Academic journal article Bulletin of the World Health Organization

A Proposal to Declare Neurocysticercosis an International Reportable Disease

Academic journal article Bulletin of the World Health Organization

A Proposal to Declare Neurocysticercosis an International Reportable Disease

Article excerpt

Voir page 403 le resume en francais. En la pagina 404 figura un resumen en espanol.

Introduction

Neurocysticercosis (NCC), defined as the infection of the central nervous system by the larval stage of the intestinal tapeworm Taenia solium, is the most important parasitic disease of the human nervous system and constitutes a public health challenge for most of the developing world (1-5). Millions of persons are affected by T. solium taeniosis/cysticercosis (T/C) in Latin America (2-5), Asia (6, 7), and Africa (8-12), where the disease is a factor in the extremely high prevalence rates of epilepsy.

According to the Commission on Tropical Diseases of the International League Against Epilepsy (13, 14), the age-adjusted prevalence of active epilepsy in tropical countries ranges from 10 to 15 per 1000 inhabitants, almost twice the level in Western countries (15). Brain imaging has revealed that 50-70% of all patients with NCC present with seizures (12, 15-19). NCC is the leading cause of the onset of epileptic seizures in persons aged over 25 years in countries where T. solium infection is endemic (9-12, 20-24), and it is also an important cause of seizures in paediatric age groups (25-27). Epilepsy caused by NCC consequently represents an enormous expenditure for the developing world in terms of human suffering, lost production, the cost of anticonvulsants and the utilization of medical resources. NCC may also cause arachnoiditis, hydrocephalus, visual loss, stroke, dementia and numerous other neurological problems (1-5, 28-31).

NCC has been estimated to cause at least 50 000 deaths annually (32). The disease is endemic in the Andean area of South America, Brazil, China, the Indian subcontinent, Indonesia, Mexico and Central America, Papua New Guinea, South-East :Asia, and sub-Saharan Africa (Fig. 1). Cysticercosis is rare in Eastern and Central Europe, the Caribbean Islands (except Haiti), the Southern Cone of South America, and North America (except for the south-western states of the USA). NCC is uncommon in Australia, Japan, New Zealand, and the Pacific Islands, except among immigrants and tourists. NCC is absent from Israel and certain countries of North Africa, the Eastern Mediterranean Crescent and Central Asia where pork consumption is not allowed for religious reasons. The countries affected by T/C and NCC are listed in Table 1 (1).

[Figure 1 ILLUSTRATION OMITTED]

Table 1. Countries and territories with reported cases of human cysticercosis and neurocysticercosis

North Africa and Eastern
Mediterranean Region(a)

Sub-Saharan Africa

Angola
Benin
Burkina Faso
Burundi
Cameroon
Congo
Cote d'lvoire
Ghana
Madagascar
Malawi
Rwanda
Senegal
South Africa
Togo
Zambia
Zimbabwe

North and Central America(b)

Belize
Costa Rica
El Salvador
Guatemala
Honduras
Mexico
Nicaragua
Panama

Caribbean Islands(c)

Haiti

South America

Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
French Guiana
Guyana
Paraguay
Peru
Suriname
Uruguay(d)
Venezuela

Eastern Europe

Albania(e)
Bosnia and Herzegovina(d)
Bulgaria
Croatia
Czech Republic(d)
Former Yugoslav Republic of Macedonia
Greece
Poland
Republic of Moldova
Romania
Russian Federation
Slovakia(d)
Slovenia
Yugoslavia(d)

Iberian Peninsula

Portugal(f)
Spain(f)

Indian subcontinent

Bangladesh
Bhutan
India
Nepal
Pakistan
Sikkim State
Sri Lanka(g)

Central and Eastern Asia(g)

China
Democratic People's Republic of Korea
Mongolia(e)
Republic of Korea

South-East Asia Region

Cambodia
Indonesia
Lao People's Democratic Republic
Malaysia
Myanmar
Papua New Guinea
Philippines
Thailand
Viet Nam

Western Pacific Region(h)

(a) No cases reported.

(b) Only imported cases in Canada and the USA.

(c) Cases in Guadeloupe and Martinique imported from Haiti.

(d) Imported cases and infections acquired abroad. …

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