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Porcine cysticercosis is caused by a zoonotic tapeworm, Taenia solium, which causes serious disease syndromes in human. Effective control of the parasite requires knowledge on the burden and pattern of the infections in order to properly direct limited resources. The objective of this study was to establish the spatial distribution of porcine cysticercosis in Mbulu district, northern Tanzania, to guide control strategies. This study is a secondary analysis of data collected during the baseline and follow-up periods of a randomized community trial aiming at reducing the incidence rate of porcine cysticercosis through an educational program. At baseline, 784 randomly selected pig-keeping households located in 42 villages in 14 wards were included. Lingual examination of indigenous pigs aged 2-12 (median 8) months, one randomly selected from each household, were conducted. Data from the control group of the randomized trial that included 21 of the 42 villages were used for the incidence study. A total of 295 pig-keeping households were provided with sentinel pigs (one each) and reassessed for cysticercosis incidence once or twice for 2-9 (median 4) months using lingual examination and antigen ELISA. Prevalence of porcine cysticercosis was computed in Epi Info 3.5. The prevalence and incidence of porcine cysticercosis were mapped at household level using ArcView 3.2. K functions were computed in R software to assess general clustering of porcine cysticercosis. Spatial scan statistics were computed in SatScan to identify local clusters of the infection. The overall prevalence of porcine cysticercosis was 7.3% (95% CI: 5.6, 9.4; n = 784). The K functions revealed a significant overall clustering of porcine cysticercosis incidence for all distances between 600 m and 5 km from a randomly chosen case household based on Ag-ELISA. Lingual examination revealed clustering from 650 m to 6 km and between 7.5 and 10 km. The prevalence study did not reveal any significant clustering by this method. Spatial scan statistics found one significant cluster of porcine cysticercosis prevalence (P = 0.0036; n = 370). In addition, the analysis found one large cluster of porcine cysticercosis incidence based on Ag-ELISA (P = 0.0010; n = 236) and two relatively small clusters of incidence based on lingual examination (P = 0.0012 and P = 0.0026; n = 241). These clusters had similar spatial location and included six wards, four of which were identified as high risk areas of porcine cysticercosis. This study has identified local clusters of porcine cysticercosis in Mbulu district, northern Tanzania, where limited resources for control of T. solium could be directed. Further studies are needed to establish causes of clustering to institute appropriate interventions.

Zoonotic infections can be controlled by interceding in the animal host. This report describes elimination of T. solium infection from a region in Peru through intervention in the pig–human cycle; such intervention should diminish complications from cysticercosis in the future. Infection of the human brain by cystic larvae of the pork tapeworm species Taenia solium is the most frequent cause of late-onset seizures and epilepsy in the world. 1 , 2 Transmission is sustained in rural areas through a pig–human cycle in which humans harbor the adult intestinal tapeworm (taeniasis) and pigs carry the cystic larvae in their flesh (cysticercosis). In poor, rural villages, domestic pig husbandry and lack of sanitation allow pigs to become infected by consuming human feces containing tapeworm eggs. In turn, humans acquire taeniasis by consuming pork contaminated with larval cysts or acquire neurocysticercosis through incidental ingestion of . . .

Taenia solium is responsible for a substantial global disease burden in pig-raising and pork-consuming regions of the developing world. The study assessed the reported spatial pattern of Taenia solium taeniosis and cysticercosis (TSTC) in Kenya, with the focus on risk mapping of TSTC in Busia County. The study employed a mixed approach, incorporating routinely collected data and open-source resources. A literature review and collection of pig population data were used to map the TSTC and pig population distribution at the national level. In Busia County, the retrospective study retrieved reports on porcine cysticercosis and epilepsy (as a proxy indicator of neurocysticercosis) from hospitals and meat inspection records. The cross-sectional study assessed risk behaviors associated with TSTC in Busia County. The TSTC reports and proportions of porcine cysticercosis and epilepsy (as a proxy indicator of neurocysticercosis) were aggregated at the county and sub-county levels and visualized using QGIS. In addition, the World Health Organization's (WHO's) T. solium mapping tool was employed for risk mapping T. solium in Busia County. The pig population data showed a linear growth trend, with a higher population reported in Central and Western Kenya. A systematic search of the literature yielded a total of fourteen research reports, with the reported cases ranging from 1.8% to 49.9% for porcine cysticercosis, 1.6% to 31.1% for human cysticercosis, and 0.18% to 19.9% for T. solium taeniosis, respectively. The retrospective data showed cases of porcine cysticercosis and epilepsy (as a proxy indicator of neurocysticercosis) in all sub-counties of Busia. The WHO risk mapping tool categorized Bunyala, Teso South, Nambale, and Butula sub-counties as high-risk areas. The questionnaire survey highlighted semi-confinement as the predominant pig husbandry practice (61.1%), with 32% of pigs having access to sewage, and there was poor community awareness about TSTC in Busia County. The study indicated the presence of TSTC transmission in Western Kenya and identified Busia County as a high-risk area based on multiple layers of evidence. This mixed approach utilized readily available data to generate new evidence that could support sustainable One Health strategies for interrupting the T. solium transmission cycle.

