Geographic, demographic and economic burden of human cystic echinococcosis in Italy based on hospital discharge records (2015–2022)

Cystic echinococcosis (CE) is a neglected zoonotic disease that remains a public-health concern worldwide. However, poor surveillance and incomplete reporting still hinder the calculation of the CE burden. This study evaluated national hospital discharge records (HDRs) from 2015 to 2022 to update CE epidemiological situation and economic impact of human CE in Italy. We reviewed 4,293 HDRs with an echinococcosis diagnosis during 2015-2022. Data extracted included age, sex, residence, nationality, primary versus secondary diagnosis, treatment type, length of stay and discharge outcome. The average annual hospital prevalence was calculated per 100,000 inhabitants and direct hospital costs were derived from records of CE as the primary diagnosis. The 2015-2022 trend was assessed and compared to an extended data set (2001-2022). From 2015 to 2022, 2,663 cases were identified nationally, over half in the southern and insular regions. The national average annual hospital prevalence was 0.56 cases/100,000 inhabitants, peaking in the islands (1.22/100,000 inhabitants). Patients were predominantly adults (>90%) and divided into the following age categories: 25-44 (20.4%), 45-64 (30.2%) and ≥65 years (41.1%); pediatric cases were rare (<3%). The mean hospital stay for primary CE diagnosis was 10.6 days with elderly patients (>65 years) accounting for 70% of in-hospital deaths. National direct hospital costs amounted to €10,726,413, with 56% borne by the South and Islands (South 23%, Islands 33%). A downward trend in hospitalised CE cases was observed from 2015 (326 cases) to 2022 (165 cases), with a notable decline in 2020 linked to the COVID-19 pandemic. Analysis of the longer time period (2001-2022) revealed 1250 fewer cases. These findings confirm CE's heterogeneous distribution, with persistent hyperendemic foci in traditional pastoral areas driving disproportionate healthcare costs. Sustained One Health surveillance, targeted regional prevention and robust national reporting are critical to further reduce CE burden in Italy.