Cystic Echinococcosis in the Mediterranean basin

In spite of the fact that Echinococcus granulosus is known to be widely distributed in the Mediterranean basin, a complete and accurate picture of its inflection prevalence in humans and animals in the different regions is rather difficult, if not impossible. Correct mapping is hindered by the fact that, on the one hand, in those countries where notification to the health authorities is compulsory, official data are unreliable and on the other by the lack of suitable series of data based on findings for humans and animals that are often partial, casual or targeted (one hospital, one slaughterhouse etc.). Though they sometimes provide a wealth of clinical information, this kind of data are of little or no use in epidemiology as they concern samples that cannot be related to a known population with well-defined characteristics for which the only analysis possible, namely percent frequency within the examined sample, can lead to misinterpretation. Thus it becomes extremely difficult, if not impossible, to estimate the specific prevalence of infection that represents the different distribution of E. granulosus in the region by specific age group, localisation and for humans by ethnic group and occupation, that could otherwise provide useful information on the current status and on the prospects for change. On the other hand infection rates at a national level, when available, do not reflect the specific health risk for the different areas. Standardisation of data collection is necessary and a close link needs to be established between epidemiology, ethno-anthropology and agrarian sociology in order to properly evaluate the data, as this would promote an economic approach, The problems of inhomogeneity of the regions, of the cultural and ethnic diversity and the different economic and social conditions, combined with the complete lack of data for certain areas, do not allow a global perspective of such a vast and complex area as the Mediterranean region. On the other hand the available data are distributed over a broad time span (decades) and for this reason do not appear to be readily comparable. Nonetheless, these data do provide the only opportunity of gaining an insight into the parasite's infection pressure in the Mediterranean basin and consequently an as critical as possible analysis of the data available for the different areas is carried out.