Taenia solium cysticercosis/taeniasis disease complex is a multifaceted neglected tropical zoonosis. Previous reviews on T. solium cysticercosis/taeniasis risk factors have been limited by geographic region and/or host, making it difficult to understand the complex web of causes underlying infection at the various stages of its life cycle. Our objective was to elucidate the causal mechanisms involved in the transmission of T. solium to all hosts through a systematic review of the literature. We conducted a systematic literature search about the epidemiology of T. solium infection published before May 2020 (OpenScience protocol https://doi.org/10.17605/OSF.IO/U64K3). We searched PubMed, Web of Science, and CABAbstracts, and reference lists of systematic reviews identified in our searches for relevant studies meeting the inclusion criteria: i) describing a risk factor-outcome association related to T. solium infection, and ii) published in English, French, Spanish, or Portuguese. Qualitative or quantitative epidemiologic associations were extracted and evaluated according to a modified version of the Quality Assessment Tool for Quantitative Studies. Our review is reported according the PRISMA guidelines. We extracted 876 associations from 159 studies. Risk factors of human cysticercosis are well-studied, while taeniasis is least-studied (10% of associations). The evidence suggests that male gender is a risk factor for human cysticercosis while female sex is a risk factor for porcine cysticercosis. The direction of association did not differ according to the quality of the studies across most studied risk factors. Our rigorous systematic review is the first to consider risk factors of human and porcine T. solium disease simultaneously, allowing a synthesis of information from both hosts in order to elucidate causal mechanisms for risk factors of cysticercosis. Our work also highlights areas of T. solium epidemiology which are understudied, such as the causal mechanisms of taeniasis.

Background Taenia solium and Taenia saginata are zoonotic parasites of public health importance. Data on their occurrence in humans and animals in western Europe are incomplete and fragmented. In this study, we aimed to update the current knowledge on the epidemiology of these parasites in this region. Methods We conducted a systematic review of scientific and grey literature published from 1990 to 2015 on the epidemiology of T. saginata and T. solium in humans and animals. Additionally, data about disease occurrence were actively sought by contacting local experts in the different countries. Results Taeniosis cases were found in twelve out of eighteen countries in western Europe. No cases were identified in Iceland, Ireland, Luxembourg, Norway, Sweden and Switzerland. For Denmark, Netherlands, Portugal, Slovenia, Spain and the UK, annual taeniosis cases were reported and the number of detected cases per year ranged between 1 and 114. Detected prevalences ranged from 0.05 to 0.27%, whereas estimated prevalences ranged from 0.02 to 0.67%. Most taeniosis cases were reported as Taenia spp. or T. saginata , although T. solium was reported in Denmark, France, Italy, Spain, Slovenia, Portugal and the UK. Human cysticercosis cases were reported in all western European countries except for Iceland, with the highest number originating from Portugal and Spain. Most human cysticercosis cases were suspected to have acquired the infection outside western Europe. Cases of T. solium in pigs were found in Austria and Portugal, but only the two cases from Portugal were confirmed with molecular methods. Germany, Spain and Slovenia reported porcine cysticercosis, but made no Taenia species distinction. Bovine cysticercosis was detected in all countries except for Iceland, with a prevalence based on meat inspection of 0.0002–7.82%. Conclusions Detection and reporting of taeniosis in western Europe should be improved. The existence of T. solium tapeworm carriers, of suspected autochthonous cases of human cysticercosis and the lack of confirmation of porcine cysticercosis cases deserve further attention. Suspected cases of T. solium in pigs should be confirmed by molecular methods. Both taeniosis and human cysticercosis should be notifiable and surveillance in animals should be improved.

