Unveiling the incidences and trends of alveolar echinococcosis in Europe: a systematic review from the KNOW-PATH project

Human alveolar echinococcosis is a notifiable parasitic infectious disease in most European countries; however, in practice, it is under-reported by national health systems. To fill this knowledge gap, data on the number, incidence, and trend of cases in Europe were extracted through a systematic review approach from both the scientific and grey literature, covering 1997-2023. This systematic review identified 4207 human alveolar echinococcosis cases from 28 of the 40 European countries investigated. Historically endemic Austria, France, Germany, and Switzerland accounted for 2864 (68·08%) of 4207 cases documented in Europe, and Lithuania, Poland, and Slovakia represented an additional 887 (21·08%) cases. Based on incidence rates and trends detected in this study, two main epicentres were seen in countries in the Alpine and the Baltic areas. The mean annual incidence from 1997 to 2023 throughout Europe was 0·063 cases per 100 000 people and in EU member states was 0·060 cases per 100 000 people. Data collected during this period suggest that alveolar echinococcosis is emerging in almost every country where this neglected parasitic infectious disease has been detected.