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The prevalence of Dirofilaria immitis and D. repens in the Old World
Abstract
Dirofilaria immitis and D. repens are endemic throughout Europe and southern eastern regions of Asia and reported with increasing frequency in Africa. Nevertheless, the increased awareness of veterinary practitioners, even in countries where the prevalence is low, has led to a decrease D. immitis prevalence in dogs, especially in previously endemic/hyper-endemic areas. Prevalence has significantly increased, however, in areas where heartworm has apparently spread more recently, such as Central and North Eastern Europe. Furthermore, autochthonous cases have been observed in Siberia. Low seroprevalence has been reported in Croatia, while in Romania it has reached 14%. In Greece, the prevalence ranges between 0.7% and 25% whilst in Turkey is 0-18%. Data for canine dirofilariosis in Africa is scarce, and most are case reports. Overall, the dominant species is Achanthocheilonema dracunculoides, although both D. immitis and D. repens have been reported from some countries. In the Far East, the prevalence ranges from 2% to 15% in northeastern of China. In Hong Kong a novel species has been found in dogs and humans (Candidatus Dirofilaria hongkongensis). In India, the prevalence ranges from 4.7%-29.5% in Northeastern states. The main factors that have influenced the spreading of Dirofilaria infections are the climate changes and the introduction of new, invasive, competent mosquito species such as Aedes albopictus and Ae. koreicus. Other factors include relocation and insufficient prevention in dogs, manly in the new areas of colonization. Feline heartworm infection has been diagnosed in every European country when diagnosed either by the Knott test or by serology for circulating antibodies and antigens of the parasite. However, prevalence is much lower than in dogs. In spite of the continuing spreading of heartworm infection, D. repens is the main concern in Europe, mostly for physicians, while the infection is nearly always asymptomatic in dogs. The infection is spreading from Portugal to the Southeastern regions of Finland and Siberia, and in some areas its prevalence overlaps that of D. immitis. Many reasons make more difficult the control of D. repens than D. immitis: the frequent lack of clinical symptoms of suspicion, the specific diagnosis being possible only by blood examination and the inefficacy of some macrocyclic lactones.
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In the citing paper
“Despite the substantial body of knowledge on the epidemiology of D. immitis in Spain and Portugal, few studies have jointly examined additional host and environmental variables—such as age, sex, breed, or habitat—in relation to realized transmission risk (6, 7).”
From Deciphering the socio-environmental factors associated with realized heartworm transmission risk in dogs from Portugal and Spain (2026) · cites this paper as [7]
In the citing paper
“Heartworm disease is an endemic disease that is continuously expanding in the European continent from the southern countries, traditionally endemic, to the centre and north of the continent”
From Expansion of canine heartworm in Spain (2022) · cites this paper as [5]
In the citing paper
“Spain and Portugal have traditionally been considered endemic countries, although not all regions of those countries have been studied [4].”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“For this reason, it is estimated that in endemic areas, such as Europe, the feline prevalence is between 5 and 20% of the canine prevalence in that same region [4].”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“In Greece, there has been an increase in the number of areas analysed in the recent years [4]. The reported prevalence in the urban cities of Thessaloniki, Larissa, Achaia, Attica, and Heraklion were 14, 7, 5.3, 0.7, and 0%, respectively. On the islands of Skiathos, Tinos, Ios, and Santorini, the reported prevalence was 0.5%.”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“Until 10 years ago, in Slovakia and Hungary, reports of D. immitis were based on isolated or imported cases [2,4,9]. However, recent studies demonstrated the endemic status of these countries.”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“In Italy, studies are still scarce. If previously, prevalence in cats was heterogeneous being 6.06–27% in the north and centre of the country, in addition to reports of isolated cases [4,9,123,124], in the last decade, studies in cats showed a prevalence of 17.6% in Linosa (an island halfway between the island of Sicily and the African coast of Tunisia) [40].”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“Several epidemiological reviews carried out in this regard [1,2,4,9,168] discussed some of these factors, such as the movement of microfilaremic reservoirs from endemic areas or travel of pets from heartworm-free regions to endemic areas.”
From What has happened to heartworm disease in Europe in the last 10 years? (2022) · cites this paper as [4]
In the citing paper
“The number of publications reporting Dirofilaria spp. infections have increased in the last two decades compared to the previous century [18, 22].”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [22]
In the citing paper
“Finally, increasing temperatures in Europe also allowed the widespread establishment of exotic, daybiting mosquito species such as Ae. albopictus [79–81], which is an important potential vector for D. immitis and D. repens and the establishment of the species in numerous European regions has been linked to increased Dirofilaria circulation [22].”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [22]
In the citing paper
“Finally, increasing temperatures in Europe also allowed the widespread establishment of exotic, daybiting mosquito species such as Ae. albopictus [79–81], which is an important potential vector for D. immitis and D. repens and the establishment of the species in numerous European regions has been linked to increased Dirofilaria circulation [22].”
