The European distribution of Echinococcus multilocularis in animals: a systematic review and meta-analysis updating the state of the art

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Echinococcus multilocularis ( Em ), causing human alveolar echinococcosis (AE), is ranked as the third most impacting food-borne zoonotic parasitic disease globally. Since the 1980s, the Em range expansion from central Europe and the increment of human AE cases have raised public health concerns. However, the status of Em occurrence in many marginal regions remains uncertain, as well as which intermediate hosts maintain Em life cycle across its European range. We followed the same approach used in the last Europe-wide systematic review and meta-analysis covering the 1968–2014 period. We aimed at summarising the data on Em true prevalence in wild and domestic hosts in 2015–2025. Our study revealed significant increments in pooled true prevalence in red foxes from eastern Austria, Denmark, southeast-central and southeast France, southwestern Germany, southwestern Hungary, northeastern Italy, northwestern and southeastern Poland, Slovenia, East Middle Sweden, and Switzerland. Conversely, Em pooled true prevalence significantly decreased in both red foxes and raccoon dogs from Latvia, in Arctic foxes from Svalbard Islands, Norway, in raccoon dogs from northeastern Germany, in red foxes from east-central and northeastern France, and northeastern Poland, and in water voles from northern Switzerland. Moreover, Em emerged for the first time in red foxes from Bosnia and Herzegovina, central Italy, and Serbia. Regarding other carnivores, Em true pooled prevalence was assessed for the first time in raccoon dogs from Denmark and Estonia, in golden jackals from Bosnia and Herzegovina, Croatia, southern Hungary, Serbia, and Slovenia, in grey wolves from southeast-central and southeastern France, central Italy, and Slovakia, in domestic dogs from northeastern France, northwestern Italy, southeastern Poland, and eastern Turkey, and in domestic cats from southeastern Poland, central-east and northeastern France. Moreover, we highlighted the Em identification in novel definitive (European wildcat, Eurasian lynx, and Eurasian badger) and intermediate hosts (Harting’s and Persian voles, Macedonian mouse, and European brown hare). The updated evidence supports a heterogeneous picture rather than a uniform continental trend, with persistent transmission in historical endemic cores alongside new reports at several edges and records from additional species. The scale-dependent results underscore the need to prioritise spatially standardised surveillance of competent hosts.

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