Two Decades of Living with Echinococcus multilocularis: A Clinical Epidemiology Study on Human Alveolar Echinococcosis in Hungary

The zoonotic parasite Echinococcus multilocularis emerged in Hungary in the early 2000s. During the next two decades, it continuously spread in both wildlife and the human population. The first comprehensive epidemiological study on human alveolar echinococcosis (HAE) was carried out in 2018. Then, a remarkable increase in HAE cases was detected in Hungary. Our study aimed to identify the potential causes of trend alterations in the epidemiology of HAE. Thus, we compared the terms before (2003–2018) and after (2019–2024) the comprehensive analysis, focusing on disease outcomes and their associated background factors. We found that, during the latter study period, the prognosis of HAE improved (proportion of improving cases increased from 23.5% to 60.9%, p = 0.0006) owing to the shortening of diagnostic delay (47.1% versus 78.3% of delay within 12 months, p = 0.029), development in surgery (17.6% versus 26.1% of surgeries were R1/R2, p = 0.57) and medication (35.3% versus 73.9% of medications proved adequate, p = 0.015); however, the proportion of advanced-stage cases entering the healthcare system remained high (56.25% versus 56.52%). On the other hand, a non-significant increase in case numbers was experienced in the southwestern part of the country (11.77% versus 26.09% of all cases in Hungary). We conclude that public interest arose from the first comprehensive HAE study that increased disease awareness within the healthcare system and contributed to better diagnoses and more efficient therapy. However, public awareness needs improvement, since the proportion of advanced-stage HAE did not decrease between the two study periods. Besides, the southwestern hotspot needs more attention and intervention. Human alveolar echinococcosis (HAE) is a severe zoonotic parasitosis which has spread across Europe. In Hungary, Echinococcus multilocularis, the causative agent of HAE, emerged in the early 2000s. After a comprehensive epidemiological study on the disease in 2018, the number of human cases began to rise. Our study aimed to determine whether a risk increase or an improvement in the disease detection changed the apparent trend of the epidemic. We found that the speed of diagnosis, the efficiency of surgery and drug therapy, and thus the disease outcome, were all improved between the two periods of our study. We concluded that publicity of the comprehensive epidemiological study enhanced the disease awareness of the healthcare professionals. On the other hand, this study called attention to the necessity of public knowledge dissemination, since the proportion of advanced-stage cases entering the healthcare system did not decrease during two decades of living with HAE in Hungary. Besides, a new epidemiological hotspot seemed to form in the southwestern part of the country.