From Vectors, host range, and spatial distribution of Dirofilaria immitis and D. repens in Europe: a systematic review (2025) · cites this paper as [22]
In the citing paper
“A particularly strong increase in the number of infections is currently observed in Eastern Europe [4,23].”
From The Incidence of Dirofilaria immitis in Shelter Dogs and Mosquitoes in Austria (2021) · cites this paper as [23]
In the citing paper
“In Europe, the parasite is predominantly found in southern countries, such as France, Greece, Italy, Portugal and Spain.”
From The Incidence of Dirofilaria immitis in Shelter Dogs and Mosquitoes in Austria (2021) · cites this paper as [23]
In the citing paper
“In addition, an increasing spread of dirofilarial infections can be observed in other countries, such as Greece, Turkey, Bulgaria and Romania [23,31,32].”
From The Incidence of Dirofilaria immitis in Shelter Dogs and Mosquitoes in Austria (2021) · cites this paper as [23]
In the citing paper
“In Europe, this has led to the modification of the epizootiological picture of diseases with key relevance in veterinary medicine, e.g., of cardiopulmonary and subcutaneous dirofilariosis caused by Dirofilaria immitis and Dirofilaria repens, respectively, and of canine angiostrongylosis due to Angiostrongylus vasorum, which have expanded their geographical distribution”
From Dirofilaria spp. and Angiostrongylus vasorum: current risk of spreading in Central and Northern Europe. (2021) · cites this paper as [10]
In the citing paper
“Dirofilaria immitis and D. repens are traditionally endemic in Southern and Eastern Europe”
From Dirofilaria spp. and Angiostrongylus vasorum: current risk of spreading in Central and Northern Europe. (2021) · cites this paper as [10]
In the citing paper
“Nevertheless, a recent increase in the number of cases was reported in Central and Northern Europe, and adjacent regions for both nematodes”
From Dirofilaria spp. and Angiostrongylus vasorum: current risk of spreading in Central and Northern Europe. (2021) · cites this paper as [10]
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- Metlarova, 2018, Current prevalence of heartworm in stray dogs from Sofia (Bulgaria). Proceedings of 6th European Dirofilaria and Angiostrongylus days, Parasit. Vectors P12, 11, 623
Cited by
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Heartworm disease – Overview, intervention, and industry perspective
Noack, S., Harrington, J. L., Carithers, D. S., Kaminsky, R., & Selzer, P. M. (2021) · International Journal for Parasitology Drugs and Drug Resistance · doi:10.1016/j.ijpddr.2021.03.004 · Cited by 145
Fuehrer, H.-P., Morelli, S., Unterköfler, M. S., Bajer, A., Bakran-Lebl, K., Dwużnik-Szarek, D., Farkas, R., Grandi, G., Heddergott, M., Jokelainen, P., et al. (2021) · Pathogens · doi:10.3390/pathogens10101268 · Cited by 96
Simón, F., Diosdado, A., Siles‐Lucas, M., Kartashev, V. V., & González‐Miguel, J. (2021) · Transboundary and Emerging Diseases · doi:10.1111/tbed.14210 · Cited by 80
What has happened to heartworm disease in Europe in the last 10 years?
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Mendoza‐Roldan, J. A., Gabrielli, S., Cascio, A., Manoj, R. R. S., Bezerra‐Santos, M. A., Benelli, G., Brianti, E., Latrofa, M. S., & Otranto, D. (2021) · Acta Tropica · doi:10.1016/j.actatropica.2021.106083 · Cited by 62
Metadata
- Authors
- Genchi, C., & Kramer, L. H.
- Affiliations
- University of Milan (IT)
- University of Parma (IT)
- Corresponding author
- Genchi, Claudio
- ORCID
- Kramer, Laura Helen
- Venue
- Veterinary Parasitology
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 280
- Pages
- 108995
- ISSN
- 0304-4017 (ISSN-L)
- OpenAlex
- W2989855055
- Semantic Scholar
- 871110b46e0a4cab5624a2d96b79c559686f4add
- Cited by
- 187
- References
- 67
- Citations by year
- 2026: 29 · 2025: 42 · 2024: 26 · 2023: 29 · 2022: 29 · 2021: 21 · 2020: 11
- FWCI
- 2.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Veterinary Parasitology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
- Life Sciences › Immunology and Microbiology › Parasitology › Helminth infection and control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Research on Leishmaniasis Studies
- Keywords
- Dirofilaria immitis, Dirofilaria repens, canine heartworm disease, feline heartworm infection, prevalence, invasive mosquito species, Aedes albopictus, Aedes koreicus, climate change, disease spread, seroprevalence, macrocyclic lactones, Old World
- MeSH terms
- Africa, Animals, Asia, Cat Diseases, Cats, Dirofilaria immitis, Dirofilariasis, Dog Diseases, Dogs, Europe, Prevalence, Dirofilaria repens
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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