Evaluation of a One Health public health program based on minimum inputs to control Taenia solium in Madagascar

Cysticercosis in humans caused by the parasite Taenia solium is one of the World Health Organizations Neglected Tropical Diseases. The parasite is transmitted between the human host and pigs. Efforts to prevent the disease have relied mainly on treatment of people with anthelmintics. However to date there is no practical and effective control method that has been delivered as a public health program. Here we describe a large-scale, minimum inputs T. solium control program implemented as a public health program in Madagascar. Initially pigs were vaccinated for porcine cysticercosis and medicated with oxfendazole, after which only young piglets and pigs imported into the program area were targeted for interventions. After piglet interventions were in place and on-going, a single mass drug administration (MDA) was delivered to the human population with a taeniacide. The outcomes were assessed one year after the human treatment, by comparing pre-and post-intervention levels of human T. solium taeniasis and porcine cysticercosis caused by T. solium. Over a twenty-two-month period, 96,735 pig vaccinations were delivered and during the MDA, 117,216 people received taeniacide. Ninety percent of the pig population were receiving vaccination and medication at the end of the intervention period. Coverage of the eligible human population by the MDA was 62.5%. Human taeniasis was found to be 1.25% prior to the MDA and 0.6% one year after the MDA. Prior to the intervention 30.8% of slaughter-age pigs had viable T. solium infection whereas no viable infection was detected in any pig treated in the program. The program successfully demonstrated effective control of T. solium transmission using minimum inputs and delivered as a public health program. Sustained control and expansion of the program could potentially lead to the elimination of the disease being a public health problem in Madagascar. Author summaryCysticercosis caused by the cestode parasite Taenia solium is one of the World Health Organizations neglected tropical diseases. We implemented One Health cysticercosis control as a public health program in a highly endemic region of Madagascar. The program was designed to require minimum inputs while achieving maximum impacts on control within a short period of time. Pigs were vaccinated with the TSOL18 vaccine and simultaneously treated with oxfendazole. Over a 2-year period, piglets 2-3 months of age were treated. After pig vaccination practices where established, the human population received a single treatment with a taeniacide. The program was evaluated by assessment of porcine cysticercosis and human taeniasis before and 12 months after the human mass drug administration. More than 95,000 pig vaccinations were delivered and 117,000 persons received taeniacide. The intervention entirely eliminated viable porcine cysticercosis in slaughter-age pigs that had received treatment as well as reducing human taeniasis. Continuation and expansion of the program would have the potential to eliminate T. solium from the program area, or even from the entire country.