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Brian Lassen
Estonian University of Life Sciences
Zoonoses in Estonia - an overview Journal Club 20th December 2011
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Small selection of parasites
* Echinococcus * Toxoplasma gondii* Giardia* Cryptosporidium * Other investigations of concern
Further data: http:/sbsp.eu (links)
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Method* Refreshing of parasite ecology* Knowledge on Human cases (Estonia)* Knowledge on Animal Hosts (Estonia)* Situation in Near Countries
(Sweden, Finland, Latvia, Lithuania)
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Echinococcus
Echinococcosis (hydatidosis, or hydatid disease)
Images: http://dpd.cdc.gov/dpdx/html/Echinococcosis.htm, http://www.constipation-remedies.co.uk/parasite-echinococcocis.php, http://www.human-healths.com/echinococcosis/echinococcosis.php
Echinococcus granulosus
Echinococcus multilocularis
alveolar echinococcosis
cystic echinococcosis
(Echinococcus vogeli)
polycystic echinococcosis
Echinococcosis (Primary Hosts)
Echinococcus granulosus
Echinococcus multilocularis
(Echinococcus vogeli)
Image life cycle: http://dpd.cdc.gov/dpdx/html/Echinococcosis.htm, http://completedogfood.net/, http://animals.nationalgeographic.com/animals/mammals/red-fox/, http://www.agefotostock.com/en/Stock-Images/Rights-Managed/K97-1258787, http://true-wildlife.blogspot.com/2011/02/coyote.html, http://www.sobi.org/photos/Cat/Mottle/index.html, http://www.cosmosmith.com/european_gray_wolves.asp, http://www.brazilianfauna.com/bushdog.php
Primary hosts
Echinococcus human cases, Sweden
Sweden, human
2004 2005 2006 2007 2008 2009 2010 2011
Total 11 14 8 17 14 15 30 18
Per 100.000 inhabitants
0.12 0.15 0.09 0.19 0.15 0.16 0.32 0.19
Smittskyddinstitutet (Smi)
Veterinaar ja Toidulaboratoorium
Statistics on animals with Echinococcus worms or cysts
found during routine diagnostics 2006-2011:
0 cases
Meat inspection and monitoring: E. granulosus infection in reindeer and elk
2000-2010 (Source: Evira)
Ech
ino
cco
cus
gra
nu
losu
s fi
nd
ing
s in
eac
h
Th
e in
cid
ence
of
rein
dee
r
parasite positive / 10000 slaughter animalsPer year
positive elkpositive deer
Echinococcus multilocularis in Finland Annual studies of voles, raccoon dogs and foxes (Source: Zoonoses monitoring programs, Evira)
Raccoon dog Fox Voles
Stu
die
d in
div
idu
als
Echinococcosis(Relevance)
Echinococcus granulosus
Echinococcus multilocularis
Images:http://www.iom.int/jahia/Jahia/nordic-and-baltic-countries, http://completedogfood.net/, http://animals.nationalgeographic.com/animals/mammals/red-fox/, http://www.agefotostock.com/en/Stock-Images/Rights-Managed/K97-1258787, http://true-wildlife.blogspot.com/2011/02/coyote.html, http://www.sobi.org/photos/Cat/Mottle/index.html, http://www.cosmosmith.com/european_gray_wolves.asp, http://www.brazilianfauna.com/bushdog.php
Fox: 29%
Fox: 0-1.5% (Davidson et al. 2011)
Fox: 0.1% (Osterman-Lind et al. 2011)
Fox: 0.3% (Saeed et al. 2006)
Wolf: ~30% (Hirvelä-Koski et al. 2003)
Wolf: 4% (Moks et al. 2008)
Dog: 4% (Bruzinskaite et al. 2009)Dog: 1%
Fox: 59% Raccoon dog: 8% (Bružinskaitė et al. 2011)
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Toxoplasma
Toxoplasma gondii
(Toxoplasmosis)
Images: http://drugster.info/ail/pathography/3456/, http://www.aafp.org/afp/2003/0515/p2131.html, http://www.teara.govt.nz/en/diseases-of-sheep-cattle-and-deer/5/2, http://www.thepregnancyzone.com
Toxoplasma gondii (Hosts)
Images: http://www.dpd.cdc.gov/dpdx/html/Toxoplasmosis.htm, http://en.wikipedia.org/wiki/Felidae
Felids
Toxoplasmosis in humans, Latvia (Source: Infectology Center of Latvia)
Humans 2006 2007 2008 2009 2010
Cases 9 10 6 6 10
Per 100.000 people ? ? 0.26 0.3 0.44
Infectious Disease Registry reported toxoplasmosis in humans (Source: THL)
Th
e in
cid
ence
in
th
e p
op
ula
tio
n
Th
e ca
ses
rep
ort
ed i
n h
um
ans
Number of toxoplasmosis cases / year Incidence / million. inhabitant / year
Toxoplasma gondii
(Relevance)
Images: http://drugster.info/ail/pathography/3456/, http://www.aafp.org/afp/2003/0515/p2131.html, http://www.teara.govt.nz/en/diseases-of-sheep-cattle-and-deer/5/2, http://www.thepregnancyzone.com
Tartu: 55% (Birgisdóttir et al. 2006)
Uppsala: 23% (Birgisdóttir et al. 2006)
Reykjavik: 10% (Birgisdóttir et al. 2006)
Copenhagen*: 28% (Lebech et al. 1999)
Uppsala: 23% (Birgisdóttir et al. 2006)
Stockholm+Skaane*: 18% (Evengard et al. 2001)
Warsaw*: 41% (Nowakowska et al. 2006)
* pregnant women
World ~33% (Montoya & Liesenfeld 2004)
Fig. 1. Global status of Toxoplasma gondii seroprevalence. Source: Pappas et al. 2009.
