Abstract
To examine the prevalence of seizures, epilepsy and seropositivity to cysticercosis in rural villagers (cysticercosis-endemic setting), rural-to-urban migrants into a non-endemic urban shanty town and urban inhabitants of the same non-endemic shanty town. Three Peruvian populations (n=985) originally recruited into a study about chronic diseases and migration were studied. These groups included rural inhabitants from an endemic region (n=200), long-term rural-to-urban migrants (n=589) and individuals living in the same urban setting (n=196). Seizure disorders were detected by a survey, and a neurologist examined positive respondents. Serum samples from 981/985 individuals were processed for cysticercosis antibodies on immunoblot. Epilepsy prevalence (per 1000 people) was 15.3 in the urban group, 35.6 in migrants and 25 in rural inhabitants. A gradient in cysticercosis antibody seroprevalence was observed: urban 2%, migrant 13.5% and rural group 18% (P<0.05). A similarly increasing pattern of higher seroprevalence was observed among migrants by age at migration. In rural villagers, there was strong evidence of an association between positive serology and having seizures (P=0.011) but such an association was not observed in long-term migrants or in urban residents. In the entire study population, compared with seronegative participants, those with strong antibody reactions (≥4 antibody bands) were more likely to have epilepsy (P<0.001). It is not only international migration that affects cysticercosis endemicity; internal migration can also affect patterns of endemicity within an endemic country. The neurological consequences of cysticercosis infection likely outlast the antibody response for years after rural-to-urban migration.
Highlights
Neurocysticercosis (NCC) is the most frequent helminthic infection of the human central nervous system, caused by the larvae of the pork tapeworm Taenia solium
Expanding upon a study on migration and chronic diseases already ongoing in Peru [9, 10], we examined the prevalence of seizures, epilepsy and seropositivity to cysticercosis in three populations of individuals older than 30 years: rural villagers from a cysticercosis-endemic setting, long-term rural-tourban migrants into a non-endemic urban shanty town and urban inhabitants born and living in the same non-endemic shanty town
Study design and study populations. This cross-sectional study assessed the prevalence of seizures and the prevalence of specific antibodies to cysticercosis in serum of three population-based groups: Rural, people born in Ayacucho who had always lived in a rural environment; Rural-to-urban Migrants, people born in Ayacucho who migrated from rural to urban areas and currently living in Lima, an 8-million metropolis; and Urban, people born and currently living in Lima
Summary
Neurocysticercosis (NCC) is the most frequent helminthic infection of the human central nervous system, caused by the larvae of the pork tapeworm Taenia solium. A growing global public health problem [1], NCC is endemic in most developing countries, where it constitutes the main cause of secondary epilepsy. NCC is emerging in industrialised countries because of migration from endemic zones [2]. Linked to poverty as for most zoonotic infections, the bulk of cysticercosis transmission occurs in rural villages where domestic pig raising coexists with poor sanitation and lack of sewage and potable water facilities. There are multiple reports of NCC in travellers and migrants to industrialised countries [2,3,4,5,6,7].
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