Gabriël S, Mwape K E, Phiri I K, Devleesschauwer B, Dorny P
Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Belgium.
Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia.
Parasite Epidemiol Control. 2018 Dec 19;4:e00082. doi: 10.1016/j.parepi.2018.e00082. eCollection 2019 Feb.
The taeniosis/cysticercosis neglected zoonotic disease complex is caused by , and is associated with significant economic and public health impacts. This paper reviews the current knowledge on in Zambia and the control strategies already studied, covering almost 20 years of research, and explores the way forward. Studies on occurrence of porcine cysticercosis indicated very high prevalences, ranging from 15 to 34% based on detection of circulating antigens, and of 46% to 68% based on full carcass dissection in slaughter age pigs. Taeniosis prevalences have been reported to range from 6.3% to 12% based on copro-Ag-ELISA. Human cysticercosis prevalence results ranged from 5.8% to 13% based on serum Ag-ELISA, and from 34% to 39% based on sero-antibody detection. Later on, a study in people with epilepsy suggested neurocysticercosis to be the single most important cause of epilepsy in this endemic area, with 57% of the people with active epilepsy diagnosed with probable or definite neurocysticercosis. While the need to reduce the disease burden of in Zambia is obvious, the exact short and long term goals, and the strategies to achieve these goals, are not clear. We have selected the most promising control/elimination strategies from reviews and assessed these for feasibility via discussions with local stakeholders from both medical and veterinary sectors. The proposed measures were evaluated using the newly developed agent-based disease transmission model, cystiSim and optimised using Zambian demographic and disease data. As a control option, yearly porcine treatments were selected as best option, while the preferred strategy for elimination was determined to be the combination of human and porcine mass drug administration combined with porcine vaccination of all eligible people and pigs, in a schedule of six iterations of four monthly interventions. These interventions are currently being field tested, combined with education. Several other hurdles to control, such as cost and socio-political factors and the need for an improved advocacy and awareness creation are discussed.
猪带绦虫病/囊尾蚴病这一被忽视的人畜共患病复合体是由……引起的，并且会对经济和公共卫生造成重大影响。本文回顾了赞比亚关于……的现有知识以及已经研究过的控制策略，涵盖了近20年的研究，并探索未来的发展方向。对猪囊尾蚴病发病情况的研究表明，基于循环抗原检测，患病率非常高，在15%至34%之间；基于屠宰年龄猪的全尸解剖，患病率在46%至68%之间。据报道，基于粪抗原酶联免疫吸附测定法，猪带绦虫病的患病率在6.3%至12%之间。基于血清抗原酶联免疫吸附测定法，人类囊尾蚴病的患病率结果在5.8%至13%之间；基于血清抗体检测，患病率在34%至39%之间。后来，一项针对癫痫患者的研究表明，在这个……流行地区，神经囊尾蚴病是癫痫的最重要单一病因，57%的活动性癫痫患者被诊断为可能或确诊的神经囊尾蚴病。虽然在赞比亚减轻……疾病负担的必要性显而易见，但确切的短期和长期目标以及实现这些目标的策略尚不清楚。我们从综述中挑选了最有前景的控制/消除策略，并通过与医学和兽医部门的当地利益相关者进行讨论来评估其可行性。使用新开发的基于主体的疾病传播模型cystiSim对提议的措施进行评估，并使用赞比亚的人口和疾病数据进行优化。作为一种控制选择，每年对猪进行治疗被选为最佳方案，而消除的首选策略被确定为对所有符合条件的人和猪进行大规模药物给药，并结合猪疫苗接种，按照四个月一次、共六次迭代的时间表进行。这些干预措施目前正在结合教育进行实地测试。还讨论了控制方面的其他几个障碍，如成本和社会政治因素，以及改善宣传和提高认识的必要性。