>60%40-60%20-40%10-20%<10%Unknown
Tartu: 55% (Birgisdóttir et al. 2006)
Cats 2006 2007 2008 2009 2010
Tested (N)(serology test)
2 3 5 8 7
Positive (%) 0 0 0 0 0
Veterinaar ja Toidulaboratoorium
Toxoplasmosis cats, Estonia
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Giardia
Sweden 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Total 2328 1710 1730 1562 1426 1429 1354 1331 1149 1291 1414 1529 1207 1311 970
Per 100.000 people
26.31 19.31 19.52 17.60 16.02 16.01 15.11 14.77 12.70 14.17 15.41 16.53 12.93 13.93 10.31
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
500
1000
1500
2000
2500
Registered Giardia infections in Swedes
Year
Ca
ses
Smittskyddinstitutet (Smi)
Reported cases of giardiasis in humans
Images: http://en.wikipedia.org/,
Giardia Dogs infectedGeneral: ~30%Estonia: ~50%
(REGISTERED cases)Humans: 291 cases/yearHumans: 5.4 cases/100.000/year(Rimhanen-Finne et al., 2011)
Outbreaks: 2007 (water)(Rimhanen-Finne et al., 2010)
Risk: Travelling (east)(Jokipii et al., 1985)
(REGISTERED cases)Humans: 350-500 cases/yearHumans: 26-37 cases/100.000/year(Terviseamet, 2011)
Lost work hours: 42.000—60.000/yearLost full time workers: 21-30/year
Second highest infected European country
(Lujan, 2011)
Veterinaar ja Toidulaboratoorium
Estonia 2006 2007 2008 2009 2010
Pets %pos (N) 0 0 0 0 0
Sheep %pos (N)
0 0 0 0 0
Cattle %pos (N) 0 100 (1) 100 (1) 100 (1) 43 (14)
Studies
~50%*
~85%
Reported cases of Giardia in animalsand study prevalences
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Cryptosporidium
Cryptosporidium parvum
(Cryptosporidiosis)
Images: http://en.wikipedia.org/,
Images: http://en.wikipedia.org/,
Estonia 2006 2007 2008 2009 2010
Pets %pos (N) 0 0 ? (2) 0 0
Sheep %pos (N) 0 0 ? (2) 0 0
Cattle %pos (N) 0 100 (1) 100 (1) 0 0
Studies
~27%
~30
Reported cases of Cryptosporidium in animalsand study prevalences
Cryptosporidium not considered present in Latvian in cattle to noteworthy extent (46% positive)!
Cryptosporidium (C. hominis, C. parvum)
Images: http://en.wikipedia.org/,
(REGISTERED cases)
Humans: 0 or ?
(REGISTERED cases)Humans: 11 cases/yearHumans: 0.2 cases/100.000/year(Rimhanen-Finne et al., 2011)
Outbreaks: 2008 (food)(Pönka et al., 2009)Outbreaks: 1986 (vets, cows)(Pohjola et al., 1986)
Nordic countries (humans)UNREGISTERED cases per REGISTERED caseGiardia: 254-867 casesCryptosporidium: 4.072-15.181 cases(Hörman et al., 2004)
Estonian projection (humans)Giardia: 6.604-32.079 cases/yearCryptosporidium: ?
ECDC
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Other concerns
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Terviseamet
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Diphyllobothrium latum
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Terviseamet
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Images: http://en.wikipedia.org/, Images: http://en.wikipedia.org/,
Dilemmas
Awareness[knowledge]
Detection[Methods]
Identification[Microscopy]
Assesment[Epidemiology]
Expertise[Interpretation]
Molecular tools[Details]
1
2
3
4
5
6
5
1
2
63 4
5
1
2
6
34
IDEAL DISTRIBUTION
ACTUAL DISTRIBUTION
The Dilemma of Synergy and The Weakest Chain
Awareness[knowledge]
Detection[Methods]
Identification[Microscopy]
Assesment[Epidemiology]
Expertise[Interpretation]
Molecular tools[Details]
Figure: Registered human cases (Terviseamet)No registered cases of Cryptosporidiosis and Echinococcosis!
The Dilemma of Awareness
It is amazing what we do not know about zoonotic parasites in Estonia!
2006 2007 2008 2009 20100
5
10
15
20
25
30
35
40
Registered human infections in Estonians
GiardiadiasisCryptosporidiosisEchinococcosisLeptospirosisListeriosisTrichinellosis
Year
Ca
se
s p
er
10
0.0
00
pe
rso
ns
Cases of cryptosporidiosis in Estonia diagnosed in Finland or refused diagnosis in Estonia
Thank [email protected]
Background artwork: sensitivelight.com
Further data:
http:/sbsp.eu (links)
http://ecdc.europa.eu