Strategies for tackling Taenia solium taeniosis/cysticercosis: A systematic review and comparison of transmission models, including an assessment of the wider Taeniidae family transmission models.

BACKGROUND: The cestode Taenia solium causes the neglected (zoonotic) tropical disease cysticercosis, a leading cause of preventable epilepsy in endemic low and middle-income countries. Transmission models can inform current scaling-up of control efforts by helping to identify, validate and optimise control and elimination strategies as proposed by the World Health Organization (WHO). METHODOLOGY/PRINCIPAL FINDINGS: A systematic literature search was conducted using the PRISMA approach to identify and compare existing T. solium transmission models, and related Taeniidae infection transmission models. In total, 28 modelling papers were identified, of which four modelled T. solium exclusively. Different modelling approaches for T. solium included deterministic, Reed-Frost, individual-based, decision-tree, and conceptual frameworks. Simulated interventions across models agreed on the importance of coverage for impactful effectiveness to be achieved. Other Taeniidae infection transmission models comprised force-of-infection (FoI), population-based (mainly Echinococcus granulosus) and individual-based (mainly E. multilocularis) modelling approaches. Spatial structure has also been incorporated (E. multilocularis and Taenia ovis) in recognition of spatial aggregation of parasite eggs in the environment and movement of wild animal host populations. CONCLUSIONS/SIGNIFICANCE: Gaps identified from examining the wider Taeniidae family models highlighted the potential role of FoI modelling to inform model parameterisation, as well as the need for spatial modelling and suitable structuring of interventions as key areas for future T. solium model development. We conclude that working with field partners to address data gaps and conducting cross-model validation with baseline and longitudinal data will be critical to building consensus-led and epidemiological setting-appropriate intervention strategies to help fulfil the WHO targets.

Epidemiology and economic impact of bovine cysticercosis and taeniosis caused by Taenia saginata in northeastern Spain (Catalonia).

BACKGROUND: In Catalonia (north-eastern Spain), Taenia saginata has been described in cattle but its occurrence in humans is unclear. Moreover, whether cattle acquired the infection in Catalonia or outside Catalonia and its economic impact have not been investigated. This study aimed to estimate the prevalence and spatial distribution of bovine cysticercosis in Catalonia (2008-2015), and the burden from T. saginata upon the animal and human sectors in Catalonia (2013-2015). METHODS: Data on cattle diagnosed with cysticercosis at meat inspection were collected and analysed. Cattle movement history was used to identify the most likely place of bovine cysticercosis infection and to investigate its spatial distribution. Data on taeniosis treatment (niclosamide and praziquantel) costs and their supply in Catalonia as well as data on patients attending primary care with diagnosis of taeniosis were collected. The financial impact associated with T. saginata due to carcasses condemned and frozen, meat inspection and human taeniosis was estimated. RESULTS: During 2008-2015, between 18 and 107 cattle were found positive for cysticercosis each year (prevalence at slaughter of 0.010%). Movement history was available for 44% of the infected cattle and in 53% of them Catalonia was identified as the place where the infection was acquired with highest probability. Two significant bovine cysticercosis clusters were detected. The number of patients diagnosed with taeniosis in primary care during the period 2013-2016 was 41-63/year. The overall economic impact of T. saginata (2013-2015) amounted to 154,903 €/year (95% CI: 113,075-196,762). Meat inspection accounted for 81.9% (95% CI: 75.8-86.2%) of the costs, followed by costs due to carcass condemnation and freezing (9.4%; 95% CI: 6.9-12.8%), and taeniosis-associated costs (8.7%; 95% CI: 6.7-11.6%). Costs due to freezing and condemnation of carcasses reached 19,442 €/year (95% CI: 17,528-21,391) (509 €/lightly infected carcass and 1,140 €/heavily infected carcass). Taeniosis-associated costs were estimated at 12,848.5 €/year (237 €/patient). CONCLUSIONS: The public health risk of T. saginata in the area seems to be low. The economic impact due to T. saginata was mainly attributed to meat inspection. The cost due to carcass condemnation and freezing was limited compared to the revenue of the beef sector. Developing and implementing risk-based surveillance is needed to lower the costs of meat inspection. Considering cattle movements might be useful in the development of such a strategy.

Taenia solium from a community perspective: Preliminary costing data in the Katete and Sinda districts in Eastern Zambia.

