cretu, Carmen Michaela; Vutova, Kamenna; Akinci, Devrim; Chipeva, Rossitza; Ciftci, Turkmen; Constantin, Corina Manuela; Fabiani, Massimo; Golemanov, Branimir; Janta, Denisa; Mihailescu, Patricia; Muhtarov, Marin; Orsten, Serra; Petrutescu, Marius; Pezzotti, Patrizio; Popa, Alexandru Cosmin; Popa, Loredana Gabriela; Popa, Mircea Ioan; Velev, Valeri; Siles-Lucas, Mar; Brunetti, Enrico; Casulli, Adriano.

In: The Lancet Infectious Diseases, Vol. 18, No. 7, 07.2018, p. 769-778.

Research output: Contribution to journalArticle

Tamarozzi, F, Akhan, O, Cretu, CM, Vutova, K, Akinci, D, Chipeva, R, Ciftci, T, Constantin, CM, Fabiani, M, Golemanov, B, Janta, D, Mihailescu, P, Muhtarov, M, Orsten, S, Petrutescu, M, Pezzotti, P, Popa, AC, Popa, LG, Popa, MI, Velev, V, Siles-Lucas, M, Brunetti, E & Casulli, A 2018, 'Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project', The Lancet Infectious Diseases, vol. 18, no. 7, pp. 769-778. https://doi.org/10.1016/S1473-3099(18)30221-4
Tamarozzi, Francesca ; Akhan, Okan ; Cretu, Carmen Michaela ; Vutova, Kamenna ; Akinci, Devrim ; Chipeva, Rossitza ; Ciftci, Turkmen ; Constantin, Corina Manuela ; Fabiani, Massimo ; Golemanov, Branimir ; Janta, Denisa ; Mihailescu, Patricia ; Muhtarov, Marin ; Orsten, Serra ; Petrutescu, Marius ; Pezzotti, Patrizio ; Popa, Alexandru Cosmin ; Popa, Loredana Gabriela ; Popa, Mircea Ioan ; Velev, Valeri ; Siles-Lucas, Mar ; Brunetti, Enrico ; Casulli, Adriano. / Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey : a cross-sectional, ultrasound-based, population study from the HERACLES project. In: The Lancet Infectious Diseases. 2018 ; Vol. 18, No. 7. pp. 769-778.
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abstract = "BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41{\%} (95{\%} CI 0·29-0·58) in Bulgaria, 0·41{\%} (0·26-0·65) in Romania, and 0·59{\%} (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.FUNDING: European Union Seventh Framework Programme.",
keywords = "Abdomen/diagnostic imaging, Animals, Bulgaria/epidemiology, Cross-Sectional Studies, Echinococcosis/diagnostic imaging, Female, Humans, Incidence, Male, Population Surveillance, Prevalence, Romania/epidemiology, Rural Population/statistics & numerical data, Turkey/epidemiology, Ultrasonography, Zoonoses/epidemiology",
author = "Francesca Tamarozzi and Okan Akhan and Cretu, {Carmen Michaela} and Kamenna Vutova and Devrim Akinci and Rossitza Chipeva and Turkmen Ciftci and Constantin, {Corina Manuela} and Massimo Fabiani and Branimir Golemanov and Denisa Janta and Patricia Mihailescu and Marin Muhtarov and Serra Orsten and Marius Petrutescu and Patrizio Pezzotti and Popa, {Alexandru Cosmin} and Popa, {Loredana Gabriela} and Popa, {Mircea Ioan} and Valeri Velev and Mar Siles-Lucas and Enrico Brunetti and Adriano Casulli",
note = "Copyright {\circledC} 2018 Elsevier Ltd. All rights reserved.",
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month = "7",
doi = "10.1016/S1473-3099(18)30221-4",
language = "English",
volume = "18",
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TY - JOUR

T1 - Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey

T2 - a cross-sectional, ultrasound-based, population study from the HERACLES project

AU - Tamarozzi, Francesca

AU - Akhan, Okan

AU - Cretu, Carmen Michaela

AU - Vutova, Kamenna

AU - Akinci, Devrim

AU - Chipeva, Rossitza

AU - Ciftci, Turkmen

AU - Constantin, Corina Manuela

AU - Fabiani, Massimo

AU - Golemanov, Branimir

AU - Janta, Denisa

AU - Mihailescu, Patricia

AU - Muhtarov, Marin

AU - Orsten, Serra

AU - Petrutescu, Marius

AU - Pezzotti, Patrizio

AU - Popa, Alexandru Cosmin

AU - Popa, Loredana Gabriela

AU - Popa, Mircea Ioan

AU - Velev, Valeri

AU - Siles-Lucas, Mar

AU - Brunetti, Enrico

AU - Casulli, Adriano

N1 - Copyright © 2018 Elsevier Ltd. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.FUNDING: European Union Seventh Framework Programme.

AB - BACKGROUND: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.METHODS: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.FINDINGS: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.INTERPRETATION: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.FUNDING: European Union Seventh Framework Programme.

KW - Abdomen/diagnostic imaging

KW - Animals

KW - Bulgaria/epidemiology

KW - Cross-Sectional Studies

KW - Echinococcosis/diagnostic imaging

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Population Surveillance

KW - Prevalence

KW - Romania/epidemiology

KW - Rural Population/statistics & numerical data

KW - Turkey/epidemiology

KW - Ultrasonography

KW - Zoonoses/epidemiology

U2 - 10.1016/S1473-3099(18)30221-4

DO - 10.1016/S1473-3099(18)30221-4

M3 - Article

VL - 18

SP - 769

EP - 778

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 7

ER -