Unveiling the incidences and trends of alveolar echinococcosis in Europe: a systematic review from the KNOW-PATH project

Adriano Casulli¹, Bernadette Abela², Daniele Petrone³, Barbara Šoba⁴, Balázs Dezsényi⁵, Jacek Karamon⁶, Laurence Millon⁷, Urmas Saarma⁸, Daniela Antolová⁹, François Chappuis¹⁰, Severin Gloor¹¹, Marcel Stoeckle¹², Beat Müllhaupt¹³, Relja Beck¹⁴, Heimo Lagler¹⁵, Felix Lötsch¹⁶, Herbert Auer¹⁷, Marie-Pierre Hayette¹⁸, Libuše Kolářová¹⁹, Sniedze Laivacuma²⁰, Mindaugas Šarkūnas²¹, Vitalijus Sokolovas²², Audronė Marcinkutė²³, Karin Troell²⁴, Ansgar Deibel¹³, Pikka Jokelainen²⁵, Małgorzata Sulima²⁶, Dagny Krankowska²⁷, Stillhard Roman²⁸, Gaëtan-Romain Joliat²⁹, Nermin Halkic²⁹, Solange Bresson-Hadni³⁰, Joanna Halina Bednarek³¹, Andrzej Załęski²⁷, Małgorzata Paul³², Sheraz Yaqub³³, Mogens Jensenius³⁴, Joke van der Giessen³⁵, Laura Nabarro³⁶, Peter Chiodini³⁷, Florent Demonmerot⁷, Jenny Knapp⁷, Beate Grüner³⁸, Peter Kern³⁸, Lynn Peters³⁸, Federica Santolamazza³⁹, Azzurra Santoro³⁹

Affiliations

¹ WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (One Health), Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Public Health on Food-, Water- and Vector-borne Helminths and Protozoa, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. Electronic address: adriano.casulli@iss.it.
² Global Programme for Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
³ Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
⁴ Laboratory of Parasitology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁵ Semmelweis University, Department of Surgery, Transplantation and Gastroenterology, Budapest, Hungary.
⁶ Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Pulawy, Poland.
⁷ National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France; Université Marie et Louis Pasteur, CNRS, Chrono-environnement (UMR 6249), Besançon, France.
⁸ Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia.
⁹ Laboratory of Human Parasitology, Institute of Parasitology of Slovak Academy of Sciences, Košice, Slovakia.
¹⁰ Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹¹ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹² Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
¹³ Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
¹⁴ Laboratory for Parasitology, Croatian Veterinary Institute, Zagreb, Croatia.
¹⁵ Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁶ Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
¹⁷ Medical Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Centre of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria.
¹⁸ Belgian National Reference Centre for Echinococcosis, EchinoLiège, Department of Medical Microbiology, University Hospital of Liège, Liège, Belgium.
¹⁹ National Reference Laboratory for Tissue Helminthoses, Institute of Medical Biochemistry and Laboratory Diagnostics and Institute of Medical Microbiology, General University Hospital, Prague, Czech Republic; National Reference Laboratory for Tissue Helminthoses, Institute of Medical Biochemistry and Laboratory Diagnostics and Institute of Medical Microbiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
²⁰ Department of Infectology, Riga Stradiņš University, Riga, Latvia; Riga East Clinical University Hospital, Riga, Latvia.
²¹ Department of Veterinary Pathobiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²² Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
²³ Department of Infectious Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
²⁴ Department of Microbiology, Swedish Veterinary Agency, Uppsala, Sweden; Department of Research and Internationalization, Norwegian Veterinary Institute, Ås, Norway.
²⁵ Infectious Disease Preparedness and One Health, Statens Serum Institut, Copenhagen, Denmark.
²⁶ Division of Tropical and Parasitic Diseases, Department of Tropical Medicine and Parasitology-National Centre for Tropical Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland.
²⁷ Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland.
²⁸ Gastroenterology and Hepatology, HOCH Health Ostschweiz, Cantonal Hospital St Gallen, St Gallen, Switzerland.
²⁹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland.
³⁰ National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France; Université Marie et Louis Pasteur, CNRS, Chrono-environnement (UMR 6249), Besançon, France; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
³¹ Department of Infectious Diseases, Collegium Medicum, Jagiellonian University, Kraków, Poland.
³² Division of Tropical and Parasitic Diseases, Department of Internal Medicine and Metabolic Disorders, Poznan University of Medical Sciences, Poznań, Poland.
³³ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³⁴ Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
³⁵ Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
³⁶ Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.
³⁷ Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK.
³⁸ Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, Ulm, Germany.
³⁹ WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (One Health), Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Public Health on Food-, Water- and Vector-borne Helminths and Protozoa, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.

PMID: 40578380
DOI: 10.1016/S1473-3099(25)00283-X

Review

Unveiling the incidences and trends of alveolar echinococcosis in Europe: a systematic review from the KNOW-PATH project

Adriano Casulli et al. Lancet Infect Dis. 2025.

. 2025 Jun 24:S1473-3099(25)00283-X.

doi: 10.1016/S1473-3099(25)00283-X. Online ahead of print.

