Porcine cysticercosis, human taeniasis, and (neuro)cysticercosis are endemic in many low- and middle-income countries (LMIC) where they present a significant health burden to affected communities. Neurocysticercosis (NCC) is one of the leading causes of human epilepsy in many hyperendemic regions in Latin America, Asia, and sub-Saharan Africa. The World Health Organization (WHO) reports an estimated 2.5–8.3 million cases of NCC annually with a disability-adjusted life year (DALY) burden of 2.8 million, but as for all neglected tropical diseases (NTDs), these values are likely to be underestimated. Diagnosis of NCC is complex and most accurately diagnosed using clinical neuroimaging that is unavailable in most hyperendemic regions in LMIC. On January 28, 2021, WHO will launch its road map for the NTDs' “Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030.” Taeniasis/cysticercosis is targeted for control success considered as steady increase in the number of countries with intensified control in hyperendemic areas [increasing from 2 (3%) in 2020 to 4 (6%) in 2023, to 9 (14%) by 2025, and to 17 (27%) by 2030]. Cross-cutting targets that include 100% access to at least basic water supply, sanitation, and hygiene in areas endemic for NTDs and 75% integrated treatment coverage for preventative chemotherapy will additionally impact on the taeniasis/cysticercosis/NCC complex. With no vaccine available for humans, prevention of infection depends on communication to the public of the life cycle of a complex zoonosis to promote behavior change, underpinned by practical control measures including treatment of human taeniasis and (neuro)cysticercosis with albendazole and praziquantel [widely used as part of the mass drug administration (MDA) deworming programs], surgery where appropriate, and effective vaccination and deworming for pigs supported by meat inspection. Here, we review recent advances in tools and implementation for Taenia solium taeniasis/(neuro)cysticercosis (TSTC) control and milestones on the onward path to elimination.
Effective and sustainable control of the Neglected Zoonoses (NZDs) demands a One Health approach. NZDs largely impact on individuals in low- and middle-income countries, disproportionally affecting resource poor communities with poor access to veterinary and human health services and to clean water and which are intrinsically dependent on animals for their livelihoods. Many NZDs in humans can be treated, but treatment is often complex and expensive. Similarly, while tools for prevention of transmission may exist, they are complex and expensive to adopt at the scale required to be effective. The cost of intervention for NZDs is high when compared to the public health benefits alone, but costs are easily outweighed by full cross sector analysis and when monetary and non-monetary benefits to all stakeholders are considered. Education is a key tool, often overlooked in favor of more complex solutions for the control of NZDs. Successful education programs have been targeted to children of school age for Taenia solium in Kenya, schistosomiasis in Nigeria, and soil transmitted helminths in China. A Snakes and Ladders board game, designed to teach children about schistosomiasis and encourage compliance with mass deworming programs, deployed in Nigerian schools, showed a 67% increase in knowledge of praziquantel and 65% of children who had previously rejected treatment requested the drug at school. For soil transmitted helminths in China, presentation of health information in cartoon format rather than in poster format, showed post-assessment knowledge to be 90% higher. With the rise in affordable smart-phone technology, internet access and airtime in communities in low- and middle- income countries e-education is an increasingly attractive proposition as an intervention tool for the NZDs. The Vicious Worm, a computer based educational health tool that has been designed around the prevention of Taenia Solium has shown remarkable efficacy in affected communities in which it has been deployed with participants applying the principles learned in their communities. This review explores the successes and benefits of education as a control tool for the NZDs.
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