Epidemiological factors associated with human cystic echinococcosis: a semi-structured questionnaire from a large population-based ultrasound cross-sectional study in eastern Europe and Turkey

Tamarozzi F., AKHAN O., Cretu C. M., Vutova K., Fabiani M., ÖRSTEN S., ...More

PARASITES & VECTORS, vol.12, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 12
  • Publication Date: 2019
  • Doi Number: 10.1186/s13071-019-3634-1
  • Journal Name: PARASITES & VECTORS
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: Cystic echinococcosis, Epidemiology of human infection, Potential risk factors, Semi-structured questionnaires, Eastern Europe, Romania, Bulgaria, Turkey
  • Hacettepe University Affiliated: Yes


BackgroundCystic echinococcosis (CE) is a neglected parasitic zoonosis prioritized by the WHO for control. Several studies have investigated potential risk factors for CE through questionnaires, mostly carried out on small samples, providing contrasting results. We present the analysis of risk factor questionnaires administered to participants to a large CE prevalence study conducted in Bulgaria, Romania and Turkey.MethodsA semi-structured questionnaire was administered to 24,687 people from rural Bulgaria, Romania and Turkey. CE cases were defined as individuals with abdominal CE cysts detected by ultrasound. Variables associated with CE at P<0.20 in bivariate analysis were included into a multivariable logistic model, with a random effect to account for clustering at village level. Adjusted odds ratios (AOR) with 95% CI were used to describe the strength of associations. Data were weighted to reflect the relative distribution of the rural population in the study area by country, age group and sex.ResultsValid records from 22,027 people were analyzed. According to the main occupation in the past 20 years, housewife (AOR: 3.11; 95% CI: 1.51-6.41) and retired (AOR: 2.88; 95% CI: 1.09-7.65) showed significantly higher odds of being infected compared to non-agricultural workers. Having relatives with CE (AOR: 4.18; 95% CI: 1.77-9.88) was also associated with higher odds of infection. Interestingly, dog-related and food/water-related factors were not associated with infection.ConclusionsOur results point toward infection being acquired in a domestic rural environment and support the view that CE should be considered more a soil-transmitted than a food-borne infection. This result helps delineating the dynamics of infection transmission and has practical implications in the design of specific studies to shed light on actual sources of infection and inform control campaigns.