Echinococcus across the north: Current knowledge, future challenges

Zoonotic Echinococcus spp. cestodes are present in almost all circumpolar nations, and have historically posed a risk to health of indigenous as well as other northern residents. However, surveillance data on both alveolar (AE) and cystic (CE) echinococcosis remains incomplete throughout the circumpolar region: Russia, Fennoscandia, Iceland, Greenland, Canada and Alaska (USA). Prevalence of Echinococcus spp. varies considerably in definitive canid hosts, animal intermediate hosts and accidental hosts like humans. Yet despite the high prevalence reported in canids in some geographic locations, human AE and CE are much less common than in endemic Asian and central European countries. This paper explores knowledge gaps and future challenges posed by Echinococcus spp. in eight circumpolar countries, a region where rapid environmental and social change are rewriting the boundaries, transmission, and impact of many pathogens, including zoonotic Echinococcus spp. Genotypes G6, G8 and G10 of Echinococcus canadensis are causative agents of human CE and have been identified in sylvatic (wild animal) and synanthropic (ecological association with humans) cervid-canine life cycles in the following northern regions: Alaska and northern Canada - G8 and G10; northern Russia - G6, G8, G10; and Fennoscandia - G10 in Finland - with no recent reports from Norway or Sweden. Echinococcus multilocularis, which causes AE, has been identified in a sylvatic arvicoline rodent-canine lifecycle in Alaska, Canada, Russia, Sweden and Svalbard (Norway). Asian, Mongolian, European and North American strains of E. multilocularis are found in Russia, with the North American N1 strain predominating in the north. The N1 strain is also found in Alaska, as well as Svalbard, whilst Asian strains have been identified in western Alaska. Central North American (N2) strain and European-type strains of E. multilocularis are present in Canada. Typing of the strain in Sweden is still pending. Individual human cases of AE with N2 and European-type strains are reported in North America, as well as multiple cases with Asian strains in Russia and historically on St Lawrence Island, Alaska (although genotyping of human cases was not available at the time). Echinococcus spp. have not been detected in Greenland and have been eliminated from Iceland. The predominance of E. multilocularis N1 strain and E. canadensis genotypes, in regions with high prevalence in definitive hosts yet low incidence of human AE and CE, suggests that these genotypes have lower zoonotic potential and pathogenicity than European and Asian strains of E. multilocularis and livestock genotypes of E granulosus sensu stricto. The continued monitoring of the emergence of Echinococcus genotypes within definitive and intermediate hosts, as well as people, is needed to assess the impact on public health risk, since the introduction of other genotypes could have serious repercussions. Lastly, determining risk factors and source attribution for human cases, including the possibility of food and waterborne transmission and the likelihood of autochthonous transmission, remain challenges.