Abstract
The pork tapeworm (Taenia solium) is a parasitic helminth that imposes a major health and economic burden on poor rural populations around the world. As recognized by the World Health Organization, a key barrier for achieving control of T. solium is the lack of an accurate and validated simulation model with which to study transmission and evaluate available control and elimination strategies. CystiAgent is a spatially-explicit agent based model for T. solium that is unique among T. solium models in its ability to represent key spatial and environmental features of transmission and simulate spatially targeted interventions, such as ring strategy. We validated CystiAgent against results from the Ring Strategy Trial (RST)-a large cluster-randomized trial conducted in northern Peru that evaluated six unique interventions for T. solium control in 23 villages. For the validation, each intervention strategy was replicated in CystiAgent, and the simulated prevalences of human taeniasis, porcine cysticercosis, and porcine seroincidence were compared against prevalence estimates from the trial. Results showed that CystiAgent produced declines in transmission in response to each of the six intervention strategies, but overestimated the effect of interventions in the majority of villages; simulated prevalences for human taenasis and porcine cysticercosis at the end of the trial were a median of 0.53 and 5.0 percentages points less than prevalence observed at the end of the trial, respectively. The validation of CystiAgent represented an important step towards developing an accurate and reliable T. solium transmission model that can be deployed to fill critical gaps in our understanding of T. solium transmission and control. To improve model accuracy, future versions would benefit from improved data on pig immunity and resistance, field effectiveness of anti-helminthic treatment, and factors driving spatial clustering of T. solium infections including dispersion and contact with T. solium eggs in the environment.
Highlights
Cysticercosis is a neglected tropical disease (NTD) that exacts a substantial health and economic burden in low-income countries
Among the 21 villages evaluated in the Ring Strategy Trial (RST), the median observed prevalence of human taeniasis and porcine cysticercosis at baseline were 2.2% and 19.2%, respectively
Development and validation of a T. solium transmission model was identified as a key goal in World Health Organization (WHO)’s 2014 framework for intensified control [14], yet none of the currently available models have been validated against data from field trials of T. solium control interventions
Summary
Cysticercosis is a neglected tropical disease (NTD) that exacts a substantial health and economic burden in low-income countries. Global eradication of T. solium transmission is unlikely in the short-term, local control or elimination is possible [3,4] due to the availability of new tools that can be deployed to interrupt transmission These include effective treatment of taeniasis [5,6] and porcine cysticercosis [7,8], improved diagnostic tests [9,10], and a vaccine to prevent pig infection [11,12]. In 2012, shortly after the success of a large-scale elimination demonstration in Peru that effectively implemented many of these tools [3], the World Health Organization (WHO) declared ambitious targets for global control and elimination of T. solium They called for validated control strategies to be identified by 2015, and for these strategies to be scaled and implemented in several countries by 2020 [13]. CystiAgent is a spatially-explicit agent based model for T. solium that is unique among T. solium models in its ability to represent key spatial and environmental features of transmission and simulate spatially targeted interventions, such as ring strategy
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