Association between environmental and climatic risk factors and the spatial distribution of cystic and alveolar echinococcosis in Kyrgyzstan

Author summary Cystic and alveolar echinococcosis (CE and AE) are parasitic zoonoses that cause a substantial disease burden in Kyrgyzstan. The etiologic agents of these diseases are parasites in the genus Echinococcus. These parasites have complex life cycles which include mammalian definitive and intermediate hosts and a free-living egg stage in the environment. Consequently, environmental and climatic factors can affect the prevalence and geographical distribution of these diseases because such factors influence the parasites' eggs survival and longevity, and can affect suitable habitats for the intermediate and definitive hosts. In this geographic correlation study, we assessed environmental and climatic determinants of the spatial distributions of CE and AE in Kyrgyzstan. We found that 10-year lag annual temperature plays an important role in AE distribution, whilst none of the variables assessed was found to significantly affect that of CE. Moreover, communities at risk where these diseases are potentially under- or misdiagnosed were identified. Our findings provide vital information for targeted, area-specific interventions in Kyrgyzstan, and add to the body of knowledge on the ecology of these neglected parasitic diseases that are emerging and reemerging in several regions in North America, Europe and Asia. Background Cystic and alveolar echinococcosis (CE and AE) are neglected tropical diseases caused by Echinococcus granulosus sensu lato and E. multilocularis, and are emerging zoonoses in Kyrgyzstan. In this country, the spatial distribution of CE and AE surgical incidence in 2014-2016 showed marked heterogeneity across communities, suggesting the presence of ecological determinants underlying CE and AE distributions. Methodology/Principal findings For this reason, in this study we assessed potential associations between community-level confirmed primary CE (no.=2359) or AE (no.=546) cases in 2014-2016 in Kyrgyzstan and environmental and climatic variables derived from satellite-remote sensing datasets using conditional autoregressive models. We also mapped CE and AE relative risk. The number of AE cases was negatively associated with 10-year lag mean annual temperature. No associations were detected for CE. We also identified several communities at risk for CE or AE where no disease cases were reported in the study period. Conclusions/Significance Our findings support the hypothesis that CE is linked to an anthropogenic cycle and is less affected by environmental risk factors compared to AE, which is believed to result from spillover from a wild life cycle. As CE was not affected by factors we investigated, hence control should not have a geographical focus. In contrast, AE risk areas identified in this study without reported AE cases should be targeted for active disease surveillance in humans. This active surveillance would confirm or exclude AE transmission which might not be reported with the present passive surveillance system. These areas should also be targeted for ecological investigations in the animal hosts.