Cysticercosis Public Health Significance

Two species of tapeworms may be transmitted to humans by ingestion of the larval or cysticercus stage encysted in the meat of livestock. These two species are Taenia sagin-ata, the beef tapeworm, and T. solium, the pork tapeworm (3). The latter is of special significance because humans may also serve as an intermediate host for the cysticercus (larval) stage, where it often localizes in the brain, causing the disease termed neurocysticercosis. Neurocysticercosis is a major public-health problem in many areas of the world, especially Latin America (22). Neurocysticercosis, although an acute life-threatening disease in severe cases, is more often a long-lasting infection affecting the quality of the patient's life and social environment. The disease is of socioeconomic importance because 75% of patients with neurocysticercosis are at productive ages and are frequently unable to work soon after the onset of symptoms. Calculations of costs for medical care, such as hospitalization, chemotherapy, neurosurgery, and computed tomography, show that US$14.5 million were spent in Mexico during 1986 to treat only the 2,700 new hospitalized cases of neurocysticercosis. For these reasons, neurocysticercosis is recognized as being of major public-health significance. Furthermore, swine cysticerosis is considered a significant economic problem because of the condemnation of pig carcasses. In Mexico, more than US$43 million were lost in 1980, the equivalent of 68.5% of the total investment in pig stock production. In the southwest United States, human neurocysticerosis is increasingly encountered. The magnitude is suggested by the fact that in Los Angeles, fecal examinations revealed more than 60 positives out of 12,000 examined (23). In one neurologic service, 45 cases were reported over a 5-year period. High rates are also seen in other areas of the world. A 1984 survey in India revealed that 4% of humans were infected with adult Taenia and more than 17% of swine were infected with cysti-cerci of T. solium (24).

The bovine form, T. saginata, although less severe in humans because it is confined, as the adult worm stage, to the human intestine, does represent a considerable economic cost because inspection of beef carcasses for cysti-cerci is mandatory, although the incidence is very low. In the United States, the rate of bovine cysticercosis identified by carcass inspection has been less than 0.3/1,000 over the last 10 years. These rates frequently are higher in certain Western states because of sporadic outbreaks. For example, in 1984, the rate for Washington was 1.9/1000 (25).

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