Hector H Garcia1, Armando E Gonzalez1, Victor C W Tsang1, Seth E O'Neal1, Fernando Llanos-Zavalaga1, Guillermo Gonzalvez1, Jaime Romero1, Silvia Rodriguez1, Luz M Moyano1, Viterbo Ayvar1, Andre Diaz1, Allen Hightower1, Philip S Craig1, Marshall W Lightowlers1, Charles G Gauci1, Elli Leontsini1, Robert H Gilman1. 1. From the Center for Global Health-Tumbes, Universidad Peruana Cayetano Heredia (H.H.G., S.E.O., L.M.M., V.A., A.D.), the Department of Microbiology (H.H.G.) and School of Public Health (F.L.-Z.), Universidad Peruana Cayetano Heredia, Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas (H.H.G., S.R.), Universidad Nacional Mayor de San Marcos, School of Veterinary Medicine (A.E.G.), and Inter-American Institute for Cooperation on Agriculture (J.R.) - all in Lima, Peru; Immunology Branch, Division of Parasitic Diseases and Malaria, National Center for Infectious Diseases (V.C.W.T.), and Data Management Activity, Division of Parasitic Diseases and Malaria, Center for Global Health (A.H.), Centers for Disease Control and Prevention, and Georgia State University (V.C.W.T.) - both in Atlanta; School of Public Health, Oregon Health and Science University and Portland State University, Portland (S.E.O.); Pan American Health Organization, Managua, Nicaragua (G.G.); University of Salford, School of Environment and Life Sciences, Greater Manchester, United Kingdom (P.S.C.); University of Melbourne, Faculty of Veterinary and Agricultural Sciences, Werribee, VIC, Australia (M.W.L., C.G.G.); and the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (E.L., R.H.G.).
Abstract
BACKGROUND: Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. METHODS: We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. RESULTS: Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass antiparasitic treatment plus vaccination was implemented. After the final strategy was implemented in phase 3, a total of 3 of 342 pigs had live, nondegenerated cysts, but no infected pig was found in 105 of 107 villages. CONCLUSIONS: We showed that the transmission of T. solium infection was interrupted on a regional scale in a highly endemic region in Peru. (Funded by the Bill and Melinda Gates Foundation and others.).
BACKGROUND: Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. METHODS: We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. RESULTS: Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass antiparasitic treatment plus vaccination was implemented. After the final strategy was implemented in phase 3, a total of 3 of 342 pigs had live, nondegenerated cysts, but no infected pig was found in 105 of 107 villages. CONCLUSIONS: We showed that the transmission of T. solium infection was interrupted on a regional scale in a highly endemic region in Peru. (Funded by the Bill and Melinda Gates Foundation and others.).
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