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Introduction: Oral semaglutide is a glucagon-like peptide 1 receptor agonist (GLP-1RA) approved for improving glycemic control in adults with type 2 diabetes (T2D). The PIONEER REAL program evaluates clinical and patient-reported outcomes of oral semaglutide treatment as part of routine clinical practice across 13 countries. Here, data from Canada, Denmark, Italy, the Netherlands, Sweden, Switzerland, and the UK are pooled and analyzed to address treatment satisfaction as well as glycated hemoglobin (HbA 1C ) and body weight changes in relevant subgroup analyses., Methods: This pooled analysis encompasses seven country-specific, non-interventional, multicenter, phase 4, prospective, single-arm clinical studies assessing the use of oral semaglutide in adults with T2D. Primary endpoint was the change in HbA 1C from baseline to end of study (EOS), and secondary endpoints included changes in body weight and treatment satisfaction. For the analyses, results were stratified by age, T2D duration, and oral semaglutide dose at EOS as well as baseline HbA 1C , body weight, and body mass index., Results: Oral semaglutide treatment was initiated by 1615 participants. At EOS, 1222 (76%) participants out of the 1483 (92%) who completed the study were on treatment. Estimated changes in HbA 1C and body weight from baseline to week 38 were - 1.0%-point (95% CI - 1.08 to - 0.97; P < 0.0001) and - 5.0% (CI - 5.37 to - 4.72; P < 0.0001). Treatment satisfaction increased significantly during the study. Shorter T2D duration interacted with higher HbA 1C reduction and body weight loss. Interaction was also observed between higher baseline HbA 1C and more pronounced decrease in HbA 1C . No significant interactions were detected between clinical outcomes and age or physician setting., Conclusion: The PIONEER REAL pooled analysis shows that people initiating oral semaglutide treatment experience improved glycemic control and body weight loss across age groups and T2D duration. This occurs regardless of specialist or primary care practice setting and is accompanied by an increased treatment satisfaction., Clinical Trial Registrations: NCT04559815 (Canada), NCT04537637 (Denmark), NCT05230615 (Italy), NCT04601740 (the Netherlands), NCT04601753 (Sweden), NCT04537624 (Switzerland), NCT04862923 (UK)., Competing Interests: Declarations Conflict of Interest Gottfried Rudofsky: receives lecture fees from Novo Nordisk. Hanan Amadid: employee and shareholder of Novo Nordisk A/S. Uffe C. Braae: employee and shareholder of Novo Nordisk A/S. Sergiu-Bogdan Catrina: No conflict of interest. Anastas Kick: Lecture/other fees from NovoNordisk and Abbott. Kabirdev Mandavya: employee of Novo Nordisk A/S. Klaus Roslind: Honorarium/Moderator at Novo Nordisk meetings. Ponnusamy Saravanan: International Doctoral Training scholarship Grant from Novo Nordisk; PhD studentship funding from BHR Pharmaceuticals, UK; Joint MRC—Abbott project grant for Magic study; Lecture/other fees from Novo Nordisk, Sanofi, Lilly, Boehringer, Abbott. William van Houtum: No conflict of interest. Akshay B. Jain: Grants from Abbott, Amgen, Novo Nordisk; Honorarium from Abbott, AstraZeneca, Amgen, Bausch Healthcare, Bayer, Boehringer Ingelheim, Care to Know, CCRN, Connected in Motion, CPD Network, Dexcom, Diabetes Canada, Eli Lilly, GSK, HLS Therapeutics, Janssen, Master Clinician Alliance, MDBriefcase, Merck, Medtronic, Moderna, Novartis, Novo Nordisk, Partners in Progressive Medical Education, Pfizer, Timed Right, WebMD; Lecture/other fees from Abbott, AstraZeneca, Amgen, Bausch Healthcare, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, Gilead Sciences, GSK, HLS Therapeutics, Insulet, Janssen, Medtronic, Novartis, Novo Nordisk, Partners in Progressive Medical Education, Pfizer, PocketPills, Roche, Takeda, Ypsomed. Ethical Approval The PIONEER REAL study protocols were approved by local independent ethics committees (IEC), institutional review boards (IRB) or equivalent authorities, and studies were conducted following good pharmacoepidemiology practices (GPP) [25] and good pharmacovigilance practices (GVP) [26] in accordance with the Declaration of Helsinki [27]. All participants signed an informed consent., (© 2024. The Author(s).)

