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 VelevMar 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

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

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    Tamarozzi, F., Akhan, O., Cretu, C. M., Vutova, K., Akinci, D., Chipeva, R., Ciftci, T., Constantin, C. M., Fabiani, M., Golemanov, B., Janta, D., Mihailescu, P., Muhtarov, M., Orsten, S., Petrutescu, M., Pezzotti, P., Popa, A. C., Popa, L. G., Popa, M. I., ... 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, 18(7), 769-778. https://doi.org/10.1016/S1473-3099(18)30221-4