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To the Editor: Alveolar echinococcosis, which is caused by the fox tapeworm Echinococcus multilocularis, is an emerging disease in Europe that shows a high mortality rate (1). Humans can become infected after ingesting parasite eggs (eg, through direct contact with dogs and red foxes [Vulpes vulpes] or with their contaminated feces). E. multilocularis tapeworm eggs are extremely resistant and can remain viable in the environment for years (2). Numbers of red foxes have increased in many countries in Europe in recent decades, and the E. multilocularis tapeworm has also expanded its range. This tapeworm has recently been reported in 17 countries in Europe, including Lithuania, Latvia, and Estonia (1). Foxes and associated tapeworms are also increasingly found in urban areas, prompting considerable public health concern (1, 3). Foxes began to colonize urban areas in Estonia in 2005, and they have since …