Introduction: Oral semaglutide provides an alternative to injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) for treatment of type 2 diabetes (T2D). The PIONEER REAL studies evaluate clinical outcomes of oral semaglutide treatment of T2D in a real-world setting. PIONEER REAL UK focused on adults living with T2D in the UK., Methods: The multi-centre, prospective and non-interventional single-arm study enrolled 333 participants and followed them for 34-44 weeks. Participants were treated as part of routine clinical practice and had not been previously treated with injectable glucose-lowering medication. The primary endpoint was change in glycated haemoglobin (HbA 1C ) from baseline to end of study (EOS). Secondary endpoints included change in body weight, proportion of participants with HbA 1C  < 7% (53 mmol/mol) at EOS and proportion of participants with ≥ 1%-point HbA 1C reduction and body weight reduction of ≥ 3% or ≥ 5% at EOS. Treatment satisfaction was assessed by Diabetes Treatment Satisfaction Questionnaire (DTSQ) status and change., Results: Of 333 participants, 299 completed the study and 227 were on treatment at EOS. People treated with oral semaglutide experienced significantly reduced HbA 1C by an estimated change of - 1.1%-points (95% CI - 1.27 to - 0.96; P < 0.0001) or - 12.2 mmol/mol (CI - 13.87 to - 10.47; P < 0.0001). Estimated change in body weight was - 4.8 kg (CI - 5.47 to - 4.12; P < 0.0001). At EOS, an HbA 1C level < 7% (53 mmol/mol) was recorded in 46.3% of participants. A ≥ 1%-point reduction in HbA 1C combined with a ≥ 3% reduction in body weight was observed in 36.4% of participants, and 27.1% had a ≥ 1%-point reduction in HbA 1C and a ≥ 5% body weight reduction. Treatment satisfaction improved significantly during the study. No new safety concerns or cases of severe hypoglycaemia were reported., Conclusion: People living with T2D in the UK experienced a meaningful decrease in HbA 1C and body weight after initiation of oral semaglutide treatment. No new safety issues were observed., Trial Registration: ClinicalTrials.gov: NCT04862923. Graphical plain language summary available for this article., (© 2024. The Author(s).)

Aims/introduction: PIONEER REAL Japan was a non-interventional prospective study of oral semaglutide in adults with type 2 diabetes in Japanese clinical practice., Materials and Methods: Adults naïve to injectable glucose-lowering therapies initiated oral semaglutide in routine clinical practice and were followed for 34-44 weeks. The primary endpoint was change in glycated hemoglobin (HbA 1c ) from baseline to end of study; the co-primary endpoint was number of adverse events (AEs). Secondary endpoints included change in bodyweight from baseline to end of study. Analyses were also carried out for subgroups aged <75 and ≥75 years., Results: A total of 624 participants initiated oral semaglutide; 578 completed the study. Mean baseline HbA 1c and bodyweight were 7.7% and 72.4 kg, respectively. At end of study, estimated change (95% confidence interval [CI]) in HbA 1c from baseline was -0.7 percentage points (-0.77, -0.61) overall, -0.8 percentage points (-0.86, -0.67) in the <75 years subgroup and -0.5 percentage points (-0.68, -0.41) in the ≥75 years subgroup (all P < 0.0001). Estimated change (95% CI) in bodyweight was -2.8 (-3.19, -2.50) kg overall, -2.9 (-3.38, -2.49) kg in the <75 years subgroup and - 2.7 (-3.18, -2.14) kg in the ≥75 years subgroup (all P < 0.0001). AEs occurred in 161 (25.8%) participants: 99 of 423 (23.4%) and 62 of 201 (30.8%) participants in the <75 and ≥75 years subgroups, respectively. Gastrointestinal AEs were the AEs most frequently leading to oral semaglutide discontinuation., Conclusions: In routine clinical practice, HbA 1c and bodyweight were significantly reduced from baseline in adults initiating oral semaglutide, including those aged ≥75 years, with no new safety concerns., (© 2024 The Author(s). Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Introduction: The study was designed to assess outcomes with once-daily oral semaglutide in adults with type 2 diabetes (T2D) naïve to injectable glucose-lowering agents, in Swedish clinical practice., Methods: In this non-interventional, multicentre study, participants initiated oral semaglutide and were followed for 34-44 weeks. The primary endpoint was glycated haemoglobin (HbA 1c ) change from baseline to end of study (EOS). Secondary endpoints included body weight (BW) change from baseline to EOS, proportion of participants achieving HbA 1c  < 7%, and proportion achieving both a HbA 1c reduction ≥ 1% and BW reduction of ≥ 3% or ≥ 5%, at EOS. Participants completed Diabetes Treatment Satisfaction Questionnaires (DTSQ status/change) and a dosing conditions questionnaire., Results: A total of 187 participants (mean age 62.5 years) initiated oral semaglutide. Baseline mean HbA 1c and BW were 7.8% (n = 177) and 96.9 kg (n = 165), respectively. Estimated mean changes in HbA 1c and BW were - 0.88%-points (95% confidence interval [CI] - 1.01 to - 0.75; P < 0.0001) and - 4.72% (95% CI - 5.58 to - 3.86; P < 0.0001), respectively. At EOS, 64.6% of participants had HbA 1c  < 7%, and 22.9% achieved HbA 1c reduction of ≥ 1% and BW reduction of ≥ 5%. DTSQ status and change scores improved by 1.44 (P = 0.0260) and 12.3 points (P < 0.0001), respectively. Oral semaglutide was easy or very easy to consume for 86.4% of participants. Most common adverse events (AEs) were gastrointestinal disorders; nine participants (4.8%) had serious AEs; one (0.5%) experienced severe hypoglycaemia., Conclusion: In this real-world study population, we observed significant reductions in HbA 1c and BW in people living with T2D when prescribed semaglutide tablets as part of routine clinical practice in Sweden, with improved treatment satisfaction among participants and no new safety concerns., Trial Registration: NCT04601753., (© 2024. The Author(s).)

Introduction: In this phase 4, multicentre, prospective, non-interventional PIONEER REAL Netherlands study, we assessed clinical outcomes associated with once-daily oral semaglutide use in real-world clinical practice in adults living with type 2 diabetes (T2D) naïve to injectable glucose-lowering medication., Methods: Participants initiated on oral semaglutide were followed for 34-44 weeks. Change in glycated haemoglobin (HbA1c) from baseline (BL) to end of study (EOS) was the primary endpoint; secondary endpoints included change in body weight (BW) from BL to EOS, the proportion of participants with HbA1c < 7.0% at EOS and the composite endpoints of HbA1c reduction ≥ 1.0%-points with BW reduction ≥ 3% or ≥ 5% at EOS. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ status/change). Safety was evaluated in all participants who initiated oral semaglutide treatment., Results: Oral semaglutide was initiated in 187 participants; 94.1% completed the study and 78.6% remained on treatment at EOS. At BL, 54.0% of participants were male, mean age was 58.8 years, mean duration of T2D was 8.7 years and mean body mass index was 35.1 kg/m 2 ; mean HbA1c was 8.6% and mean BW was 103.1 kg. Significant improvements from BL to EOS were observed for HbA1c and BW (estimated change [95% confidence interval]: - 1.16%-points [- 1.48 to - 0.85]; p < 0.0001, and - 5.84 kg [- 6.88 to - 4.80]; p < 0.0001, respectively). At EOS, 47.5% of participants had an HbA1c level < 7.0%; 41.8% and 35.5% of participants achieved composite endpoints of HbA1c reduction ≥ 1.0%-points plus BW reduction ≥ 3% or ≥ 5%, respectively. DTSQ status and change scores improved by 2.1 (p = 0.0003) and 10.8 points (p < 0.0001), respectively. Oral semaglutide was easy or very easy to consume for 81.5% of participants. Adverse events were mostly mild/moderate, with gastrointestinal disorders being the most common., Conclusion: In this real-world population, we reported clinically significant reductions in HbA1c and BW, improved treatment satisfaction and no new safety concerns. A graphical abstract is available with this article., Clinical Trial Registration: NCT04601740., (© 2024. The Author(s).)

