Zoonoses in Estonia - an overview
Journal Club 20th December 2011
Brian Lassen
Estonian University of Life Sciences
Small selection of
parasites
* Echinococcus
* Toxoplasma gondii
* Giardia
* Cryptosporidium
* Other investigations of concern
Further data: http:/sbsp.eu (links)
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/,
Echinococcus
Images: http://en.wikipedia.org/,
Echinococcosis
(hydatidosis, or
hydatid disease)
Echinococcus multilocularis
alveolar
echinococcosis
Echinococcus granulosus
cystic
echinococcosis
(Echinococcus vogeli)
polycystic
echinococcosis
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
Echinococcosis
(Primary Hosts)
Primary hosts
Echinococcus multilocularis
Echinococcus granulosus
(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
Echinococcosis human cases, Estonia
Veterinaar ja Toidulaboratoorium
Terviseamet
Echinococcus granulosus infections in
humans, Finland
Echinococcus human cases, Sweden
Sweden,
human
2004
2005
Total
11
14
0.12
0.15
Per 100.000
inhabitants
Smittskyddinstitutet (Smi)
2006
2007
2008
2009
2010
2011
8
17
14
15
30
18
0.09
0.19
0.15
0.16
0.32
0.19
Statistics on animals with
Echinococcus worms or cysts
found during routine diagnostics
2006-2011:
0 cases
Veterinaar ja Toidulaboratoorium
The incidence of reindeer
Echinoccocus granulosus findings in each
Meat inspection and monitoring:
E. granulosus infection in reindeer and elk
2000-2010 (Source: Evira)
positive deer
positive elk
parasite positive / 10000 slaughter animals
Per year
Studied individuals
Echinococcus multilocularis in Finland
Annual studies of voles, raccoon dogs and foxes
(Source: Zoonoses monitoring programs, Evira)
Raccoon dog
Fox
Voles
Echinococcosis
(Relevance)
Echinococcus multilocularis
Echinococcus granulosus
Fox: 0.3% (Saeed et al. 2006)
Fox: 0.1% (Osterman-Lind et al. 2011)
Fox: 0-1.5% (Davidson et al. 2011)
Wolf: ~30% (Hirvelä-Koski et al. 2003)
Fox: 29%
Wolf: 4% (Moks et al. 2008)
Dog: 1%
Dog: 4% (Bruzinskaite et al. 2009)
Fox: 59%
Raccoon dog: 8% (Bružinskaitė et al. 2011)
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
Toxoplasma
Images: http://en.wikipedia.org/,
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-ofsheep-cattle-and-deer/5/2, http://www.thepregnancyzone.com
Toxoplasma
gondii
(Hosts)
Felids
Images: http://www.dpd.cdc.gov/dpdx/html/Toxoplasmosis.htm, http://en.wikipedia.org/wiki/Felidae
Studied Cases
Toxoplasmosis, human cases, Estonia
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
The cases reported in humans
The incidence in the population
Infectious Disease Registry reported
toxoplasmosis in humans (Source: THL)
Number of toxoplasmosis cases / year
Incidence / million. inhabitant / year
Toxoplasma
gondii
(Relevance)
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)
Tartu: 55% (Birgisdóttir et al. 2006)
* pregnant women
World ~33% (Montoya & Liesenfeld 2004)
Images: http://drugster.info/ail/pathography/3456/, http://www.aafp.org/afp/2003/0515/p2131.html, http://www.teara.govt.nz/en/diseases-ofsheep-cattle-and-deer/5/2, http://www.thepregnancyzone.com
Tartu: 55% (Birgisdóttir et al. 2006)
>60%
40-60%
20-40%
10-20%
<10%
Unknown
Fig. 1. Global status of Toxoplasma gondii seroprevalence.
Source: Pappas et al. 2009.
Toxoplasmosis cats, Estonia
Cats
2006
2007
2008
2009
2010
Tested (N)
(serology test)
2
3
5
8
7
Positive (%)
0
0
0
0
0
Veterinaar ja Toidulaboratoorium
Giardia
Images: http://en.wikipedia.org/,
Giardia lamblia
(Giardiasis)
Images: http://en.wikipedia.org/,
Cases per 100.000 people
Not listed among
zoonotic infections in
Estonia!
Years
Giardiasis in humans in
Latvia and Lithuania
Absence of data!
