Presentation at 3rd GRF One Health Summit 2015 Session Wildlife, Livestock and Pets

1. Fostering Intersectoral Collaboration For Control Of
Taeniasis And Cysticercosis In Humans And Pigs
3rd GRF One Health Summit
October 2015
A Colston

2. Background I
• Cysticercosis caused by Taenia solium metacestode larval stage in
intermediate hosts is a worldwide public health problem
• The human tapeworm carrier is the definitive host and source of T.
solium eggs, which are released in faeces
Slide 1

3. Background II
• T. solium oncospheres develop into the larval stage in pigs or
humans after the ingestion of the released eggs
• Larval cysts of T. solium cause neurocysticercosis (NCC) when
larvae encyst in the human central nervous system
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4. Life-cycle of Taenia solium
Parasite Immunology Vol 36 (8) p388-396
http://onlinelibrary.wiley.com/doi/10.1111/pim.12126/full#pim12126-fig-0001

5. Geographical Distribution
• T. solium strains from geographically diverse regions are
conserved
Slide 4
Source: WHO (World Health Organisation)

6. Control of T. solium
Education – latrine use, handwashing, correct cooking of pork,
improved meat inspection of swine carcasses
Mass treatment of humans – niclosamide, praziquantel
Mass treatment of swine - oxfendazole
Vaccination of swine
Tethering or penning of swine - to prevent
coprophagia
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7. Effectiveness of Control Strategies I
Education – latrine use, handwashing, correct cooking of pork,
inspection of swine carcasses at abattoir and condemnation
Variable results, need for infrastructure development, sustainability?
43% reduction in prevalence of porcine cysticercosis (Ngowi et al. 2008)
Cultural barriers
Mass treatment of humans
Efficacy in the short term has been demonstrated
Sensitisation important to achieve adequate coverage
Fears/ misconceptions
Slide 6
From WHO Landscape analysis – Control of Taenia solium. Author: Thomas 2015

8. Effectiveness of Control Strategies II
Mass treatment of swine
Oxfendazole most effective; anthelmintic resistance/ meat withdrawal
Up to 100% efficacy after single dose of 30mg/kg, short term
Vaccination of swine
TSOL 18 most effective
Up to 100% reduction in prevalence after primary course, short term evaluation
Tethering or penning of swine - to prevent coprophagia
Some evidence it is effective in reducing prevalence
High cost – feed, housing
Combination strategies
Offers best chance of sustainable control
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9. TSOL18 Vaccine History
• 1999 – Oncosphere antigens shown to be protective
• Plancarte, A., … & M. W. Lightowlers (1999). Vaccination against T. solium cysticercosis in
pigs using native and recombinant oncosphere antigens. Int. J. Parasitol. 29:643–647.
• 2004 - TSOL18 identified as potential protective antigen from oncosphere
proteins
• Flisser, A., … & M. W. Lightowlers (2004). Induction of protection against porcine
cysticercosis by vaccination with recombinant oncosphere antigens. Infect. Immun.
72:5292–5297.
• 2007 - Expression and stability improved by movement to eukaryotic
expression system
• Cai, X. et al. (2007). Effective Production and Purification of the Glycosylated TSOL18
Antigen, Which Is Protective against Pig Cysticercosis. Infection & Immunity 76(2): 767-
770.
• 2010 – field studies with TSOL18 showed good protection in pigs
• Assana, E., …& Lightowlers, MW. Elimination of Taenia solium transmission to pigs in a
field trial of the TSOL18 vaccine in Cameroon. Int J Parasitol. 2010 Apr;40(5):515-9.
Slide 8

10. Oxfendazole in Swine
2012 Significant reduction in risk of taeniasis with single dose
Pondja A, Neves L, Mlangwa J, Afonso S, Fafetine J, et al. (2012) Use of Oxfendazole to
Control Porcine Cysticercosis in a High-Endemic Area of Mozambique. PLoS Negl Trop
Dis 6(5): e1651. doi:10.1371/journal.pntd.0001651
2012 – High tissue OFZ levels after single dose, 17 day withdrawal. Human
use?
L. Moreno, M.T. Lopez-Urbina, C. Farias, G. Domingue, M. Donadeu, B. Dungu, H.H. García, L.A.
Gomez-Puerta, C. Lanusse, A.E. González, A high oxfendazole dose to control porcine cysticercosis:
Pharmacokinetics and tissue residue profiles Food and Chemical Toxicology 50 (2012) 3819–3825
2013 - Single 30 mg/kg oral dose showed a 100% efficacy against all
the nematode parasites
Luis Alvareza, Carlos Saumell, Luis Fusé, Laura Moreno, Laura Ceballos, Gilbert Domingue, Meritxell
Donadeu, Baptiste Dungu, Carlos Lanusse. Efficacy of a single high oxfendazole dose against
gastrointestinal. Veterinary Parasitology 194 (2013) 70– 74
Slide 9

11. Delivering Effective Control Strategies
• Complex National Picture
• Different National strategies for human and livestock disease
• Cultural/ behavioural practices
• Accessibility/ delivery
• Other threats eg ASF
• Private sector versus Public sector
• Multi agency approach
• Human versus veterinary
• Different approaches in different countries
• Private (pharma companies, individual farmer pays)
• Public (National government ministries, NGOs)
• Integration sharing resources e.g extension staff
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12. Public Sector
• National organisations
• Human and veterinary disease control are often dealt with separately
• National primary health care schemes
• National livestock health programmes e.g. Cameroon
• Potential to integrate with other NTD control programme e.g. SCI
• NTD and Water and sanitation sector
• International
• WHO
• FAO
• NGOs
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13. Private Sector
• Human Pharma
• Integrate with other NTDs
• Veterinary Pharma
• Harmonisation of drug registration
• Different distribution channels
• Individual farmer pays
• Difficult for vaccine if no perceived benefit
• OFZ broad spectrum anthelmintic benefits
• Pig farming is a low cost production system
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14. GALVmed Survey Key Findings
• Need to increase awareness of Porcine Cysticercosis and its
effects on human health and pig production
• Drug distributors and extension workers
• Educate butchers and traders
• Agricultural legislation
• RSA PC is notifiable
• Pig confinement legislation
• Not enforced
• Individual farmer pays
• Cameroon public good
• Uganda and RSA private good
• Tanzania mixed public and private
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15. Project Objectives
• Availability of Pig Tools
• Oxfendazole (demonstrate efficacy at 30mg/kg p.o., register claim with MCI,
Morocco (Paranthic® 10%), expand registration in Uganda, Tanzania, RSA, Nepal
• TSOL18 vaccine (M. Lightowlers, Univ of Melbourne), Commercial Production
(IIL), registration in India, then Nepal, Uganda, Tanzania, RSA
• Field trials in Uganda, Tanzania, RSA, Nepal
• Determine effectiveness of concurrent administration of OFZ/TSOL 18 over 18-24
months in high endemic areas
• Working with District Veterinarians, NGO, Stakeholders
• In areas where human MDA of praziquantal for schistosomiasis control
• To develop integrated control models
Slide 14

16. Monitoring and Evaluation
• Coverage of mass drug administration (pigs and human)
• Analytical (pigs and humans)
• Awareness
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17. THANKYOU!!
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