Taenia solium taeniosis/cysticercosis is a global health problem, especially in low-income countries in Asia, Latin America, and sub-Saharan Africa. This zoonotic parasite was more than two decades ago declared eradicable, but so far, control has not been achieved in any low- or middle-income country. In sub-Saharan Africa, only a few small scale and short-term intervention studies against T. solium have been carried out, whereas actual attempts for control have not been trialled. Challenges are missing links between human and animal health, complicated by absence of collaboration between health and livestock sectors at the ministerial level, in addition to, lack of international funding focusing on controlling this problem. However, to be sustainable control initiatives cannot solely depend on international donors in the long run. Despite T. solium getting more international attention, there are gaps in our understanding of how and when transmission of this parasite occurs, and in sub-Saharan Africa little is known about the distribution, and therefore the burden. Control of other parasitic diseases such as schistosomiasis through praziquantel treatment, also efficacious against taeniosis, is currently on-going in many African countries. The properties of praziquantel enables integrated control, but so far options for integrating control of T. solium within existing programmes have not been assessed. Therefore, the objective of the present project was to describe the epidemiology and potential impact on control of T. solium, by exploring transmission dynamics, assessing integration of control with schistosomiasis control, and developing a transmission model to evaluate intervention options, thereby contributing towards future design and implementation of feasible and sustainable control efforts against T. solium in sub-Saharan Africa.

The PhD project found that co-distribution of T. solium taeniosis/cysticercosis and schistosomiasis does occur, and in Tanzania the National Schistosomiasis Control Programme seemed to have an effect on taeniosis prevalence, and in areas with annual treatment, also on porcine cysticercosis. This could call for the integration of T. solium control in already existing programmes. Praziquantel mass drug administration was unable to break the parasite life cycle in the period investigated, and therefore presumably unsuitable as a stand-alone tool. The computational model cystiSim designed did however predict that community-wide mass drug administration could break the life cycle, if the duration of the programme was extended to more than 25 years. cystiSim predicted the best-bet option for control to be a One Health approach targeting both the definitive host through mass drug administration, and the intermediate host through mass treatment and vaccination programmes. If cystiSim proves valid, then decision makers will have a tool capable of guiding them in what is needed in terms of interventions to reach the levels of control they desire.

Supervisors

Professor Maria Vang Johansen (Supervisor) Section for Parasitology and Aquatic Diseases Department of Veterinary and Animal Sciences Faculty of Health and Medical Sciences Dyrlægevej 100, 1870-DK Frederiksberg C, Denmark

Associate Professor Pascal Magnussen (Co-supervisor) Section for Parasitology and Aquatic Diseases Department of Veterinary and Animal Sciences Faculty of Health and Medical Sciences Dyrlægevej 100, 1870-DK Frederiksberg C, Denmark and Centre for Medical Parasitology Faculty of Health and Medical Sciences Bartholinsgade 2, 1356-DK Copenhagen K, Denmark

Funding

The PhD was funded by a scholarship from the Faculty of Health and Medical Sciences, University of Copenhagen , the Bill and Melinda Gates Foundation  (ICTC-project), the Danish International Development Agency  ( SLIPP-project ), and CYSTINET: European Network on taeniosis/cysticercosis  (COST ACTION TD1302).