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In particular, clandestine home slaughter, mainly of goats and/or sheep and associated with the presence of sheepdogs and stray dogs, enable the spread of CE in the Mediterranean basin. The infection is closely associated with pastoral communities characterized by low standards of hygienic conditions, where dogs and livestock are raised together close to humans. Moreover, based on a recent report on the Hospital Discharge Records (HDRs) from 2001 to 2014, the Italian average incidence rates are linked to a cost of more than 53 million euros and about 3000 disability-adjusted life years (DALYs), being the highest annual average of costs and DALYs observed in Sardinia and Sicily. Sardinia and Sicily present the highest CE average incidence, and the observed rates correspond to 6.8/10 5 and 4.0/10 5, respectively. Human CE is distributed in all the territories, with several regional variations (sporadic, endemic, and hyperendemic). Italy has an annual CE incidence of 1.6/10 5 inhabitants. The areas in which the burden of infection is particularly relevant are South America, North Africa, Central Asia, Eastern Europe, Russia, the Near and Middle East, Western China, and the Mediterranean littoral. Human CE is an important public health problem with worldwide distribution, since it has been reported in all continents except Antarctica. Human echinococcosis is a zoonotic disease caused by a species of medical importance, the Echinococcus granulosus sensu lato ( s.l.), an etiological agent of cystic echinococcosis (CE).