Alveolar echinococcosis (AE) is a rare zoonotic disease caused by the larval stage of Echinococcus multilocularis. Despite its low world-wide prevalence, this disease shows differences in the regional distribution of cases. In the present cohort study, we analyse the distribution of AE according to environmental and geographical factors in Germany. We identified the place of residence of 591 cases of AE from the national database for AE, and georeferenced these localities in the Universal Transverse Mercator coordinate system. Data on elevation, air temperature, precipitation height and land cover were mapped out and correlated with the distribution of cases of disease during the period 1992-2018. Moran's I statistic was used for spatial autocorrelation. Differences in frequency distribution between elevation, air temperature, precipitation height and landscape feature classes were analysed with the Kruskal-Wallis test. With the multiple linear regression analysis, we determined the influences and interactions of geographical and climatic factors on the number of AE cases. The results showed a heterogeneous distribution of AE cases with a higher concentration in southern Germany than in the rest of Germany (I = 0.225517, Z = 35.8182 and p < 0.001). There was a statistically significant difference in frequency distribution between precipitation height, air temperature, elevation and landscape feature classes and AE cases in Germany (p < 0.0001). In regions with higher elevations (505-672 m), moderate average air temperatures (6.0-7.9°C) and higher precipitation rates (701-1000 mm) most AE cases were recorded. It seems, that regions with higher precipitation rates, higher elevations and moderate average air temperatures have a higher infection burden and infection conditions. It is therefore extremely important to generate greater awareness of the disease in these regions, with the aim of recognising potential cases of AE as early as possible and introducing the appropriate therapeutic measures.

肺泡棘球co病（AE）是由多叶棘球oc幼虫期引起的一种罕见的人畜共患病。尽管该病在世界范围内的流行率较低，但在病例分布区域中仍显示出差异。在当前的队列研究中，我们根据环境和地理因素分析了德国的AE分布。我们从国家AE数据库中确定了591例AE病例的居住地，并在Universal Transverse Mercator坐标系中对这些地点进行了地理定位。绘制了有关海拔，气温，降水高度和土地覆盖的数据，并将其与1992-2018年期间疾病病例的分布相关联。Moran的I统计量用于空间自相关。使用Kruskal-Wallis检验分析了海拔，气温，降水高度和景观特征类别之间的频率分布差异。通过多元线性回归分析，我们确定了地理和气候因素对AE病例数的影响和相互作用。结果表明，在德国南部，AE病例的异质性分布高于德国其他地区（I = 0.225517，Z = 35.8182，p <0.001）。在德国，降水高度，气温，海拔高度和景观要素类与AE案例之间的频率分布存在统计学差异（p <0.0001）。在高海拔地区（505-672 m），平均气温中等（6.0-7.9°C）和降水率较高（701-1000 mm）的地区，大多数AE案例都被记录下来。似乎那些降水率较高的地区，更高的海拔和适中的平均气温有更高的感染负担和感染条件。因此，在这些地区提高对这种疾病的认识非常重要，目的是尽早发现潜在的AE病例并采取适当的治疗措施。