The tapeworm Taenia solium is endemic in Zambia, however its socioeconomic cost is unknown. During a large-scale interventional study conducted in Zambia, baseline economic costs of human and porcine T. solium infections were measured. Questionnaire surveys were conducted within three neighbourhoods in Zambia's Eastern province in 2015 and 2016. A human health questionnaire, capturing costs of clinical symptoms commonly attributable to human cysticercosis and taeniasis, was conducted in randomly selected households (n = 267). All pig-keeping households were administered a pig socioeconomic questionnaire (n = 271) that captured pig demographic data, costs of pig-keeping, and economic losses from porcine cysticercosis. Of all respondents 62% had reportedly experienced at least one of the surveyed symptoms. Seizure-like episodes were reported by 12%, severe chronic headaches by 36%, and vision problems by 23% of respondents. These complaints resulted in 147 health care consultations and 17 hospitalizations in the five years preceding the study, and an estimated productivity loss of 608 working days per year. Of all pigs 69% were bought within villages. Nearly all adult pigs were sold to local traders, and tongue palpation for detection of cysticerci was commonly performed. Reportedly, 95% of pig owners could not sell tongue-positive pigs, while infected pigs fetched only 45% of the normal sale value. These preliminary costing data indicate that human and porcine T. solium infections substantially impact endemic areas of Eastern Zambia. A full socioeconomic burden assessment may enable improved T. solium management in sub-Saharan Africa.

A preliminary analysis of some epidemiological factors involved in porcine cysticercosis in Bafut and Santa subdivisions, North West Region of Cameroon.

OBJECTIVE: To examine the magnitude and some risk factors of porcine cysticercosis in Bafut and Santa, two sub-divisions noted for pig farming in the North West Region of Cameroon. METHODS: A total of 499 pigs in 300 households were examined by tongue inspection and serologically by Ag-ELISA. Information was sought on the age and sex of the animals, prevailing husbandry systems, types of feed, the state of each pen and the state of toilets. Futhermore, a questionnaire was administered to the farmers to determine their awareness on taeniasis/cysticercosis and related factors. RESULTS: The prevalence of the disease was significantly higher in Santa (10.2%) than in Bafut (4.2%), although there was a higher level of awareness in both localities (62.3%). Age of pigs, traditional rearing systems (roaming, tethered, earth floor pen, raised floor pen), faecal disposal in the environment and poor sanitation significantly influenced the seroprevalence of porcine cysticercosis in both localities. Most farmers (79.7%) used a combination of concentrate, grass and kitchen waste to feed pigs. Financial loss from porcine cysticercosis was estimated at 346 900 CFA representing 2% of total income. CONCLUSIONS: Control measures advanced here include sensitization campaigns, periodic examination and treatment of infected pigs by veterinarians, improved husbandry systems, proper use of standard latrines regularly inspected by sanitary officers, and sound hygienic and sanitary practices.

Improvement of the synthetic tri-peptide vaccine (S3Pvac) against porcine Taenia solium cysticercosis in search of a more effective, inexpensive and manageable vaccine.

Vaccination of pigs may curtail Taenia solium transmission by reducing the number of cysticerci, the precursors of adult intestinal tapeworms in humans. Several antigen preparations induce protection against porcine cysticercosis in experimental settings but only one subunit vaccine (S3Pvac) has been tested and proved effective in the field against naturally acquired disease. Besides improving of the vaccine's effectiveness, significant reductions in production costs and in the logistics of its administration are necessary for the feasibility of nationwide control programs. This review highlights the development of several versions of S3Pvac aimed to increase effectiveness, reduce costs and increase feasibility by novel delivery systems and alternative routes of administration.

Neurocysticercosos in South-Central America and the Indian subcontinent. A comparative evaluation.

Neurocysticercosis is an important public health problem in South-Central American and South Asia. A review of the differences in epidemiological and clinical attributes of cysticercosis and taeniasis in South Central America and India, respectively, is undertaken in the present communication. Intestinal taeniasis is hyperendemic in several American countries. In comparison, the prevalence of Taenia solium infestation is lower in India. The clinical manifestations in several American neurocysticercosis series comprise epilepsy, intracranial hypertension and meningeal-racemose cysticercosis, in roughly equal proportions. An overwhelming majority of the Indian subjects present with seizures. The commonest pathological substrate of the disorder in Indian patients is the solitary parenchymal degenerating cyst. The reasons for the predominance of solitary forms in India, and of multilesional forms in South Central America are discussed. The magnitude of Taenia solium infestation and the frequency of pork consumption in a given population appear to influence the quantum of cyst load in affected individuals.