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Randomized Controlled Trial
. 2021 Sep;27(9):2389-2398.
doi: 10.3201/eid2709.203349.

Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru

Randomized Controlled Trial

Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru

Seth E O'Neal et al. Emerg Infect Dis. 2021 Sep.

Abstract

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p<0.001), despite a smaller proportion of population treated by targeted approaches (RS 1.4%, RT 19.3%, MT 88.5%). Our findings suggest multiple approaches can achieve rapid control of T. solium transmission.

Keywords: Neglected tropical diseases; One Health; Peru; enteric infections; epidemiology; food safety; neurocysticercosis; parasites; pork tapeworm; public health intervention; taeniasis; zoonoses.

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Figures

Figure 1
Figure 1
Lifecycle of the Taenia solium tapeworm in humans and pigs.
Figure 2
Figure 2
Flowchart of participating villages, humans, and pigs in a study of Taenia solium intervention strategies, Peru. Humans were treated with niclosamide, pigs (when treated) with oxfendazole. MT, mass treatment; RS, ring screening; RT, ring treatment.
Figure 3
Figure 3
Timeline showing interventions in humans and pigs during a study of Taenia solium tapeworms, Peru. NSMm, presumptive treatment with niclosamide for humans; NA, not applicable; NSMr, presumptive treatment with niclosamide for humans only in rings; OXFm, presumptive treatment with oxfendazole for pigs; OXFr, presumptive treatment with oxfendazole for pigs only in rings; SCRr/NSMr, stool screening and treatment with niclosamide for humans with diagnosed taeniasis only in rings.
Figure 4
Figure 4
Cumulative Taenia solium seroincidence among pigs by study approach over time, Peru. A) Ring screening; B) ring treatment; C) mass treatment. In ring screening, human participants living near pigs with cysticercosis were screened for taeniasis using stool coproantigen; identified cases were treated with niclosamide. In ring treatment, human participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment, human participants received treatment with niclosamide every 6 months regardless of location. Diamonds indicate point estimates; vertical bars indicate 95% CIs.
Figure 5
Figure 5
Comparison of cumulative Taenia solium seroincidence among pigs by study arm over time, Peru. A) Ring screening; B) ring treatment; C) mass treatment. Each intervention approach used niclosamide for human taeniasis in villages. Each approach included 2 arms: 1 with oxfendazole treatment of pigs for cysticercosis and 1 without pig treatment. In ring screening, participants living near pigs with cysticercosis were screened for taeniasis using stool coproantigen; identified cases were treated with niclosamide. In ring treatment, participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment, participants received treatment with niclosamide every 6 months regardless of location. Diamonds indicate point estimates; vertical bars indicate 95% CIs.

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