Abstract

BackgroundThe pork tapeworm, Taenia solium, and associated human infections, taeniasis, cysticercosis and neurocysticercosis, are serious public health problems, especially in developing countries. The World Health Organization (WHO) has set goals for having a validated strategy for control and elimination of T. solium taeniasis/cysticercosis by 2015 and interventions scaled-up in selected countries by 2020. Timely achievement of these internationally-endorsed targets requires that the relative benefits and effectiveness of potential interventions be explored rigorously within a quantitative framework.MethodsA deterministic, compartmental transmission model (EPICYST) was developed to capture the dynamics of the taeniasis/cysticercosis disease system in the human and pig hosts. Cysticercosis prevalence in humans, an outcome of high epidemiological and clinical importance, was explicitly modelled. A next generation matrix approach was used to derive an expression for the basic reproduction number, R0. A full sensitivity analysis was performed using a methodology based on Latin-hypercube sampling partial rank correlation coefficient index.ResultsEPICYST outputs indicate that chemotherapeutic intervention targeted at humans or pigs would be highly effective at reducing taeniasis and cysticercosis prevalence when applied singly, with annual chemotherapy of humans and pigs resulting, respectively, in 94 and 74% of human cysticercosis cases averted. Improved sanitation, meat inspection and animal husbandry are less effective but are still able to reduce prevalence singly or in combination. The value of R0 for taeniasis was estimated at 1.4 (95% Credible Interval: 0.5–3.6).ConclusionsHuman- and pig-targeted drug-focussed interventions appear to be the most efficacious approach from the options currently available. The model presented is a forward step towards developing an informed control and elimination strategy for cysticercosis. Together with its validation against field data, EPICYST will be a valuable tool to help reach the WHO goals and to conduct economic evaluations of interventions in varying epidemiological settings.

Highlights

  • The pork tapeworm, Taenia solium, and associated human infections, taeniasis, cysticercosis and neurocysticercosis, are serious public health problems, especially in developing countries

  • We estimate that annual implementation of the test & treat approach, targeting all people with taeniasis but not cysticercosis, would avert a median equal to 94% (95% credible interval, 95% CrI: 83–97%) of human cysticercosis cases

  • Solium taeniasis/cysticercosis [1], and to the research priorities highlighted by the World Health Organization (WHO) for zoonoses and marginalized infections [6], we have developed EPICYST, a transmission model to explore in-depth the transmission dynamics of the taeniasis/cysticercosis disease system and assess a range of interventions applied singly or in combination

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Summary

Introduction

The pork tapeworm, Taenia solium, and associated human infections, taeniasis, cysticercosis and neurocysticercosis, are serious public health problems, especially in developing countries. Whilst a variety of potential interventions have shown promise in their ability to control taeniasis and cysticercosis, there remains a number of challenges that must be overcome to facilitate the control and elimination of taeniasis and cysticercosis as public health problems and help the WHO to achieve its 2020 goals [5] These include further development of new drugs and accessible diagnostics in humans, conducting randomised clinical field trials to assess pigfocussed strategies such as drug treatment and vaccination, implementing a progression of behaviour-change interventions, and building transmission models to assess intervention strategies [6]

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