Reported cases of giardiasis in humans
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
Registered Giardia infections in Swedes
2500
2000
Cases
1500
1000
500
0
1997
1998
1999
2000
2001
2002
2003
2004
Year
Smittskyddinstitutet (Smi)
2005
2006
2007
2008
2009
2010
2011
Giardia
(REGISTERED cases)
Dogs infected
General: ~30%
Estonia: ~50%
(REGISTERED cases)
Humans: 291 cases/year
Humans: 5.4 cases/100.000/year
Humans: 350-500 cases/year
Humans: 26-37 cases/100.000/year
(Rimhanen-Finne et al., 2011)
(Terviseamet, 2011)
Outbreaks: 2007 (water)
(Rimhanen-Finne et al., 2010)
Risk: Travelling (east)
Lost work hours: 42.000—60.000/year
Lost full time workers: 21-30/year
(Jokipii et al., 1985)
Second highest infected
European country
(Lujan, 2011)
Images: http://en.wikipedia.org/,
Reported cases of Giardia in animals
and study prevalences
Estonia
2006
2007
2008
2009
2010
Pets %pos (N)
0
0
0
0
0
~50%*
Sheep %pos
(N)
0
0
0
0
0
~85%
Cattle %pos (N)
0
100 (1)
100 (1)
100 (1)
43 (14)
Veterinaar ja Toidulaboratoorium
Studies
Cryptosporidium
Images: http://en.wikipedia.org/,
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)
Reported cases of Cryptosporidium in animals
and study prevalences
Estonia
Studies
2006
2007
2008
2009
2010
Pets %pos (N)
0
0
? (2)
0
0
Sheep %pos (N)
0
0
? (2)
0
0
~27%
Cattle %pos (N)
0
100 (1)
100 (1)
0
0
~30
Cryptosporidium
not considered
present in
Latvian in cattle
to noteworthy
extent (46%
positive)!
Images: http://en.wikipedia.org/,
Cryptosporidium
(C. hominis, C. parvum)
(REGISTERED cases)
Humans: 11 cases/year
Humans: 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)
(REGISTERED cases)
Humans: 0 or ?
ECDC
Nordic countries (humans)
UNREGISTERED cases per REGISTERED case
Giardia: 254-867 cases
Cryptosporidium: 4.072-15.181 cases
(Hörman et al., 2004)
Estonian projection (humans)
Giardia: 6.604-32.079 cases/year
Cryptosporidium: ?
Images: http://en.wikipedia.org/,
Other concerns
Images: http://en.wikipedia.org/,
Terviseamet
Images: http://en.wikipedia.org/,
Diphyllobothrium latum
Images: http://en.wikipedia.org/,
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
Terviseamet
Images: http://en.wikipedia.org/,
Images: http://en.wikipedia.org/,
Dilemmas
Images: http://en.wikipedia.org/,
The Dilemma of
Synergy and
The Weakest Chain
IDEAL
DISTRIBUTION
1
5
2
1
Awareness
[knowledge]
2
Detection
[Methods]
3
Identification
[Microscopy]
4
Assesment
[Epidemiology]
5
Expertise
[Interpretation]
6
Molecular tools
[Details]
6
3
4
ACTUAL
DISTRIBUTION
1
5
2
3
6
4
Awareness
[knowledge]
The Dilemma of Awareness
It is amazing what we do not know about
zoonotic parasites in Estonia!
Cases per 100.000 persons
Registered human infections in Estonians
40
35
Giardiadiasis
Cryptosporidiosis
Echinococcosis
Leptospirosis
Listeriosis
Trichinellosis
30
25
20
15
10
5
0
2006
2007
2008
2009
2010
Year
Figure: Registered human cases (Terviseamet)
No registered cases of Cryptosporidiosis and Echinococcosis!
Cases of cryptosporidiosis in Estonia diagnosed in Finland
or refused diagnosis in Estonia
Detection
[Methods]
Identification
[Microscopy]
Assesment
[Epidemiology]
Expertise
[Interpretation]
Molecular tools
[Details]
Take home message:
„Absence of data does not
mean absence of pathogens
or problems!“
Thank You
Brian.Lassen@gmail.com
Background artwork: sensitivelight.com
Further data:
http:/sbsp.eu (links)
http://ecdc.europa.eu