Shifts in population and employment patterns in Israel since 1948 have been accompanied by profound changes in the distribution of echinococcal disease. Formerly, it was most commonly imported with the mass immigration of Jews after 1948 from the Arab countries of North Africa and Asia Minor, and appeared to be relatively uncommon in Israel-born Jews and Arabs. In 1980 the disease was made notifiable, and this paper presents a review of the years 1981-1989. The prevalence pattern that prevailed after the end of mass immigration has reversed so that cases are now twice as common in Arabs as in Jews. Among the Arabs the disease appears most commonly in the north of the country, especially among the Druze, less commonly among Christians and least in Muslims. We suggest that this prevalence pattern is related largely to home slaughter of sheep, to differing attitudes to dogs, and possibly also to the hunting of wild pig. Targetted education and better enforcement of existing regulations can lead to a reduction in disease.