Aims: Combining insulin with a glucagon-like peptide-1 receptor agonist (GLP-1RA) to treat type 2 diabetes (T2D) is common. While many studies have investigated concomitant therapy with basal insulin+GLP-1RA, few have reported on premixed insulin+GLP-1RA. We aimed to address this gap using data from the Clinical Practice Research Datalink Aurum database in England., Methods: This retrospective cohort study with propensity score matching assessed glycaemic levels and other clinical outcomes in people with T2D, comparing biphasic insulin aspart 30/70 (BIAsp 30) + GLP-1RA with basal insulin (insulin detemir/glargine U100) + GLP-1RA (from 2006 to 2021)., Results: In total, 4770 eligible people were identified; 1511 had a BIAsp 30 + GLP-1RA regimen and were propensity score-matched to an equal number receiving basal+GLP-1RA. There was no significant difference in glycated haemoglobin (HbA1c) reduction between cohorts at 6 months (p = 0.15), with a decrease of -1.07 (95% CI: -1.16; -0.98) %-points (-11.7 mmol/mol [95% CI: -12.7; -10.7]) in the BIAsp 30 + GLP-1RA cohort, versus -0.97 (95% CI: -1.07; -0.88) %-points (-10.6 mmol/mol [95% CI: -11.7; -9.6]) in the basal+GLP-1RA cohort. Body mass index (BMI) decreased by -0.35 kg/m 2 (95% CI: -0.52;-0.18) at 6 months with BIAsp 30 + GLP-1RA, versus -0.72 kg/m 2 (95% CI: -0.90;-0.54) with basal+GLP-1RA (p = 0.003). BMI was influenced by the initiation sequence of GLP-1RA in relation to insulin (p < 0.0001). Hypoglycaemia rates were low and not significantly different between cohorts., Conclusions: Combining BIAsp 30 + GLP-1RA provides glycaemic control with no significant difference to that of propensity score-matched people receiving basal insulin+GLP-1RA, with no increase in hypoglycaemia risk or weight gain., (© 2024 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Aim: PIONEER REAL Canada examined real-world clinical outcomes associated with the use of once-daily oral semaglutide in adults with type 2 diabetes., Materials and Methods: This was a 34- to 44-week, multicentre, prospective, open-label, non-interventional study in adults who were treatment-naive to injectable glucose-lowering medication and initiated oral semaglutide in routine clinical practice. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline to the end of the study (EoS). Secondary endpoints assessed at EoS were change from baseline in body weight (BW); the proportion of participants reaching HbA1c levels <7% and the composite endpoints, HbA1c reduction ≥1% point with BW reduction ≥3% and ≥5%; and treatment satisfaction measured using Diabetes Treatment Satisfaction Questionnaires (DTSQ) status and change. Primary analyses were based on the in-study observation period., Results: In total, 182 participants initiated oral semaglutide (mean age, 58.6 years; HbA1c, 8.0%; BW, 93.7 kg). The estimated changes (95% confidence interval) from baseline to EoS in HbA1c and BW were -1.09% points (-1.24, -0.94; p < .0001) and -7.17% (-8.24, -6.11; p < .0001), respectively. At EoS, 53.7% of participants had HbA1c levels <7%; 39.3% and 31.6% reached HbA1c reduction ≥1% point plus BW reduction ≥3% and ≥5%, respectively. Treatment satisfaction significantly increased (DTSQ status, +4.47 points; DTSQ change, 11.83 points; both p < .0001). At EoS, 75.3% of participants remained on oral semaglutide (55.5% received oral semaglutide 14 mg). No new safety signals were identified for oral semaglutide., Conclusions: In PIONEER REAL Canada, participants treated with oral semaglutide in routine clinical practice experienced clinically relevant reductions in HbA1c and BW and increased treatment satisfaction., (© 2024 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Introduction: Real-world data provide insight into how medications perform in clinical practice. The PIONEER REAL Switzerland study aimed to understand clinical outcomes with oral semaglutide in adults with type 2 diabetes (T2D)., Methods: PIONEER REAL Switzerland was a 34-44-week, multicentre, prospective, non-interventional, single-arm study of adults with T2D naïve to injectable glucose-lowering medication who were initiated on oral semaglutide in routine clinical practice. The primary endpoint was change in glycated haemoglobin (HbA 1c ) from baseline (BL) to end of study (EOS); secondary endpoints included change in body weight (BW) from BL to EOS and the proportion of participants achieving HbA 1c  < 7.0% and the composite endpoints HbA 1c reduction ≥ 1%-points with BW reduction ≥ 3% or ≥ 5% at EOS. Safety was assessed in participants who received ≥ 1 dose