Incidence of hydatid disease in children: A systematic review and meta-analysis

Hydatid disease (echinococcosis) is a zoonotic infection caused by Echinococcus species, characterized by cyst formation in various organs, most commonly the liver and lungs. While often asymptomatic in the early stages, progressive cyst growth can lead to severe complications, including organ dysfunction, secondary infections, or rupture. In this review, we aimed to assess the incidence of hydatid disease among pediatric populations across different regions. We searched PubMed, Scopus, Cochrane, and Web of Science for studies reporting the incidence of hydatid disease in children up to February 20, 2025. A random-effects meta-analysis was performed using STATA version 28. Subgroup analyses were conducted based on country, geographic region, and cyst location. Study quality was assessed using the Newcastle-Ottawa Scale. We pooled data from nine studies, yielding an overall incidence of 3.37 per 1,000 children (95% confidence interval [CI]: 0.52-8.48), with substantial heterogeneity (I ² = 99.97%). The highest incidence was reported in China (17.86 per 1,000), followed by Turkey (1.48 per 1,000) and Bulgaria (1.47 per 1,000). Lower incidence rates were reported in Iran (0.62 per 1,000) and Romania (0.12 per 1,000). Studies conducted in rural areas showed a higher incidence (14.84 per 1,000) compared to those including patients from diverse geographic regions (1.91 per 1,000). Based on the available evidence, we conclude that the incidence of hydatid cysts in children varies across countries, with the highest rates observed in China and in rural areas. Echinococcosis poses a significant threat to both public health and livestock; therefore, effective monitoring and control strategies are crucial to reduce its impact.