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Abstract
The emergence of the zoonotic tapeworm Echinococcus multilocularis, causative agent
of alveolar echinococcosis (AE), poses a public health risk. A previously designed
risk map model predicted a spread of E. multilocularis and increasing numbers of alveolar
echinococcosis patients in the province of Limburg, The Netherlands. This study was
designed to determine trends in the prevalence and worm burden of E. multilocularis
in foxes in a popular recreational area in the southern part of Limburg to assess
the risk of infection for humans and to study the prevalence of E. multilocularis
in dogs in the adjacent city of Maastricht. Thirty-seven hunted red foxes were tested
by the intestinal scraping technique and nested PCR on colon content. Additionally,
142 fecal samples of domestic dogs from Maastricht were analyzed by qPCR for the presence
of E. multilocularis. In foxes, a significantly increased prevalence of 59% (95% confidence
interval 43-74%) was found, compared to the prevalence of 11% (95% CI 7-18%) in 2005-2006.
Average worm burden increased to 37 worms per fox, the highest since the first detection,
but consistent with the prediction about the parasite population for this region.
Updated prediction on the number of AE cases did not lead to an increase in previous
estimates of human AE cases up to 2018. No dogs in the city of Maastricht tested positive,
but results of questionnaires showed that deworming schemes were inadequate, especially
in dogs that were considered at risk for infection.