Establishing a Global Campaign for Combating Cysticercosis: An Opportunity for Improving Human Health and Livestock Production in Developing Countries

Transcription

1 Establishing a Global Campaign for Combating Cysticercosis: An Opportunity for Improving Human Health and Livestock Production in Developing Countries A. L. Willingham 1,2, M. V. Johansen 1,3 & T. F. Randolph 2 1 WHO/FAO Collaborating Center for Parasitic Zoonoses The Royal Veterinary and Agricultural University Frederiksberg, Denmark 2 Livestock, People and the Environment Programme International Livestock Research Institute, Nairobi, Kenya 3 DBL-Institute for Health Research & Development Charlottenlund, Denmark on behalf of Cysticercosis Working Group in Eastern and Southern Africa and Bellagio Establishing a Global Campaign for Combating Cysticercosis Conference Group

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3 Global distribution of Taenia solium cysticercosis/taeniosis High prevalence Moderate prevalence Low prevalence (imported cases) No information available/no evidence

4 Regional projections of total demand and consumption of pork (million tonnes) PORK Developed Region Developing Region 39 81

5 The pig population in Africa increased 284% during the 20 year period far more than for any other livestock species during that time period and the trend continues.

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7 Larval Taenia solium cysts in pig muscles

8 Larval Taenia solium cysts on pig s tongue

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10 Subcutaneous cysts in a Vietnamese cysticercosis patient

11 Neurocysticercosis - the most common preventable cause of epilepsy!

12 Prevalence of Human and Porcine Cysticercosis Infection and Human Taeniasis in 8 Villages in the Central Sierra of Peru Prevalence (%) Canchayllo Centro Progreso Pampas Llacta Santa Cruz 27 de Mayo Casacancha Village From Garcia et al., 2002 Taeniasis - Humans (CoproAg) Cysticercosis - Humans Cysticercosis - Pigs

13 Taenia solium cysticercosis potentially eradicable Humans are the only definitive hosts Human tapeworm infections sole source of infection for intermediate host pigs Domestic pigs can be managed No wildlife reservoirs exist Safe & effective chemotherapy available

14 Strategies for Intervention Courtesy of U.S. Centers for Disease Control and Prevention Mass taeniacidal treatment Improve sanitation Cook meat Control slaughter Meat inspection Restrain pigs Treat pigs Vaccinate pigs*

15 Treatment of T. solium infections Human taeniosis Praziquantel (5 10 mg/kg single dose) Niclosamide (2 g single dose) Human cysticercosis Praziquantel (50 mg/kg daily x 15 days) Albendazole (15 mg/kg daily x 8 days) Porcine cysticercosis Oxfendazole (30 mg/kg P.O. single dose)

16 Control of Taenia solium infections Most likely best bet options Mass treatment for human taeniosis Mass treatment/vaccination of pigs Health Education and Agricultural Extension Added value Reduce epilepsy Increase smallholder pig production

17 International Task Force for Disease Eradication Recommendations - Potentially Eradicable Diseases Poliomyelitis 1 Mumps 1 Rubella 1 Dracunculiasis 1 Lymphatic Filariasis 1 Cysticercosis 2 1 Through World Health Assembly resolutions and the establishment of global alliances all have received attention for their eradication/elimination but cysticercosis which is now classified as one of the neglected diseases in neglected populations 2 Zoonosis

18 ITFDE 2003 review of cysticercosis conclusions and recommendations Demonstration of effective control/elimination of T. solium transmission on a national scale to stimulate further action ( Proof of Principle example) Program strategy including multiple interventions in flexible mass or targeted approaches Economic factors should be considered in designing any control program Need better documentation of the prevalence and economic impact and for epidemiologic studies to better understand cysticercosis transmission dynamics Evaluate the impact of interventions involving the mass distribution of praziquantel and albendazole (eg schistosomiasis, lymphatic filariasis) on cysticercosis/ taeniosis (and vice versa).

