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

TerviseametVeterinaar ja Toidulaboratoorium

Echinococcosis human cases, Estonia

Echinococcus granulosus infections in humans, Finland

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)

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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

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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, human cases, EstoniaS

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Years

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)

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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

Images: http://en.wikipedia.org/,

Giardia lamblia (Giardiasis)

Not listed among zoonotic infections in Estonia!

Cas

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Years

Giardiasis in humans in Latvia and Lithuania

Absence of data!

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/,

Cryptosporidiosis in humans in Latvia and Lithuania

Absence of data!

Reported cryptosporidiosis in humans(Source: Infectious Disease Registry, THL)

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

Dupouy-Camet and Peduzzi 2004, http://www.eurosurveillance.org/viewarticle.aspx?articleid=467

Dupouy-Camet and Peduzzi 2004, http://www.eurosurveillance.org/viewarticle.aspx?articleid=467

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]

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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

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15

20

25

30

35

40

Registered human infections in Estonians

GiardiadiasisCryptosporidiosisEchinococcosisLeptospirosisListeriosisTrichinellosis

Year

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Cases of cryptosporidiosis in Estonia diagnosed in Finland or refused diagnosis in Estonia

Take home message:

„Absence of data does not mean absence of pathogens

or problems!“

Thank YouBrian.Lassen@gmail.com

Background artwork: sensitivelight.com

Further data:

http:/sbsp.eu (links)

http://ecdc.europa.eu