Cysticercosis in humans caused by the parasite Taenia solium is one of the World Health Organization’s Neglected Tropical Diseases. The parasite is transmitted between the human host and pigs. Efforts to prevent the disease have relied mainly on treatment of people with anthelmintics. However, to date, there is no practical and effective control method that has been delivered as a public health program. Here we describe a large-scale, minimum inputs T. solium control program implemented as a public health program in Madagascar. Initially all pigs were vaccinated for porcine cysticercosis and medicated with oxfendazole, after which only young piglets and pigs imported into the program area were targeted for interventions. After piglet interventions were in place and on-going, a single mass drug administration (MDA) was delivered to the human population with a taeniacide. The outcomes were assessed one year after the human treatment, by comparing pre-and post-intervention levels of porcine cysticercosis caused by T. solium and human T. solium taeniasis. Over a twenty-two-month period, 96,735 pig vaccinations and oxfendazole medications were delivered and during the MDA, 117,216 people received taeniacide. Ninety percent of the pig population were receiving vaccination and medication at the end of the intervention period. Coverage of the eligible human population by the MDA was 62.5%. Prior to the intervention 30.8% of slaughter-age pigs had viable T. solium infection, reduced to 8% after the program. Human taeniasis was found to be 1.25% prior to the MDA and 0.6% one year after the MDA. The program successfully demonstrated effective control of T. solium transmission to pigs using minimum inputs and delivered as a public health program. Sustained control and expansion of the program could potentially lead to the elimination of the disease being a public health problem in Madagascar.

Experimental pigs have been used to study human Taenia solium cysticercosis and neurocysticercosis. Biomarkers such as cardiac troponin I (cTnI) have been used to study various disease states such acute myocardial infarction (AMI) and the effect these diseases have on this molecule. However, no studies have been done to establish the effect of anthelminthic treatment on cTnI in pigs with cysticercosis and the role this biomarker plays with regards to inflammation following treatment. To investigate the effect of anthelminthic treatment on cardiac troponin I (cTnI) levels in pigs naturally infected with cysticercosis. A total of 36 pigs were included in this study and were assigned to either the positive (+ve) or negative (-ve) groups based on cysticercosis infection status as determined by tongue examination and Ag-ELISA (apDIA-Belgium). Pigs in each group were then randomly assigned to either treated or not-treated (control) groups. Treatment was done using oxfendazole (OXF) at effective dose of 30mg/kg orally. Baseline serum samples were collected prior to treatment and thereafter at 24hrs, 48hrs and 72hrs post treatment. This was followed by weekly sampling up to 11 weeks post treatment. Laboratory and statistical analysis of cTnI was done using Ag-ELISA and GraphPad prism software (9.0.0 version) i.e., two-way repeated measures ANOVA, respectively. Carcass dissections were done 12 weeks post treatment, and a correlation analysis was performed to establish the relationship between cTnI concentration and number of cysts in the positive pool of pigs. Both hourly and weekly observations post-treatment revealed a significantly high concentration of cTnI in the infected and treated (IT) group (mean = 0.041 ± 0.002 ng/ml) in comparison to the other treatment and control groups, i.e., infected and not-treated (INT) group (mean = 0.024 ± 0.009 ng/ml) (p = 0.015) as well as the negative groups [not infected and treated (NIT) (mean = 0.016 ± 0.0009 ng/ml) (p = 0.003) and not infected and not treated (NINT) (mean = 0.014 ± 0.006 ng/ml)(p = 0.001)], respectively, throughout the observation period. This study shows that there was a strong relationship between cardiac damage/inflammation and the rise in cTnI concentration following treatment with OXF. Pearson correlation analysis results revealed a strong positive correlation between the number of active cysts and the concentration of cTnI in the INT group. This study shows that OXF treatment of pigs with T. solium cysticercosis results in increased concentration of cTnI possibly due to the cardiac damage/inflammatory response following treatment as the cysts degenerate/calcify. This makes cTnI a very good biomarker for cardiac injury/damage following treatment in pigs with cysticercosis.

