Summer Buzz

Polyxeni Potter

Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Human Alveolar Echinococcosis in Kyrgyzstan

Jumagul Usubalieva, Gulnara Minbaeva, Iskender Ziadinov, Peter Deplazes, and Paul R. Torgerson

Author affiliations: Government Sanito-Epidemiology Unit, Bishkek, Kyrgyzstan (J. Usubalieva, G. Minbaeva); University of Zurich, Zurich, Switzerland (I. Ziadinov, P. Deplazes, P.R. Torgerson)

Abstract

Human echinococcosis is a reportable disease in Kyrgyzstan. Between 1995 and 2011, human alveolar echinococcosis increased from <3 cases per year to >60 cases per year. The origins of this epidemic, which started in 2004, may be linked to the socioeconomic changes that followed the dissolution of the former Soviet Union.

Alveolar echinococcosis (AE) is a devastating disease in humans, caused by the larval stage of the fox tapeworm, Echinococcus multilocularis (1). In the absence of treatment, the condition is often fatal, although expensive and successful treatment options are available and have recently been documented to be effective (2). The closely related parasite E. granulosus, commonly transmitted between dogs and livestock, causes cystic echinococcosis (CE) when it infects humans. CE has emerged throughout central Asia following the dissolution of the former Soviet Union and has been attributed to changes in animal husbandry practices, decline in veterinary public health services, and increases in dog populations (3). We report evidence of an emerging epidemic of human AE in the former Soviet Republic of Kyrgyzstan.

The Study

Echinococcosis is notifiable in Kyrgyzstan, a small, mountainous, central Asian country (199,900 km²) of ≈5.5 million inhabitants. All confirmed diagnoses are reported to the Government Sanito-Epidemiology Unit in Bishkek. Cases are reported as either CE or AE by morphologic and histologic examination of resected lesions after surgical treatment. Age, sex, origin, and occupation of patients with reported cases are recorded. This reporting procedure has been used since the time of Soviet administration. However, the number of cases is likely underreported, and many case-patients with echinococcosis do not receive treatment because of widespread poverty and misdiagnoses. We analyzed the official reported cases of AE for the years 1995 through 2011 and present the annual numbers of all case-patients, categorized by sex and district of origin.

Figure 1

Thumbnail of Number of alveoloar echinococcosis cases reported in Kyrgyzstan, by patient sex, 1995–2011.

Figure 1. . Number of alveoloar echinococcosis cases reported in Kyrgyzstan, by patient sex, 1995–2011.

Figure 2

Thumbnail of Relative incidence of alveoloar echinococcosis in Kyrgyzstan, by district, 1995–2011. The size of the bars on the map is proportional to the incidence.

Figure 2. . Relative incidence of alveoloar echinococcosis in Kyrgyzstan, by district, 1995–2011. The size of the bars on the map is proportional to the incidence.

After the first AE case was recorded in 1996 in Kyrgyzstan, 0–3 cases occurred each year until 2003. Since 2004, the numbers of reported cases have increased substantially, reaching 61 in 2011 (Figure 1)