of oral semaglutide., Results: Of the 185 participants (female/male, n = 67/118) initiating oral semaglutide, 168 (90.8%) completed the study and 143 (77.3%) remained on treatment with oral semaglutide at EOS. At BL, participants had a mean age of 62 years, diabetes duration of 6.4 years, HbA 1c of 7.7%, BW of 95.6 kg and body mass index of 33.2 kg/m 2 ; 56.2% of participants were receiving glucose-lowering medications. Significant reductions were observed for HbA 1c (estimated change - 0.91%; 95% confidence interval [CI] - 1.10, - 0.71; p < 0.0001) and BW (estimated change - 4.85%; 95% CI - 5.70, - 4.00; p < 0.0001). In total, 139 adverse events (AEs) were reported in 65 (35.1%) participants; most were mild or moderate. The most frequent AEs were gastrointestinal disorders (27.0%); 31 AEs in 20 (10.8%) participants led to discontinuation of oral semaglutide. Six serious AEs were reported; all were considered unlikely to be related to oral semaglutide., Conclusion: People living with T2D treated with oral semaglutide in Switzerland achieved clinically significant reductions in HbA 1c and BW, with no new safety signals., Clinical Trial Registration: ClinicalTrials.gov: NCT04537624. A graphical abstract is available for this article., (© 2024. The Author(s).)

Aims: This study investigated the ethnic differences in glycaemic levels and clinical characteristics among insulin-naïve people with type 2 diabetes (T2D) initiating biphasic insulin aspart 30/70 (BIAsp 30) in primary practice in England., Materials and Methods: Retrospective, observational cohort study utilizing data from the Clinical Practice Research Datalink Aurum database, including White, South Asian, Black and Chinese insulin-naïve adults with T2D, initiating BIAsp 30. The index date was that of the first BIAsp 30 prescription. Endpoints included change in glycated haemoglobin (HbA1c) and body mass index (BMI) 6 months post index., Results: In total, 11 186 eligible people were selected (9443 White, 1116 South Asian, 594 Black, 33 Chinese). HbA1c decreased across all subgroups 6 months post index: estimated %-point changes [95% CI of -2.32 (-2.36; -2.28) (White); -1.91 (-2.02; -1.80) (South Asian); -2.55 (-2.69; -2.40) (Black); and -2.64 (-3.24; -2.04) (Chinese)]. The BMI increased modestly 6 months post index in all subgroups [estimated changes (95% CI) kg/m 2 : White, 0.92 (0.86; 0.99); South Asian, 0.60 (0.41; 0.78); Black, 1.41 (1.16; 1.65); and Chinese, 0.32 (-0.67; 1.30)]. In the overall population, hypoglycaemic event rates increased from 0.92 events per 100 patient-years before the index to 3.37 events per 100 patient-years post index; event numbers were too low to be analysed by subgroup., Conclusions: Among insulin-naïve people with T2D initiating BIAsp 30, clinically meaningful HbA1c reductions in all ethnicities were observed. Some ethnic groups had larger reductions than others, but differences were small. In all groups, small BMI increases were seen, with small differences observed between groups. Hypoglycaemia rates were low., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Parasite aggregation within hosts is a fundamental feature of parasite distributions, whereby the majority of parasites are harboured by a minority of hosts. Parasite aggregation can influence their transmission and hence control. In this narrative review, possible sources of aggregation of Taenia solium cysticerci in pigs are discussed, along with implications for control of the parasite. While heavy T. solium infections in pigs could most likely be associated with ingestion of high doses of infective parasite eggs, consistent with coprophagic behaviour of pigs, lighter infections indicate a role of indirect routes of transmission to pigs, mostly from lower infection doses. Light infections are likely to be missed by commonly used diagnostic methods - tongue examination or meat inspection - and end up in the food chain. Hence, they entail a 'hidden' risk and are of a particular public health concern, especially in areas where meat is consumed raw or undercooked. To be effective and sustainable, control strategies against T. solium likely require a broader understanding of, and consideration for parasite transmission dynamics. More importantly, a holistic One Health approach incorporating interventions on humans, pigs and the environment will likely have a larger, more successful and sustainable impact., Competing Interests: Uffe C. Braae is currently employed by Novo Nordisk A/S. There is no conflict of interest to declare for other authors, (© 2023 The Authors.)

