The Evolution of Cystic Echinococcosis in Humans and Ruminants in Portugal—A One Health Approach

Abstract

Cystic echinococcosis, also known as hydatid disease, is a significant parasitic zoonosis with public health implications, albeit often neglected. In Portugal, data on this zoonosis are scarce despite being a mandatory notifiable disease in both humans and animals. To assess the impact of cystic echinococcosis on both livestock and humans, we compiled data from slaughterhouse records of ruminants, human hospitalizations, and confirmed cases of human echinococcosis. Overall, a total of 298 cases of cystic echinococcosis were identified in ruminants slaughtered from national farms for human consumption in Portugal between 2008 and 2022, comprising 192 cases in ovines, 95 in bovines, and 11 in caprines. Echinococcosis led to 582 hospitalizations in Portuguese public hospitals, with an average hospital stay of 11 days (±15.66), and resulted in 13 deaths (2.23%) from 2008 to 2018. Each infected animal was associated with a 7% increase in the incidence rate of human hospitalization (p = 0.002, IRR = 1.070, 95% CI: 1.025–1.117). Additionally, for every 100,000 person-years observed between 2008 and 2018, the total number of hospitalizations was 0.528. Residence in the Alentejo region was associated with a 5.3-fold increase in the incidence rate of human hospitalizations and an 8-fold higher risk of death from echinococcosis.

Global, Regional and National Burden of Human Cystic Echinococcosis from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

“…Our data offer evidence that public health officials and policy makers may use to formulate and implement cost–benefit interventions to tackle the disease burden attributable to cystic echinococcosis. We recommend that more health resources should be allocated to low-SDI regions, women and the elderly aged 55 to 65 years to reduce the disease burden caused by cystic echinococcosis, and sustainable, integrated interventions based on the One Health concept are needed if we are to achieve the elimination of cystic echinococcosis from this wormy world [ 41 , 42 ].…”

Advances in Detecting Cystic Echinococcosis in Intermediate Hosts and New Diagnostic Tools: A Literature Review

“…This process results in the formation of cystic lesions, which can fill with fluid and grow to extremely large sizes that damage the host's organs, resulting in crippling symptoms and even death in some cases [19]. Aside from the detrimental effects of this damage on individual animals, it also has substantial economic consequences for the global livestock industry [20]. A significant economic impact is associated with CE in ruminant populations [21].…”

“…Aside from the detrimental effects of this damage on individual animals, it also has substantial economic consequences for the global livestock industry [ 20 ]. A significant economic impact is associated with CE in ruminant populations [ 21 ].…”

“…A significant economic impact is associated with CE in ruminant populations [ 21 ]. It reduces milk and meat production in cattle, resulting in a decline in productivity, causing the slaughter or culling of infected animals, and directly affecting the meat and dairy industries [ 20 ]. There are substantial public health implications associated with echinococcosis, with millions of people at risk of contracting the disease from contaminated food and water, and a very high economic burden [ 22 ].…”