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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Taenia solium is endemic in most of the world, causing seizures and other neurological symptoms. Transmission is mainly maintained in rural areas by a human to pig cycle. Despite claims on its eradicability, sustainable interruption of transmission has not yet been reported. This manuscript reviews the conceptual basis for control, available diagnostic and control tools, and recent experiences on control in the field performed in Peru along the past decade

por el Grupo de Trabajo en Cisticercosis en Perú RESUMEN La neurocisticercosis, infección del sistema nervioso humano por el estadio larvario de la Taenia solium, es una causa importante de epilepsia y otras manifestaciones neurológicas en el Perú y en la mayoría de países en desarrollo. Desde 1987, el Grupo de Trabajo en Cisticercosis en Perú ha desarrollado una serie de estudios epidemiológicos que han llevado a estimar el impacto y entender la transmisión de la Taenia solium, y que posteriormente se aplicaron al diseño y ejecución de un programa de control en Tumbes, en la costa norte del país. En este artículo se revisan los principales hallazgos epidemiológicos, así como las líneas generales del programa de eliminación y las herramientas utilizadas. Los avances en el control de la teniasis/cisticercosis en nuestro país abren el camino hacia su eliminación y eventual erradicación.Palabras clave: Cisticercosis; Taenia solium; Epidemiología; Control de enfermedades transmisibles; Perú (fuente: DeCS BIREME). EPIDEMIOLOGY AND CONTROL OF CYSTICERCOSIS IN PERU ABSTRACTNeurocysticercosis, the infection of the human central nervous system by the larval stage of the cestode Taenia solium, is an important cause of epilepsy and other neurological manifestations in Peru and most developing countries. Since 1987, the Cysticercosis Working Group in Peru has performed a series of epidemiological studies which led to estimate the impact and to better understand the transmission of Taenia solium. This information was later applied to the design and execution of a control program in Tumbes, in the Northern Coast of Peru. This paper reviews the main epidemiological findings, as well as the conceptual framework of the elimination program and the tools used. Advances in the control of taeniasis/cysticercosis in our country open the road towards its elimination and potential eradication.

La neurocisticercosis, infección del sistema nervioso humano por el estadio larvario de la Taenia solium, es una causa importante de epilepsia y otras manifestaciones neurológicas en el Perú y en la mayoría de países en desarrollo. Desde 1987, el Grupo de Trabajo en Cisticercosis en Perú ha desarrollado una serie de estudios epidemiológicos que han llevado a estimar el impacto y entender la transmisión de la Taenia solium, y que posteriormente se aplicaron al diseño y ejecución de un programa de control en Tumbes, en la costa norte del país. En este artículo se revisan los principales hallazgos epidemiológicos, así como las líneas generales del programa de eliminación y las herramientas utilizadas. Los avances en el control de la teniasis/cisticercosis en nuestro país abren el camino hacia su eliminación y eventual erradicación.