Introduction: Insulin degludec (degludec) has proven benefits in type 2 diabetes (T2D), in terms of improved glycaemic control, low risk of hypoglycaemia, and flexibility in dosing time. This prospective non-interventional UPDATES study aimed to investigate whether results obtained from randomised clinical trials and other real-world studies with degludec are generalisable to patients with T2D in routine clinical practice in Saudi Arabia., Methods: Eligible adults (n = 561) with T2D received degludec for 26-34 weeks, at physicians' discretion and in accordance with local routine clinical practice. The primary endpoint was mean change in HbA 1c from baseline to end of study (EOS). Secondary endpoints included mean change from baseline to EOS in fasting plasma glucose (FPG), daily insulin dose and rate of hypoglycaemia., Results: At baseline, mean age, HbA 1c and FPG were 55.7 years, 9.4% and 185.6 mg/dL, respectively. Mean (standard error [SE]) changes from baseline to EOS (crude analysis) were statistically significant for HbA 1c (- 1.1 [0.08] %-points, 95% CI - 1.29, - 0.98; P < 0.0001), FPG (- 39.1 [3.42] mg/dL, 95% CI - 45.9, - 32.4; P < 0.0001) and total daily insulin dose (+ 4.7 [1.6] units, 95% CI 1.63, 7.86; P = 0.003, insulin-experienced population). In exploratory analysis of patients switching from insulin glargine U100 or U300 to degludec, similar reductions were seen in HbA 1c and FPG. The rate of hypoglycaemia was significantly reduced with degludec versus previous treatment, with no apparent or unexpected safety and tolerability issues. The number of insulin-experienced patients utilising resources associated with severe hypoglycaemia was also reduced. Most patients (95.5%) were willing to continue treatment at EOS, and expressed a preference for degludec over their previous regimen (93.0%)., Conclusion: Patients with T2D treated with degludec in routine clinical practice in Saudi Arabia experienced clinically significant improvements in glycaemic control and a lower rate of hypoglycaemia compared with baseline, with no new safety concerns reported., Clinical Trial Registration: NCT03785522., (© 2022. The Author(s).)

Consumer purchase data (CPD) can be a powerful tool in the investigation of foodborne outbreaks through analyses of electronic records of food that individuals buy. The objective of this study was to develop a common framework for use of CPD in foodborne outbreak investigations using the expertise of European public health professionals from 11 European countries. We also aimed to describe barriers and limitations preventing CPD utilization. CPD are mainly gathered from supermarket loyalty programmes, smaller consortia, and independent supermarkets. Privacy legislation governing CPD was perceived as the most crucial barrier for CPD usage, but still resolvable. The main practical challenges were obtaining consumer consent for CPD usage, the associated workload, data access, format, and analysis. Harmonising methods and reporting across countries, standardised consent forms and electronic consent methods were identified as solutions. This guideline was developed to support outbreak investigators in overcoming barriers in using CPD, thereby increasing public health professionals' application and value of this powerful investigation tool. In addition, we hope this framework will lead to more public health institutions, in collaboration with food safety authorities, making use of CPD in outbreak investigations in the future., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objectives: The aim of this study was to make a comprehensive economic assessment of the costs of hospital-acquired C. difficile infections (CDI). Methods: We carried out a retrospective matched cohort study utilizing Danish registry data with national coverage to identify CDI cases and matched reference patients without CDI (controls) for economic burden assessment in Denmark covering 2011-2014. Health care costs and public transfer costs were obtained from national registries, and calculated for 1 year prior to, and 2 years after index admission using descriptive statistics and regression analysis. Results: The study included 12,768 CDI patients and 23,272 matched controls. The total health care cost was significantly larger for CDI cases than controls throughout all periods. During the index admission period, cost was €12,867 per CDI case compared to €4,522 ( p < 0.001) for controls, which increased to an average of €31,388 and €19,512 ( p < 0.001) in Year 1 for the two groups, respectively. Excess costs were found both among infections with onset in hospitals and in the community. Diagnosis compatible with complications increased costs to on average >€91,000 per case. The regression analysis showed that CDI adds a substantial economic burden, but only explains about 1/3 of the crude difference observed in the matched analysis. Discussion: The major economic impact of hospital-acquired CDI with complications underlines the importance of preventing complications in these patients. Our study provides an informed estimate of the potential economic gain per patient by successful intervention, which is likely to be relatively comparable across countries., Competing Interests: RI was employed by the company i2minds. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Braae, Møller, Ibsen, Ethelberg, Kjellberg and Mølbak.)

