Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru.

Ian W Pray,Armando E Gonzalez,Robert H Gilman,Claudio Muro,Cesar M Gavidia,Hector H Garcia,Ricardo Gamboa,Luz Maria Moyano,Seth E O’Neal,Viterbo Ayvar,Percy Vilchez

doi:10.3201/eid2709.203349

Abstract

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p<0.001), despite a smaller proportion of population treated by targeted approaches (RS 1.4%, RT 19.3%, MT 88.5%). Our findings suggest multiple approaches can achieve rapid control of T. solium transmission.

Highlights

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined
When we identified a pig with cysticercosis of the tongue, we opened a treatment ring comprising all households within a 100-m radius of the house where the tongue-positive pig was raised
We offered all persons >2 years of age living within the treatment ring the standard oral niclosamide dose for taeniasis and a second oral dose 15 days later

Summary

Introduction

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. We previously completed a pilot study in Peru to evaluate a targeted ring approach to control transmission of T. solium, which exhibits spatial clustering [12]. The premise of this approach is that selective treatment for taeniasis among high-risk subgroups within villages might reduce transmission and limit the number of persons treated [17]. We conducted a follow-up study to compare effectiveness of 2 ring approaches and mass treatment, and to explore whether including treatment for cysticercosis in pigs provided additional control benefits

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Results

Conclusion