Present status, actions taken and future considerations due to the findings of Echinococcus multilocularis in two Scandinavian countriesHelene Wahlström (SE), Heidi L Enemark (DK) Rebecca K Davidson (NO), Antti Oksanen (FI)

Vet Parasitol, in press

Background

www.scantours.com

1999 Svalbard

2000

2011

Considered free from E. multilocularis*

Considered free from E. multilocularis*

Kapel & Saeed, 2000Henttonen et al., 2001

Osterman Lind et al., 2011Enemark et al., 2013*Prevalence <1% in final host

2013

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

First finding in DK First finding in SE

Finding of high endemic focus in Southern DK

Surveillance - timeline

Pos. cat detected by German lab

DKSENO/FI

MC-PCR

Detection of Em in DK Detection of Em in SE

Surveillance of Em in foxes

2000

2002

2004

2006

2008

2010

2012

0

500

1000

1500

2000

2500

3000

3500

4000

DenmarkSwedenNorwayFinland

MethodsSur DK SE NO FI

2000 - CoA ELISA (SSCT)

- CoA ELISA (SCT)

2001 - CoA ELISA (SSCT)

- CoA ELISA (SCT)

2002 SCT CoA ELISA (SSCT)

CoA ELISA (egg PCR)

CoA ELISA (SCT)

2003 - CoA ELISA (SSCT)

CoA ELISA (egg PCR)

CoA ELISA (SCT)

2004 - CoA ELISA (SSCT)

CoA ELISA (egg PCR)

CoA ELISA (SCT)

2005 - CoA ELISA (SSCT)

CoA ELISA (egg PCR)

CoA ELISA (SCT)

2006 - CoA ELISA (SSCT)

Egg PCR CoA ELISA (SCT)

2007 - CoA ELISA (SSCT)

Egg PCR CoA ELISA (SCT)

2008 - CoA ELISA (SSCT)

Egg PCR CoA ELISA (SCT)

2009 - CoA ELISA (SSCT)

Egg PCR CoA ELISA (SCT)

2010 - CoA ELISA (SSCT)MC-PCR

- CoA ELISA (SCT)

2011 SCT MC-PCR Egg PCR CoA ELISA (SCT)

2012 SCT MC-PCR Egg PCR CoA ELISA (SCT)

2013 SCT MC-PCR MC-PCR CoA ELISA (SCT)

MC-PCR

Required to document fredomSurveillance of

geographical

spread &

prevalence

(0.1%)

Surveillance of prevalence (low),

detection of hot spots

Total no of foxes Dec. 2014: 1169

DK: surveillance 2011-2014

Total no of racoon dogs Dec. 2014: 265

Other wild carnivores Dec. 2014: 66In total: 1500

National:SE: very low 0.1%DK: low 1.2% RegionalSE: Certain regions 1% DK: Southern Denmark >30%

Prevalence

25%

Positive findings in foxes/fox scatsFindings in foxes and raccoon dogs

Location of positive findings

20002012-14

2014

2011

2011

2011

2014

2014 (intermediate host)

2004 & 2012 (PCR pos. cats)

Costs of E. multilocularis surveillance

Costs (Euro)

DK SE NO FI

Annually 50,000 400,000 150,000 60,000

Per animal /sample

170 96(174/317)

Intensified surveillance

659,000

1.2% 0.1% 0 0 >30% 1%

Obligation of notification

DK SE NO FI

Em in animals

Yes Yes Yes Yes

AE in humans

No Yes (since 2004;

voluntary basis since 1994)

Yes (since 2003)

Yes (since 1995)

Spp.info Available upon

request

Not required Not required Not required

Risk assessment

DK: No risk assessment for human AE Export of Danish dogs to SE – negligible risk vs. import of dogs

from high endemic European areas (Bødker et al., 2007)

SE: Very low risk for humans 1 per 9 mio every 5th year (Wahlstrom et al., 2012)

Need for more knowledge concerning Em prevalence in urban fox populations

NO: Likely that Em is detected during the next decade (VKM, 2012)

Unlikely that Em is detected upon first introduction Moderate probability of import via rehomed stray dogs FI: Considerable risk of introduction via wildlife Difficult to assess due to lacking info of the situation in

northwestern Russia AH treatment of improted pets and increased surveillance

recommended (Maijala et al., 2001)

Surveillance in humans

DK* SE NO FI

Reported cases

1 (+ 1)

2 (2012) 19 (2006-2013) 16 (1975-2002)**

No AE22 E. granulosus (2000-2014)

No tested annually

86 (2009-13)

3 (<2011)37-79 (>2011)

? ?

Annual No ELISA positive

1-3 (<2012)6 (2012 & 2013)

8 (totally) ? ?

Autochthonous cases

No No 2 arctic fox researchers (Svalbard) seroconverted

No

* Number of cases unknown as AE is not notifiable** Not notifiable < 2003

First human AE cases in SE (n=2)(infected abroad)

2004

First human AE case in DK (infected abroad)

First finding of Em in foxes in SE

First finding of Em in foxes in DK

2000

No. of tested patients/analysis per million inhabitants in Denmark and Sweden,

2008(SE)/2009(DK) to 2013

DKSE

Actions due to findings of Em in DK Before 2013: No import requirements to prevent introduction 2000 (first detection in the Copenhagen area) & 2012 (first

detection in Højer): No actions February 2013 (high endemic area in Højer/southern DK):

● prophylactic treatment* (praziquantel) of dogs (free roaming/hunting) recommended each 4 weeks

● praziquantel treatment of dogs entering from Central Europe February 2014 (detection of Em in Central Jutland):

● Treatment recommendations extended to the whole countryIn addition:● Prevent dogs from eating rodents● Wash free roaming dogs regularly● Rinse raw fruits and vegetables before consumption

Tønder municipality

* Prophylactic treatment generally not allowed in DK

Actions due to findings of Em in SE

Before 1994: all imported dogs dewormed in quarantine After 2011 (first detection):

● General advice on food hygiene – but no specific recommendations

● Worried consumers recommended to boil their food● Worried dog owners recommended to treat prophylactically

each month – however not a general recommendation!● Deworming after travel to high endemic areas

Further considerations

Aim of surveillance?freedom of infectiongeographical spreadsudden changes in prevalence

Role of foodborne transmission?

Conclusions

Repeated monitoring needed to describe geographical distribution evaluated fluctuations in prevalence (identification of hot spots).

Reliable statistics on AE required – including spp. level! (DK: notifiability).

Call for better/repeated risk assessment to allow for effective risk management in different prevalence situations.

Increased awareness among clinicians needed.

Microsatellite (EmsB) subtyping

Introduction and spread???

D

S

V

G

H

Juremalm et al., in prep.

Acknowledgments

Mohammad Nafi Al-Sabi, DTU-VETMariann Chriel, DTU-VETHenrik Vedel Nielsen, SSITorben Grubbe, DVFADanish Veterinary & Food Admin.

Virva ValleAntti LavikainenEviraFinnish Forest Research Institute

Maria Cedersmyg, SBAAnders Wallensten, PHASRoland Lindqvist, NFASilvia Botero, Karolinska inst.Maria Dahlen, SVAGiampaolo Cocca, SVANational board of Agriculture

Knut Madslien, NVIØivind Øines, NVIInger Sofie Hamnes, NVINorwegian Food Safety Authority