The emerging epidemic of echinococcosis in Kazakhstan

Since independence from the Soviet Union in 1991 the annual surgical incidence of cystic echinococcosis in Kazakhstan has increased from 1.4 cases/100 000 in 1991 to 5.9 cases/100 000 in 2000. In some regions the annual surgical incidence is now over 10 cases/100 000. Twenty-nine percent of recorded cases in 2000 were in children aged <14 years, which indicates recent transmission. Most of the cases are occurring in the regions where the sheep industry is concentrated, indicating that the zoonotic sheep strain of Echinococcus granulosus is the likely cause of the problem. The gross domestic product (GDP) of Kazakhstan has declined by nearly 50% since independence. Concurrently there has been decreased health spending with decreases in the numbers of hospitals, hospital beds and physicians. This situation suggests that an increase in the diagnosis of echinococcosis is an unlikely explanation for the epidemic but that there is an increase in transmission to the human population.