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168 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** 4.16 Taeniasis and (neuro)cysticercosis Introduction Taeniasis is a parasitic zoonosis caused by the tapeworm Taenia solium. Humans acquire the infection by eating raw or undercooked pork. Millions of tapeworm eggs (invisible to the naked eye) are excreted into the environment through infected people’s stool. Pigs become infected by eating human stool containing eggs or by ingesting eggs from the environment. Eggs develop into small cysts throughout the pig’s body (porcine cysticercosis). Humans can also become infected with T. solium eggs by ingesting contaminated food or water (human cysticercosis) or as a result of poor hygiene. Tapeworm larvae (cysticerci) develop in the muscles, skin, eyes and the central nervous system. When cysts develop in the brain, neurocysticercosis may result. Symptoms include epilepsy, severe headache and blindness, and can be fatal. Neurocysticercosis is the most frequent preventable cause of epilepsy worldwide. Fig. 4.16.1 Countries and areas at risk of cysticercosis, 2012 Endemic (full life-cycle) Suspected endemic Imported cases (possible human cysticercosis transmission) No data available Not applicable
*** THE DISEASES − CHAPTER 4 169 Investment case In Peru, symptoms of neurocysticercosis have been estimated to cause to the average sufferer a loss of 44.5 hours of productive activity per month. Such symptoms cause two-thirds of wage-earners to lose their jobs, and only 61% are able to re-engage in wage-earning activities. 1 Annual losses due to porcine cysticercosis have been estimated at about US$ 25 million for 10 West and Central African countries in 2002, 2 and US$ 5 million for the Eastern Cape Province of South Africa in 2004. 3 Porcine cysticercosis has a serious impact on pigproducing communities, leading to poor-quality pork, falling pork prices or pork being condemned as unfit for human consumption, thereby reducing income and rendering an important source of protein unsafe to eat. Investment targets for veterinary public-health interventions may be included in updates to the analyses contained in Chapter 2 of this report. 4 _____________________ 1 URajkotia Y, Lescano AG, Gilman RH, Cornejo C, Garcia HH, Cysticercosis Working Group of Peru. Economic burden of neurocysticercosis: results from Peru. Trans R Soc Trop Med Hyg. 2007;101:840–6. doi:10.1016/j.trstmh.2007.03.008. 2 Zoli A, Shey-Njila O, Assana E, Nguekam J-P, Dorny P, Brandt J et al. Regional status, epidemiology and impact of Taenia solium cysticercosis in Western and Central Africa. Acta Trop. 2003;87:35–42. doi:10.1016/S0001-706X(03)00053-6. 3 Carabin H, Krecek RC, Cowan LD, Michael L, Foyaca-Sibat H, Nash T et al. Estimation of the cost of Taenia solium cysticercosis in Eastern Cape Province, South Africa. Trop Med Int Health. 2006;11:906–16. doi:10.1111/j.1365-3156.2006.01627. 4 Maurice J. Of pigs and people–WHO prepares to battle cysticercosis. Lancet. 2014;384:571–2. doi:10.1016/S0140-6736(14)61353-2. Burden and distribution The lack of data on this zoonotic disease results from the absence of any systematic programme to generate them; the data therefore remain fragmented. There are indications, however, that the burden of cysticercosis may be emerging in South Africa due to value and trade patterns in pig production. T. solium cysticercosis is especially common where humans live in close proximity with their pigs, with low levels of sanitation and poor understanding of porcine management. Cysticercosis has been a serious public-health problem in Latin America for decades (1). The disease is endemic in South and South-East Asia (2) and is emerging in large areas of sub-Saharan Africa (Fig. 4.16.1; Table 4.16.1). New reports of neurocysticercosis cases are re-emerging in the developed world, with recent reports in Europe (3) and the United States of America (4). WHO estimates that at least 50 million people worldwide have epilepsy. Neurocysticercosis is responsible for about 30% of epilepsy cases in endemic countries (6) and around 3% globally ( 7). The Global burden of disease (2010) study estimated that neurocysticercosis was responsible for around 0.5 million DALYs per year. In low- and middle-income countries where pork is consumed, the burden of epilepsy is almost 6.8 million DALYs per year (8). Where access to health services is limited, mortality due to neurocysticercosis is about 3–6 times higher in these disadvantaged populations than in the general population.
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