Epidemiology of echinococcosis in Kyrgyzstan

Alveolar echinococcosis (AE) is among the most lethal parasitic diseases if untreated. AE is considered to be confined to the Northern hemisphere with an estimate of 18,000 new cases occurring globally every year. Overall, AE results in approximately 666,000 DALYs per year. The disease is caused by the fox tapeworm, Echinococcus multilocularis. AE is an emerging disease in many European countries including Switzerland (Deplazes et al., 2017, Adv Parasitol.). Outside of Europe there is a hotspot for AE in central Asia with a focus on Kyrgyzstan (Bebezov et al., 2018, PLOS Emerg. Inf. Dis.). After the dissolution of the Soviet Union in 1992, Kyrgyzstan faces an emergence of cystic and alveolar echinococcosis. E. multilocularis has a complex lifecycle where carnivores (mostly foxes and dogs) play an important role in the transmission of the parasite.

Our institute is involved since years in epidemiological investigations, education and technology transfer to improve the scientific environment in several Kyrgyz laboratories. Results of these studies documented high prevalences of E. multilocularis in dogs (Ziadinov et al., 2008, Int J Parasitol.), foxes Ziadinov et al., 2010, Vet Parasitol.), and humans. The local prevalence of AE in a study that started 2012 was 4.1%, based on the PCR, serology and ultrasound results (Bebezov et al., 2018, EID). 

At present, a treatment study with several hundred AE patients in Kyrgyzstan is ongoing as a collaboration between the Institute of Parasitology, the section of Epidemiology at the Vetsuisse Faculty Zurich, the University Hospital Zurich, and the Department of Disease Prevention and Sanitary - Epidemiological Surveillance, Ministry of Health of the Kyrgyz Republic The Kyrgyz National Veterinary Research Institute. A further SNF-project (Transmission modelling of emergent echinococcosis in Kyrgyzstan’’, focuses on the environmental contamination with E. multilocularis eggs, geographic distribution of the cases and risk factor analyzes. Furthermore, a PhD program at the Graduate School for Cellular and Biomedical Sciences (GCB) of the Universities of Bern andZurich is planned with the aim to develop and validate diagnostic strategies for early AE. The project is focussed on the detection of specific antibodies against recombinant and affinity purified native antigens and the detection of circulating E. multilocularis antigens (using monoclonal antibodies and nanobodies), the development of reliable tests for laboratories with restricted infrastructure, and a fast-test applicable in the field in parallel to ultrasound studies. Altogether, this project should help to improve the serological diagnosis of early AE cases and contribute to the improvement of laboratory methods in the country.

Institute members: Philipp Kronenberg (doctoral student), Felix Grimm, Saša Štefanić, Cristian Alvarez, Peter Deplazes (Project Leader)

Funding sources: WHO: drugs for human AE; SNF Project: No. 173131 – ‘’Transmission modelling of emergent echinococcosis in Kyrgyzstan’’ main applicant P. Torgerson, co-applicants Prof. P. Deplazes, and Prof. B. Müllhaupt).

In collaboration with: Prof. Paul R. Torgerson, Head of the Epidemiology Department at the Vetsuisse Faculty in Zurich, PD Dr. Beat Müllhaupt, Head of Hepatology in the division of Gastroenterology and Hepatology at the University Hospital of Zurich, Dr. Giulia Paternoster, PhD student, Epidemiology Department at the Vetsuisse Faculty in Zurich, Dr. Gulnara Minbaeva and Dr. Jumagul Usibaeva, MD’s, Department of Disease Prevention and Sanitary - Epidemiological Surveillance, Ministry of Health of the Kyrgyz Republic, Dr. Elimira Akmatova and Kuban Abdykerimov, Veterinarian, Kyrgyz National Veterinary research Institute in Bishkek Kyrgyzstan.