title: Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership.
abstract: Cystic echinococcosis (CE) is a neglected parasitic zoonosis with considerable socioeconomic impact on affected pastoral communities. CE is endemic throughout the Mediterranean, including Morocco, where the Mid Atlas is the most prevalent area for both human and animal infection. The highest hospital annual incidence of human CE is recorded in the provinces of Ifrane and El Hajeb. However, hospital-based statistics likely underestimate the real prevalence of infection, as a proportion of cases never reach medical attention or official records.
  
  
  
  In 2012, a project on clinical management of CE in Morocco was launched with the aims of estimating the prevalence of human abdominal CE in selected rural communes of the above mentioned provinces using ultrasound (US) screening and training local physicians to implement US-based focused assessment and rational clinical management of CE according to the WHO-IWGE Expert Consensus. A total of 5367 people received abdominal US during four campaigns in April-May 2014. During the campaigns, 24 local general practitioners received >24 hours of hands-on training and 143 health education sessions were organized for local communities. We found an overall CE prevalence of 1.9%, with significantly higher values in the rural communes of Ifrane than El Hajeb (2.6% vs 1.3%; p<0.001). CE cysts were predominantly in inactive stage, especially in older age groups. However, active cysts were present also in adults, indicating acquisition of infection at all ages. Province of residence was the only risk factor consistently associated with CE infection.
  
  
  
  Our results show a high prevalence and on-going, likely environmental transmission of CE in the investigated provinces of Morocco, supporting the implementation of control activities in the area by national health authorities and encouraging the acceptance and divulgation of diagnosis and treatment algorithms based on imaging for CE at both national and local level.
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Houda
authors.initials: H
authors.lastname: Chebli
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Abderrhamane
authors.initials: A
authors.lastname: Laamrani El Idrissi
authors.affiliation: Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University "Mohammed V", Rabat, Morocco.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Benazzouz
authors.affiliation: Parasitology laboratory, Military Teaching Hospital "Mohammed V", Rabat, Morocco; Team Research in parasitology, tropical and fungal infectious diseases, School of Medicine and Pharmacy, University "Mohammed V", Rabat, Morocco.
authors.forename: Badre Eddine
authors.initials: BE
authors.lastname: Lmimouni
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Haddou
authors.initials: H
authors.lastname: Nhammi
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Mourad
authors.initials: M
authors.lastname: Elabandouni
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Youbi
authors.affiliation: Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University "Mohammed V", Rabat, Morocco.
authors.forename: Rajaa
authors.initials: R
authors.lastname: Afifi
authors.affiliation: Parasitology laboratory, Military Teaching Hospital "Mohammed V", Rabat, Morocco; Team Research in parasitology, tropical and fungal infectious diseases, School of Medicine and Pharmacy, University "Mohammed V", Rabat, Morocco.
authors.forename: Sara
authors.initials: S
authors.lastname: Tahiri
authors.affiliation: Department of Hepatogastroenterology (Medicine C), Ibn Sina Hospital, University "Mohammed V", Rabat, Morocco.
authors.forename: Abdellah
authors.initials: A
authors.lastname: Essayd El Feydi
authors.affiliation: Department of Hepatobiliary Surgery (Surgery B), Ibn Sina Hospital, University "Mohammed V", Rabat, Morocco.
authors.forename: Adbellatif
authors.initials: A
authors.lastname: Settaf
authors.affiliation: Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.affiliation: Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Directorate of Epidemiology, Division of Infectious Diseases, Service of Parasitic Diseases, Ministry of Health of Morocco, Rabat, Morocco.
authors.forename: Souad
authors.initials: S
authors.lastname: Bouhout
authors.affiliation: Department of Control of Neglected Tropical Diseases, WHO Headquarters, Geneva, Switzerland.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Abela-Ridder
authors.affiliation: Department of Control of Neglected Tropical Diseases, WHO Headquarters, Geneva, Switzerland.
authors.forename: Simone
authors.initials: S
authors.lastname: Magnino
authors.affiliation: Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy.|Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetti
authors.affiliation: Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy.|Division of Infectious and Tropical Diseases, San Matteo Hospital Foundation, Pavia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Filice
authors.affiliation: Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; WHO-Collaborating Centre for Clinical management of Cystic Echinococcosis, Pavia, Italy.
authors.forename: Francesca
authors.identifier: 0000-0003-0478-3914
authors.initials: F
authors.lastname: Tamarozzi
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004443:Echinococcosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007391:International Cooperation; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D015995:Prevalence; D012424:Rural Population; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult