1. statusactions future considerations Present status, actions taken and future considerations due to the findings of Echinococcus multilocularis in two Scandinavian countries Helene Wahlström (SE), Heidi L Enemark (DK) Rebecca K Davidson (NO), Antti Oksanen (FI) Vet Parasitol, in press

2. Background www.scantours.com 1999 Svalbard 2000 2011 Considered free from E. multilocularis* Kapel & Saeed, 2000 Henttonen et al., 2001 Osterman Lind et al., 2011 Enemark et al., 2013 *Prevalence <1% in final host 2013

3. First finding in DK First finding in SE Finding of high endemic focus in Southern DK Surveillance - timeline Pos. cat detected by German lab DK SE NO/FI MC-PCR

4. Detection of Em in DK Detection of Em in SE Surveillance of Em in foxes

6. Methods MC-PCR Required to document fredom Required to document fredom Surveillance of geographical spread & prevalence (0.1%) Surveillance of geographical spread & prevalence (0.1%) Surveillance of prevalence (low), detection of hot spots Surveillance of prevalence (low), detection of hot spots

7. Total no of foxes Dec. 2014: 1169 DK: surveillance 2011-2014 Total no of racoon dogs Dec. 2014: 265 Other wild carnivores Dec. 2014: 66 In total: 1500

8. National: 0.1% SE: very low 0.1% 1.2% DK: low 1.2% Regional 1% SE: Certain regions 1% >30% DK: Southern Denmark >30% Prevalence 25%

9. Positive findings in foxes/fox scats Findings in foxes and raccoon dogs Location of positive findings 2000 2012-14 2014 2011 2014 2014 (intermediate host) 2004 & 2012 (PCR pos. cats)

10. Costs of E. multilocularis surveillance 1.2% 0.1% 0 0 1.2% 0.1% 0 0 >30% 1% >30% 1%

11. Obligation of notification

12. Risk assessment DK: No risk assessment for human AE Export of Danish dogs to SE – negligible risk vs. import of dogs from high endemic European areas (Bødker et al., 2007) SE: Very low risk for humans 1 per 9 mio every 5 th year (Wahlstrom et al., 2012) Need for more knowledge concerning Em prevalence in urban fox populations NO: Likely that Em is detected during the next decade (VKM, 2012) Unlikely that Em is detected upon first introduction Moderate probability of import via rehomed stray dogs FI: Considerable risk of introduction via wildlife Difficult to assess due to lacking info of the situation in northwestern Russia AH treatment of improted pets and increased surveillance recommended (Maijala et al., 2001)

13. Surveillance in humans * Number of cases unknown as AE is not notifiable ** Not notifiable < 2003

14. First human AE cases in SE (n=2)(infected abroad) 2004 First human AE case in DK (infected abroad) First finding of Em in foxes in SE First finding of Em in foxes in DK 2000 No. of tested patients/analysis per million inhabitants in Denmark and Sweden, 2008(SE)/2009(DK) to 2013 DK SE

15. Actions due to findings of Em in DK Tønder municipality * Prophylactic treatment generally not allowed in DK

16. Actions due to findings of Em in SE Before 1994: all imported dogs dewormed in quarantine After 2011 (first detection): ●General advice on food hygiene – but no specific recommendations ●Worried consumers recommended to boil their food ●Worried dog owners recommended to treat prophylactically each month – however not a general recommendation! ●Deworming after travel to high endemic areas

17. Further considerations Aim of surveillance? freedom of infection geographical spread sudden changes in prevalence Role of foodborne transmission?

18. Conclusions Repeated monitoring needed to describe geographical distribution evaluated fluctuations in prevalence (identification of hot spots). Reliable statistics on AE required – including spp. level! (DK: notifiability). Call for better/repeated risk assessment to allow for effective risk management in different prevalence situations. Increased awareness among clinicians needed.

19. Microsatellite (EmsB) subtyping Introduction and spread???

20. D S V G H Juremalm et al., in prep.

21. Acknowledgments Mohammad Nafi Al-Sabi, DTU-VET Mariann Chriel, DTU-VET Henrik Vedel Nielsen, SSI Torben Grubbe, DVFA Danish Veterinary & Food Admin. Virva Valle Antti Lavikainen Evira Finnish Forest Research Institute Maria Cedersmyg, SBA Anders Wallensten, PHAS Roland Lindqvist, NFA Silvia Botero, Karolinska inst. Maria Dahlen, SVA Giampaolo Cocca, SVA National board of Agriculture Knut Madslien, NVI Øivind Øines, NVI Inger Sofie Hamnes, NVI Norwegian Food Safety Authority