Control of cystic echinococcosis (CE) relies on interrupting Echinococcus granulosus sensu lato transmission through interventions in dogs and livestock. However, primary prevention measures aimed at avoiding ingestion of Echinococcus eggs may help reduce the burden of human CE. CE is generally considered, to variable extents, to be foodborne, but there is little evidence on the actual contamination of matrices and sociocultural factors involved in parasite transmission. An overall appraisal of published literature suggests that environmental contamination, possibly through hand-to-mouth transmission, may be of primary importance. While in most endemic areas sufficient epidemiological information is available to start CE control programs, identifying the main sources of infection to humans would allow optimization of site-specific interventions while avoiding irrelevant health education messages. Transmission routes of Echinococcus granulosus s.l. eggs to humans are influenced by economic and anthropological conditions.The relative contribution of foodborne, waterborne, and hand-to-mouth transmission has not been quantified.The infective episode is not traceable, because of the absence of acute infection symptoms, long incubation period, and lack of diagnostic tools for this purpose.Standardization and validation of highly sensitive and specific molecular tools for the detection of Echinococcus spp. eggs will help in assessing the degree of matrix contamination and documenting the effectiveness of control strategies.Detection of Echinococcus spp. DNA from eggs does not indicate their infectivity.Factors affecting transmission of E. granulosus s.l. to humans should be more thoroughly investigated, to enable implementation of area-specific health education.