Human Echinococcosis in Bulgaria: A Comparative Epidemiological Analysis(*)

By Todorov, T.; Boeva, V. | Bulletin of the World Health Organization, February 1999 | Go to article overview

Human Echinococcosis in Bulgaria: A Comparative Epidemiological Analysis(*)


Todorov, T., Boeva, V., Bulletin of the World Health Organization


Voir page 116 le resume en francais. En la pagina 117 figura un resumen en espanol.

Background

Bulgaria occupies some 110 000 [km.sup.2] of the eastern portion of the Balkan Peninsula in south-eastern Europe. It is separated from Romania by the lower Danube River along most of its northern border. The Black Sea lies to the east, Turkey and Greece to the south, and Macedonia and Yugoslavia constitute its western boundary. The country is divided into nine departments and 28 districts and the population was estimated at 8 427 000 in 1994.

Human cystic echinococcosis is still a major problem in Bulgaria, in health and economic terms. Although a decline in incidence was observed during the last 20 years, following a control campaign, the disease is still prevalent in all parts of the country.

The present report describes a retrospective and prospective survey of hospital registries of surgically confirmed cases of human cystic echinococcosis and prevalence of infestation in animal hosts in Bulgaria. The aims of the study were to determine some of the epidemiological characteristics of the disease over a long period (1950-95) and to undertake a comparative analysis of the situation before and after the introduction of control measures and of the level of transmission in recent years.

Materials and methods

The study included all hospital cases, admitted and readmitted, with a final diagnosis of echinococcosis, confirmed surgically, covering a period of 46 years. The collection of baseline data was performed retrospectively for the period 1950-62 by reviewing the hospital documentation of patients who underwent surgery for hydatid cysts in all surgical departments and university surgical clinics in the country (1, 2). A prospective study was carried out (1971-95) after a reporting system was established between all departments (clinics) of surgery and district hygiene epidemiological inspection services (n = 28). The surgically confirmed cases were reported yearly to the centre responsible for prevention and control of echinococcosis and were analysed periodically (3-5). Data on infection of animal intermediate hosts and dogs in defined areas were also recorded.

Surgically confirmed new human cases were classified according to place of residence at the time of diagnosis. Other data, including age and sex, were also recorded.

Results

The study on echinococcosis included three periods, the first covering 13 years (1950-62), the second 12 years (1971-82) and the third 13 years (1983-95).

Retrospective survey

Prior to the implementation of the control campaign, a retrospective collection of data on echinococcosis was undertaken to measure the level of infection in humans and prevalence in intermediate and defined hosts. The survey, which covered the first study period, was designed to obtain insight into the importance of echinococcosis as a public health problem. It revealed a total of 6469 surgically confirmed new cases and 852 readmitted cases. The annual number of new cases was 497, representing an incidence of 6.5 per 100 000 population (Table 1). The annual surgical incidence of echinococcosis varied from 1.9 to 16.6 per 100 000 population, depending on the district (n = 28). Very high incidences, from 9.1 to 16.6 per 100 000, were observed in eight (28.6%) districts, lower rates, from 3.4 to 7.4 per 100 000, were recorded in 15 (53.6%) and the lowest rates, from 1.9 to 2.8 per 100 000, were seen in five (17.8%) (1).

Table 1. Distribution of surgical cases of echinococcosis (new and readmitted) for the three study periods in Bulgaria

                                     No. of
                      No. of        cases per
Period               new cases        year

1950-62                6 469           497
1971-82                2 094           176
1983-95                3 780           291

                             Incidence
                           (per 100 000)          No. … 

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