A One-Health evaluation of the burden of cystic echinococcosis and its prevention costs: Case study from a hypo-endemic area in Italy

Abstract

An integrated model, based on a One Health approach, was implemented to estimate the epidemiological and economic outcomes of cystic echinococcosis (CE) in Veneto region, an hypo-endemic area of Northern Italy, and the costs for its prevention. Data and information needed to populate the model were retrieved from published literature, official statistics, expert opinions, or actively searched through data mining (i.e., Hospital and slaughterhouse data), when fundamental data were not available. Human-health and animal-health costs, both public and private, were considered. The overall impact of CE in the study area was estimated in an yearly cost of about 0.5 million €, due to an average of 19.5 human hospitalized cases and about 200 infected animals among cattle and sheep, per year. The human:animal costs ratio was about 8:1. Most of the infected animals were autochthonous, while the identification of an autochthonous source of the infection for the human cases was extremely difficult, and unlikely in most cases. No specific action resulted to be in place for human surveillance, while veterinary surveillance accounted for a yearly cost of about 22,000 €. Sheepherders were found to pay privately an overall amount of around 2000 € for the preventive treatment of their dogs every year, but the applied protocol proved to be sub-optimal. The source of most of the human cases was likely external to the study area, and their economic impact accounts for a cost that is far exceeding that of surveillance and preventive actions in place in the veterinary sector. Although autochthonous human cases appeared to be very rare, the strengthening of preventive actions and surveillance systems can reduce the risk of their increment.

Changes in the global epidemiological characteristics of cystic echinococcosis over the past 30 years and projections for the next decade: Findings from the Global Burden of Disease Study 2019

“…Over the past three decades, the global burden of CE has almost been halved, possibly attributed to the advancements and widespread adoption of medical techniques like ultrasound diagnosis and rapid immune testing reagents [ 24 ]. Previous studies have found a high prevalence of CE in regions where traditional sheep herding continues to be a major source of income, such as Central Asia, as well as North Africa and the Middle East [ 14 , 24 ]. We also found that approximately half of the global new cases were concentrated in Central Asia, while one-fifth were reported in North Africa and the Middle East.…”

“…However, regions with lower SDI indices still had relatively high YLLs. Moving forward, it is crucial that decision-makers prioritise regions with lower SDI indices and implement additional preventive measures and control strategies, while also noting that the CE incidence in areas with high SDI levels showed an increasing trend, which may be attributed to the increased logistics trade and unbalanced development [ 14 ].…”

“…Alike to other NTDs, CE primarily affects rural and marginalised communities, where access to health care services is often limited [ 12 , 13 ]. However, unlike NTDs, it is not limited to tropical and subtropical regions, but also affects pastoral and rural communities in medium- to high-income countries, as observed in high-prevalence or endemic areas in Central, Southern, and insular Italy [ 3 , 14 ]. However, recent research on the epidemiological characteristics and burden of CE has only focussed on a few countries, with limited studies on the global-level burden.…”

Cystic Echinococcosis in the Early 2020s: A Review

“…A pilot study conducted in Argentina [ 94 ] has highlighted the significant advantages of the vaccine in mitigating the transmission of disease among sheep, a promising advancement in the efforts to prevent echinococcosis. These interventions are part of the One Health approach [ 2 , 81 , 96 , 97 ], emphasizing the interconnectedness of human and animal health.…”