Authors

Affiliations

¹ WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (One Health), Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Public Health on Food-, Water- and Vector-borne Helminths and Protozoa, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. Electronic address: adriano.casulli@iss.it.
² Global Programme for Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
³ Unit of Epidemiology, Biostatistics and Mathematical Modelling, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
⁴ Laboratory of Parasitology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁵ Semmelweis University, Department of Surgery, Transplantation and Gastroenterology, Budapest, Hungary.
⁶ Department of Parasitology and Invasive Diseases, National Veterinary Research Institute, Pulawy, Poland.
⁷ National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France; Université Marie et Louis Pasteur, CNRS, Chrono-environnement (UMR 6249), Besançon, France.
⁸ Department of Zoology, Institute of Ecology and Earth Sciences, University of Tartu, Tartu, Estonia.
⁹ Laboratory of Human Parasitology, Institute of Parasitology of Slovak Academy of Sciences, Košice, Slovakia.
¹⁰ Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹¹ Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹² Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
¹³ Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
¹⁴ Laboratory for Parasitology, Croatian Veterinary Institute, Zagreb, Croatia.
¹⁵ Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
¹⁶ Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
¹⁷ Medical Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Centre of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria.
¹⁸ Belgian National Reference Centre for Echinococcosis, EchinoLiège, Department of Medical Microbiology, University Hospital of Liège, Liège, Belgium.
¹⁹ National Reference Laboratory for Tissue Helminthoses, Institute of Medical Biochemistry and Laboratory Diagnostics and Institute of Medical Microbiology, General University Hospital, Prague, Czech Republic; National Reference Laboratory for Tissue Helminthoses, Institute of Medical Biochemistry and Laboratory Diagnostics and Institute of Medical Microbiology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
²⁰ Department of Infectology, Riga Stradiņš University, Riga, Latvia; Riga East Clinical University Hospital, Riga, Latvia.
²¹ Department of Veterinary Pathobiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
²² Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
²³ Department of Infectious Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
²⁴ Department of Microbiology, Swedish Veterinary Agency, Uppsala, Sweden; Department of Research and Internationalization, Norwegian Veterinary Institute, Ås, Norway.
²⁵ Infectious Disease Preparedness and One Health, Statens Serum Institut, Copenhagen, Denmark.
²⁶ Division of Tropical and Parasitic Diseases, Department of Tropical Medicine and Parasitology-National Centre for Tropical Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, Poland.
²⁷ Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland.
²⁸ Gastroenterology and Hepatology, HOCH Health Ostschweiz, Cantonal Hospital St Gallen, St Gallen, Switzerland.
²⁹ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland.
³⁰ National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France; Université Marie et Louis Pasteur, CNRS, Chrono-environnement (UMR 6249), Besançon, France; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
³¹ Department of Infectious Diseases, Collegium Medicum, Jagiellonian University, Kraków, Poland.
³² Division of Tropical and Parasitic Diseases, Department of Internal Medicine and Metabolic Disorders, Poznan University of Medical Sciences, Poznań, Poland.
³³ Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³⁴ Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
³⁵ Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
³⁶ Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.
³⁷ Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK.
³⁸ Department of Internal Medicine III, Division of Infectious Diseases, Ulm University Hospital, Ulm, Germany.
³⁹ WHO Collaborating Centre for the Epidemiology, Detection and Control of Cystic and Alveolar Echinococcosis (One Health), Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Parasites, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Union Reference Laboratory for Public Health on Food-, Water- and Vector-borne Helminths and Protozoa, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.

PMID: 40578380
DOI: 10.1016/S1473-3099(25)00283-X

Erratum in

Correction to Lancet Infect Dis 2025; published online June 24. https://doi.org/10.1016/S1473-3099(25)00283-X.
[No authors listed] [No authors listed] Lancet Infect Dis. 2025 Sep;25(9):e497. doi: 10.1016/S1473-3099(25)00437-2. Epub 2025 Jul 11. Lancet Infect Dis. 2025. PMID: 40659024 No abstract available.

Abstract

Human alveolar echinococcosis is a notifiable parasitic infectious disease in most European countries; however, in practice, it is under-reported by national health systems. To fill this knowledge gap, data on the number, incidence, and trend of cases in Europe were extracted through a systematic review approach from both the scientific and grey literature, covering 1997-2023. This systematic review identified 4207 human alveolar echinococcosis cases from 28 of the 40 European countries investigated. Historically endemic Austria, France, Germany, and Switzerland accounted for 2864 (68·08%) of 4207 cases documented in Europe, and Lithuania, Poland, and Slovakia represented an additional 887 (21·08%) cases. Based on incidence rates and trends detected in this study, two main epicentres were seen in countries in the Alpine and the Baltic areas. The mean annual incidence from 1997 to 2023 throughout Europe was 0·063 cases per 100 000 people and in EU member states was 0·060 cases per 100 000 people. Data collected during this period suggest that alveolar echinococcosis is emerging in almost every country where this neglected parasitic infectious disease has been detected.

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Conflict of interest statement

Declaration of interests FL declares funding for projects unrelated to this study from Hochschuljubilaumsfonds, Medizinisch-Wissenschaftlicher Fonds des Burgermeisters der Bundeshauptstadt Wien, Karl-Landsteiner-Gesellschaft, and Kooperation Entwicklung und Forschung; honoraria from Pfizer, Valneva, Shionogi, and Takeda; support for attending educational meetings from Diasorin; is a member of the board of the Austrian Society for Tropical Medicine, Parasitology, and Migration Medicine; and has stock or stock options in Eli Lilly. MSt declares consulting fees and support for attending meetings and travel from Gilead, paid to their institution; and participation on a data safety monitoring board or advisory board for MSD, Gilead, ViiV, and Moderna. PK declares grants or contracts from the German Research Foundation (Transmission ecology and risk factors for cystic echinococcosis in Sub-Saharan Africa). PC declares receiving travel expenses from Elanco Animal Health. All other authors declare no competing interests.

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Unveiling the incidences and trends of alveolar echinococcosis in Europe: a systematic review from the KNOW-PATH project

Affiliations

Unveiling the incidences and trends of alveolar echinococcosis in Europe: a systematic review from the KNOW-PATH project

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

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LinkOut - more resources

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Miscellaneous