Epidemiology of Echinococcus multilocularis infections: A review of the present knowledge and of the situation in Germany

Human alveolar echinococcosis (AE) and infections of foxes, raccoon dogs and dogs as the most important definitive hosts of Echinococcus (E.) multilocularis in Central Europe remain topics of general interest. Nonetheless, the incidence in humans in Germany is low (appr. 30 reported new cases per year, maximum 56 cases in 2018). Usually, the infection does not cause any clinical signs in definitive host, whereas it is often lethal in intermediate hosts, particularly in primates. Infections with E. multilocularis occur in all parts of Germany, in particular in the red fox ( Vulpes vulpes); a total of 5602 cases were officially reported in Germany between 2004 and 2019. The epidemiological situation in the definitive hosts can be characterised as endemic and stable. We here review the present knowledge on the life cycle and biology of E. multilocularis and the epidemiological situation in Germany.