Projected Burden of Cystic Echinococcosis in Afghanistan, Iran, and Pakistan: A Regional Modeling Study

Abstract

Background: We aimed to estimate and forecast the sex-specific and national burden of cystic echinococcosis in Iran, Afghanistan, and Pakistan through 2040.

Methods: We utilized data from the Global Burden of Disease Study 2023 on cystic echinococcosis incidence, prevalence, and mortality for Iran, Afghanistan, and Pakistan between 1990 and 2023. An illness–death model, a compartmental dynamic model, was applied to project the age-standardized prevalence rate (ASPR) of CE through 2040. The model accounted for sex-specific epidemiological variations, enabling comparative regional and temporal analyses.

Results: Between 1990 and 2023, all three countries exhibited a general decline in cystic echinococcosis burden, with projections indicating continued decreases through 2040. Iran showed the highest age-standardized prevalence rate in 2023 (7.39 per 100,000), followed by Afghanistan (5.28) and Pakistan (0.95). By 2040, Afghanistan and Pakistan are expected to experience marked reductions of 48.15% and 49.28%, respectively, whereas Iran is projected to decline more modestly by 11.65%. Female prevalence is anticipated to decrease sharply in Afghanistan (−56.34%) and Pakistan (−51.10%), but remain relatively unchanged in Iran (+1.90%), suggesting persistent gender-specific transmission dynamics.

Conclusion: Despite overall declining trends, substantial heterogeneity persists across countries and between sexes. The steeper projected declines in Afghanistan and Pakistan may reflect recent improvements in zoonotic control, while Iran’s slower progress, especially among females, underscores ongoing exposure and inequitable access to preventive interventions. Sustained, gender-sensitive, and regionally coordinated One Health strategies are essential to further reduce cystic echinococcosis burden and achieve equitable health outcomes across the region.