University of Liberia, Monrovia, Liberia.
Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
PLoS Negl Trop Dis. 2021 Mar 23;15(3):e0009234. doi: 10.1371/journal.pntd.0009234. eCollection 2021 Mar.
The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso.
METHODOLOGY/PRINCIPAL FINDINGS: Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces.
CONCLUSIONS/SIGNIFICANCE: Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis.
多宿主带绦虫/囊尾蚴病系统与全球范围内严重的神经发病率以及经济负担有关。我们研究了在布基纳法索的布尔基姆代、桑吉和纳亚拉三省，是否较低成本的行为干预措施足以实现当地消除人类囊虫病。
方法/主要发现：各省有关人类行为（即使用厕所和食用猪肉）以及人和猪疾病的血清流行率的数据，用于为带绦虫/囊尾蚴病系统的确定性、隔室模型提供信息。通过贝叶斯融合估计的参数提供了由于未煮熟而导致人类摄入猪带绦虫囊虫以及人类暴露于环境中的猪带绦虫卵后传播率的后验分布。通过这些途径降低传播的效果，确定了以市场为重点的烹饪行为干预和社区主导的卫生和卫生方案的独立和组合，消除人类囊虫病作为公共卫生问题（每 1000 人<1 例）所需的有效性。发现由于食用未煮熟的猪肉而导致囊虫传播在不同的传播环境中差异很大。在桑吉，由于未煮熟而导致的传播率比布尔基姆代高 6%（95%CI：1.03，1.09；p 值<0.001），比纳亚拉低 35%（95%CI：0.64，0.66；p 值<0.001）。我们发现，在市场上减少 67%和 62%的食用猪肉未煮熟，可以分别消除纳亚拉和桑吉的囊虫病。在布尔基姆代，需要减少 73%的未煮熟猪肉。通过卫生和卫生方案将人类接触猪带绦虫卵的程度减少 25%至 30%的幅度较小的减少，与各省的消除有关。
结论/意义：尽管由于当地传播动态和行为的有效性存在差异，但关于正确烹饪重要性的教育，结合社区主导的卫生和卫生工作，对于减少囊虫病和神经囊虫病的发病率具有重要意义。
