The aim of this review is to discuss the situation of alveolar echinococcosis in France, in the light of the current knowledge on its transmission patterns in the world, especially Europe. An important risk of higher contamination of the rural environment may be suspected from newly reported cases of infected foxes or voles in several countries where the disease was not found before. Furthermore, the increase of prevalence rate in foxes in Bade-Würtemberg (Germany) and Franche-Comté (France), traditionally endemic, is also in support of this new trend. Urban foxes and the spreading of infected foxes to cities may also be the cause of the extension to urban and suburban areas of a disease which was believed to be limited to rural areas. The setting up of an epidemiosurveillance system for fox (dog, cat) populations is currently in progress. It will be grounded on coprotests (ELISA, PCR) for the detection of E. multilocularis material in definitive hosts faeces and on sampling based on the multiscale analysis of the characteristics of landscapes favourable to transmission. A register of human cases has been established at the European level (WHO collaborative centre of the University of Franche-Comté and University of Ulm and Hohenheim). Unfortunately, the evolution of the parasite distribution and of the risks of exposure in France is unrecognised. Progress in surveillance and prevention could be expected if health authorities would attribute higher priority to this disease.