Retrospective multidisciplinary analysis of human alveolar echinococcosis in Hungary using spatial epidemiology approaches

Abstract

Background Human alveolar echinococcosis (HAE), which is caused by Echinococcus multilocularis tapeworm, is an increasing healthcare issue in Hungary. Of the 40 known cases in the country, 25 were detected in the last five years. Our study aimed to reveal the epidemiological backgrounds of these cases. MethodsWe investigated the spatial impact of potential risk factors of HAE by cluster analysis, and local and global regression models. This analysis was completed by a questionnaire survey on the patients’ lifestyle. ResultsWe found two HAE hyperendemic foci in the country with very dissimilar biotic and climatic features, and controversial impact of different environmental factors. Only two factors, viz forest cover and socio-economic development, proved important countrywide. The most forested and the least developed districts showed the highest HAE risk. Among the patients, kitchen gardening and dog ownership seemed the most risky activities. ConclusionsOur models detected an anomaly in one of the poorest regions of Hungary where all risk factors behaved contrary to that of the neighbouring areas. This phenomenon was supposed to be the result of under-detection of the disease, and it called attention to the urgent priority of knowledge dissemination to the public and the healthcare professionals.