Control of Taenia solium; A Case for Public and Private Sector Investment.

Lian F Thomas,E Anne J Cook,Jonathan Rushton,Eric M Fèvre

doi:10.3389/fvets.2019.00176

Abstract

The zoonotic helminth T. solium is one of the leading causes of acquired epilepsy in endemic countries, resulting in a high burden both in human health and social stigma of affected people (1–3). In 2012 T. solium was highlighted as a priority for control in the World Health Assembly resolution 66.12 (4). Despite a call for validated control strategies by 2015 and a “Tool Kit” of control options being available, relatively few examples of successfully implemented and sustainable control programs are available (5–7). A minimal control strategy focusing solely on the porcine host has also been proposed although the cost-effectiveness of such has yet to be explored (8). Although acknowledgment has been made of the need for initiatives to be sustainable, we are yet to see sufficient consideration of the balance between the provision of public and private goods, and the need for engagement of the people and organizations in the pork value chains within T. solium control strategies. We utilized a food chain risk analysis model to determine the incremental cost-effectiveness ratio (ICER) in terms of $/infective meal avoided, of combining a pharmaceutical intervention in pigs with strengthened meat hygiene services. The addition of a vaccination and treatment protocol, at an additional 10.3% cost, was illustrated to have the potential to improve the ICER of improving meat inspection by 74.6%. The vaccination and treatment protocol also had the potential to reduce the losses borne by the pork industry of condemned meat by 66%, highlighting the potential to leverage private sector investment in T. solium control.

Highlights

Taenia solium is a zoonotic tapeworm which utilizes a porcine intermediate and a human definitive host
We suggest that a cost-sharing model between the private and public sector may be a suitable direction to take for T. solium control, based upon the delivery of private or public goods through the different control interventions
The current study aimed to explore this hypothesis by determining the incremental cost-effectiveness ratio (ICER) in terms of $/infective meal avoided, of the “minimal intervention strategy” of pharmaceutical intervention in pigs in combination with strengthened meat hygiene services in western Kenya

Summary

Introduction

Taenia solium is a zoonotic tapeworm which utilizes a porcine intermediate and a human definitive host. It is thought that T. solium has been associated with a hominid definitive host pre-dating the advent of Homo sapiens [9] and has accompanied modern humans as they colonized the globe [10]. Humans acquire a T. solium taeniosis infection through consumption of pork containing viable cysticerci and pigs acquire T. solium cysticercosis through the ingestion of infective eggs or proglottids excreted in the feces of infected humans [11]. The ingestion of infective eggs by humans due to fecal contamination of food or drinking water, or auto-infection from a tapeworm carrier, can lead to an aberrant intermediate infection, cysticercosis, with larval cysts found in muscle, optical or neural tissue. Infection of the central nervous tissue, neurocysticercosis (NCC) is considered to be a major causes of acquired epilepsy in endemic counties [12], leading to significant reductions in quality of life [13] and making T. solium the foodborne parasite with the greatest global burden [14].

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