Future Projection of Cystic Echinococcosis in Iran to 2040: A Secondary Analysis Based on Global Burden of Disease (2021).

BACKGROUND AND AIMS: Hydatid cyst disease caused by Echinococcus granulosus poses a major zoonotic threat in Iran, especially in rural and pastoral areas. It causes considerable public health and economic costs due to high treatment expenses, decreased livestock productivity, and carcass condemnation.

METHODS

We applied the illness-death model (IDM) by incorporating remission to simulate disease dynamics and project the age-standardized prevalence rate (ASPR) by sex at the national level and across 31 provinces of Iran. The model was calibrated using historical data from the Global Burden of Disease (GBD).

RESULTS

Nationally, ASPR is projected to decline from 8.87 in 2021 to 7.3 (6.9-7.7) by 2040, reflecting a 17.7% reduction. Females experience a sharper decline (-25.4%) than males (-11.6%), despite higher initial prevalence. By 2040, Gilan, Isfahan, Lorestan, and Ilam will have the highest ASPRs, while Sistan and Baluchistan, Kermanshah, and South Khorasan will have the lowest. Provincial declines vary, with the steepest in Sistan and Baluchistan (-28.7%), Kermanshah (-27.1%), and South Khorasan (-26.7%); Isfahan, Gilan, and Lorestan will see the smallest declines.

CONCLUSION

Iran has made notable progress in controlling CE, but geographic and sex-based disparities persist due to socioecological and cultural differences. Success requires integrating zoonotic control with community-driven approaches. By focusing on pastoral vaccination, urban dog management, and culturally tailored education, Iran can shift from reducing prevalence to achieving elimination.