A field trial was conducted in Tanzania to determine the effectiveness of TSOL18 vaccine used concurrently with oxfendazole (OFZ), and of OFZ alone, on T. solium cysticercosis determined by organ and half carcase dissection of slaughter age pigs. This study followed a quasi-experimental group design. Suitable trial sites were randomly allocated to either treatment group T1 (OFZ treatment alone [30mg/kg, Paranthic 10%]) or T2 (TSOL18 [1ml, Cysvax] plus OFZ). Three 4-monthly treatments were administered to eligible pigs. A random selection of pigs were necropsied at baseline and at endline, 2-3.5 months after the final treatment. Additionally, untreated pigs from T1 and T2 areas were necropsied at endline to provide contemporaneous comparisons with T1 and T2 pigs. Baseline prevalence of viable T. solium cysticerci for T1 was 25.5% (Exact 95% CI: 13.9, 40.3; n = 12/47), and for T2 was 12.0% (CI: 6.4, 20.0; n = 12/100). At endline, prevalence was 2.8% for T1 (CI: 0.1, 14.5, n = 1/36) and 0% for T2 (CI: 0, 4.7, n = 0/77). Among untreated pigs, three had viable cysticerci, one from T1 area (12.5%, CI: 0.3, 52.7; n = 1/8) and two from T2 area (5.7%, CI: 0.7, 19.2, n = 2/35). Fisher's exact test showed significant changes in prevalence from baseline to endline in both groups (T1: p = 0.005, T2: p = 0.001). Firth's penalized Maximum Likelihood method suggested the changes were not significant relative to their controls (T1: p = 0.245, T2: p = 0.076). These findings showed a significant reduction in the prevalence of viable cysticerci from baseline to endline after both interventions. However, the changes could not be definitively attributed to the interventions due, in part, to small numbers of control pigs. Concurrent administration of the TSOL18 and OFZ cleared infection among assessed pigs whereas infection remained after treatment with OFZ only. Further studies including larger sample sizes would be required for more definitive conclusions. A One Health approach is recommended for rapid and sustainable impact.

Taenia spp. are responsible for a substantial health and economic burden in affected populations. Knowledge of the fate of the eggs of Taenia spp. in the environment and of other factors facilitating the transmission of eggs to intermediate hosts is important for the control/elimination of infections caused by Taenia spp. The aim of this systematic review was to summarize current knowledge of the factors influencing the survival and dispersal of Taenia spp. eggs in the environment. Publications retrieved from international databases were systematically reviewed. Of the 1465 papers initially identified, data were ultimately extracted from 93 papers. The results of this systematic review indicate that survival is favoured at moderate temperatures (0–20 °C). Humidity seems to affect the survival of Taenia spp. eggs more than temperature. Under field circumstances, Taenia spp. eggs have been found to survive for up to 1 year. Taenia spp. eggs are commonly found on vegetables (0.9–30%) and in soil and water samples (0–43%), with their presence posing a risk to the consumer. Invertebrates may act as transport hosts, transferring the infection to an intermediate host, but the importance of this route of transmission is still open to question. Wastewater treatment systems are not capable of entirely eliminating Taenia spp. eggs. Access to surface water and the use of sewage sludge as fertilizer on pastures are important risk factors for bovine cysticercosis. Although information on the survival and spread of Taenia spp. eggs is available, in general the data retrieved and reviewed in this article were old, focused on very specific geographical regions and may not be relevant for other areas or not specific for different Taenia spp. Furthermore, it is unknown whether egg survival differs according to Taenia sp. Future studies are necessary to identify sustainable methods to identify and inactivate parasite eggs in the environment and reduce their spread. Graphical Abstract

Taenia solium cysticercosis is a disease known as porcine cysticercosis (PC) in swine/pigs but also taeniosis and cysticercosis in humans. The larval stage of the pork tapeworm (T. solium) has for decades been responsible for lowering economic productivity of pigs and has direct human health defects. This study assessed the disease situation in pigs to provide baseline data for appropriate disease control in humans and pigs in Oyam district following a significant improvement in latrine coverage in Uganda. A study was conducted in Oyam district in which blood was obtained from 394 pigs and analyzed for the presence or absence of circulating antigens of T. solium using a commercial enzyme-linked immunosorbent assay (cysticercosis Ag ELISA). The sampled pigs were also subjected to lingual examination for the presence or absence of T. solium cysts. Furthermore, structured questionnaires were administered to pig owners to collect information about pig management systems, feeding, housing, sex, breed and ages of pigs as well as awareness of T. solium cysticercosis and its control. The association of risk factors with prevalence of porcine cysticercosis was assessed using chi-square and logistic regression analyses at the 95% confidence level. These results were then compared with those of Nsadha et al. (2010). The overall prevalence of PC was 27% (Lingual examination) and 33% (ELISA), indicating a 17% increase in infection rates in the district from the result of Nsadha et al. (2010). While latrine coverage increased from below 50% to 74 an increase of 24%. Local breeds, age of pigs, poor household hygiene, consuming pork and tethering and free-range husbandry systems were significant predictors of infection. There was no significant association between the possession or use of latrine and prevalence of PC in the study area. PC is still endemic in Oyam District and significant risk factors are: breeds, age, husbandry practices, pork consumption and household hygiene. Therefore, efforts to expand latrine coverage should be accompanied by improvements in latrine quality, community sensitization, and broader investments in sanitation infrastructure in the study area and in other settings with similar epidemiological profiles. Furthermore, future studies could factor in the impact of environmental contamination and latrine status to give a comprehensive picture of the epidemiology of the infection in the area.