Echinococcoses in Iran, Turkey, and Pakistan: Old Diseases in the New Millennium

Abstract

Echinococcosis is considered a cosmopolitan zoonosis caused by different species of small taeniid tapeworms of the genus Echinococcus and is regarded as a neglected zoonosis. Cystic and alveolar echinococcoses are endemic diseases of Tibetan, Pamir, and Iranian plateaus. All of the countries within the Iranian plateau are affected by echinococcosis. Pakistan, Turkey, and Iran are the three most populous countries of the region, in which echinococcosis is highly endemic. The three neighboring countries share strong cultural and socioeconomic ties. The present study aimed to provide a broad review of the status of cystic and alveolar echinococcosis, summarizing the current knowledge about geographical distribution, molecular epidemiology, and transmission dynamics of Echinococcus granulosus sensu lato and Echinococcus multilocularis in this region. Additionally, we aimed to understand disease burden and risk factors as basic requirements for establishing a surveillance system and planning prevention and control programs. A considerable body of information is available on different aspects of echinococcosis in this region; however, several information and research gaps need to be filled before planning control programs. None of the countries in the region have an elaborate echinococcosis control program. Effective control programs require multi/intersectoral coordination within a One Health approach with a long-term political and administrative commitment and enhanced international collaboration among the three countries.

Keywords: Iran; Pakistan; Turkey; alveolar echinococcosis; cystic echinococcosis; epidemiology; genotypes; hydatid disease; transmission.

FIG 1

Geographical districts of Iran, Pakistan, and Turkey.

FIG 2

Distributions of the genotypes of E. granulosus sensu lato in human, livestock, and carnivorous species in Iran, Pakistan, and Turkey based on molecular identification (for more details, please refer to the main text).

FIG 3

Epidemiology of cystic echinococcosis in Iran, Pakistan, and Turkey. (A) Uncontrolled population of free-roaming dogs in urban areas in Iran. (B) Unregulated abattoir in Turkey. (C) Home slaughter butcher’s shop and stray dog in Pakistan. (D) Free-roaming dogs feeding on a dead livestock body left around an abattoir in Iran. (E and F) Traditional animal husbandry in the region: a shepherd with his dogs and children herding livestock with a sheep dog in Iran. (G) Unfenced vegetable fields in Pakistan and the dogs roaming freely in the farms. (H) Community-based ultrasound survey on cystic echinococcosis in Iran.