19 Cysticercosis: One of the Neglected Diseases in Neglected Populations Lack of awareness presence burden & impacts Perceived low burden of disease Indecision on which sector(s) should take responsibility for investigation and control health vs. agriculture lack veterinary public health infrastructure

20 International Action Planning Workshop on Taenia solium Cysticercosis August, 2002 Arusha, Tanzania Current global situation Tools available for diagnosis, prevention & control Technical and financial support available Formulation of a Regional/Global Action Plan for research & control Activities

21 Measuring the Burden of Taenia solium Cysticercosis Essential evidence base making the case securing political will - prioritization financial/technical support Necessary for cost-benefit analysis Consider the health, agricultural and other impacts together

22 WHO initiative on Assessing the Global Burden of Cysticercosis Objectives: To estimate the societal cost of cysticercosis in selected developing and developed countries around the world To construct country-specific decision analysis trees to reflect the variation in the prevalence and the probability of diagnosis and treatment of human and porcine cysticercosis To describe the international variability in the monetary burden of cysticercosis

23 Gathering and organising information for the assessment Literature review Published/unpublished/grey literature Identify a range of possible values for the epidemiological and economical parameters Submission of data from local collaborators Epidemiological data Agricultural data Economical data Decision tree analyses Organise the information in a tree for easier understanding of the process

24 Cysticercosis consequences Social stigmatisation Individual, farm and community levels May remain after treatment Impact on smallholder farming communities Human health, social and family life and productivity protein-energy malnutrition (reduced meat quality and condemnation of pig carcasses) seriously reduces farmers household income

25 Cysticercosis consequences Reduction in trade regional national international Public health costs to diagnose, treat, monitor epilepsy cases and associated accidents burns traffic accidents drowning

26 Preliminary estimate of the costs of Cysticercosis, Eastern Cape, SA Cost (US$1,000) OVERALL COSTS (HUMANS) OVERALL COSTS (PIGS) OVERALL COSTS (ALL) Category

27 Establishing a Global Program for Combating Cysticercosis Rockefeller Foundation s Conference Center Bellagio,, Italy 7 9 September 2004

28 Objectives of the Bellagio Conference Presentation of results of burden and impact assessment of cysticercosis Consideration of current regional status of cysticercosis and constraints for research & control Consensus for needs, justification and benefits of a global alliance for combating cysticercosis Consideration of best practices for establishing a successful global cysticercosis program Formulation of an appropriate and sustainable Action Plan for launching a global program

29 Outcomes of the Bellagio Conference Consensus for the establishment of a global program for combating cysticercosis International Cysticercosis Coordination Center Regional Working Groups established based on CWGESA model Regional Reference Centers established for diagnostics, training, etc. Inclusion in new WHO Neglected Diseases initiative? Inclusion in FAO Pro-Poor Livestock Livestock Policy initiative?

30 Donors (public, private) FAO Goals WHO - Steering Committee (stakeholders) - Tech. Advisory Committee ICCC Resource mobilization Coordination FAO-WHO Collaborating Center (KVL/DBL) Regional networks, individual researchers, collaborating institutions

31 ILRI s Planned Activities to Assist in Combating Cysticercosis Facilitating Risk Analysis initially securing the evidence base (epi & eco) Assisting Development/Transfer of Tools diagnostics T. solium vaccine Promoting Awareness, Advocacy, Alliances networks (ESA, WCA, SA & SEA)

32 Cysticercosisrelated issues Poverty: Cause & Effect Health Inequity Food Security & Safety Environmental Health Risk Linkage with Epilepsy Trade Barrier Impacts on Tourism Hinders Development

33 Cysticercosis research & control as a catalyst Epilepsy Cysticercosis Research & Control Human health/ well-being Sanitation Other parasitic/ infectious diseases Pig Management Meat Inspection

34 Current situation Gates Foundation support for Elimination Initiative of Cysticercosis Initiative in Peru Wellcome Trust support for porcine cysticercosis vaccine development and testing Need to prepare endemic countries for using this Proof of Principle and tools for prevention and control! The actions have been planned now we need the means

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