Background: Taenia solium is a zoonotic parasite responsible for neurocysticercosis-a major cause of late-onset acquired epilepsy in humans. Lack of affordable, specific and sensitive diagnostic tools hampers control of the parasite. This study assessed the performance of an antigen detection enzyme-linked immunosorbent assay (Ag-ELISA) in the diagnosis of viable T. solium cysticercosis in naturally infected slaughter-age pigs in an endemic area in Tanzania., Methods: A total of 350 pigs were bled before they were slaughtered and their carcases examined. Serum was analyzed for circulating antigens by using a monoclonal antibody-based B158/B60 Ag-ELISA. Each carcase was examined for the presence of Taenia hydatigena cysticerci and half carcase musculature together with the whole brain, head muscles, tongue, heart and diaphragm were sliced with fine cuts (< 0.5 cm) to reveal and enumerate T. solium cysticerci. Half carcase dissection can detect at least 84% of infected pigs. Prevalence and their 95% confidence intervals (CI) were calculated in Stata 12. Sensitivity, specificity, predictive values and likelihood ratios were determined., Results: Twenty-nine pigs (8.3%, 95% CI: 5.6-11.7%) had viable T. solium cysticerci while 11 pigs had T. hydatigena cysticerci (3.1%, 95% CI: 1.6-5.5%). No co-infection was observed. Sixty-eight pigs (19.4%, 95% CI: 15.4-20%) tested positive on Ag-ELISA; of these, 24 had T. solium cysticerci and 7 had T. hydatigena cysticerci. Sensitivity and specificity were determined to be 82.7% and 86.3%, respectively. Positive and negative predictive values were 35.2% and 98.2%, respectively. Likelihood ratios for positive and negative Ag-ELISA test results were 6.0 and 0.2, respectively. There was a significant positive correlation between the titre of circulating antigens and intensity of T. solium cysticerci (r (348)  = 0.63, P < 0.001)., Conclusions: The Ag-ELISA test characteristics reported in this study indicate that the test is more reliable in ruling out T. solium cysticercosis in pigs, than in confirming it. Hence, a negative result will almost certainly indicate that a pig has no infection, but a positive result should always be interpreted with caution. Estimates of T. solium prevalence based on Ag-ELISA results should, therefore, be adjusted for test performance characteristics and occurrence of T. hydatigena.

A field trial was conducted in Tanzania to determine the effectiveness of TSOL18 vaccine used concurrently with oxfendazole (OFZ), and of OFZ alone, on T. solium cysticercosis determined by organ and half carcase dissection of slaughter age pigs. This study followed a quasi-experimental group design. Suitable trial sites were randomly allocated to either treatment group T1 (OFZ treatment alone [30mg/kg, Paranthic 10%]) or T2 (TSOL18 [1ml, Cysvax] plus OFZ). Three 4-monthly treatments were administered to eligible pigs. A random selection of pigs were necropsied at baseline and at endline, 2-3.5 months after the final treatment. Additionally, untreated pigs from T1 and T2 areas were necropsied at endline to provide contemporaneous comparisons with T1 and T2 pigs. Baseline prevalence of viable T. solium cysticerci for T1 was 25.5% (Exact 95% CI: 13.9, 40.3; n = 12/47), and for T2 was 12.0% (CI: 6.4, 20.0; n = 12/100). At endline, prevalence was 2.8% for T1 (CI: 0.1, 14.5, n = 1/36) and 0% for T2 (CI: 0, 4.7, n = 0/77). Among untreated pigs, three had viable cysticerci, one from T1 area (12.5%, CI: 0.3, 52.7; n = 1/8) and two from T2 area (5.7%, CI: 0.7, 19.2, n = 2/35). Fisher's exact test showed significant changes in prevalence from baseline to endline in both groups (T1: p = 0.005, T2: p = 0.001). Firth's penalized Maximum Likelihood method suggested the changes were not significant relative to their controls (T1: p = 0.245, T2: p = 0.076). These findings showed a significant reduction in the prevalence of viable cysticerci from baseline to endline after both interventions. However, the changes could not be definitively attributed to the interventions due, in part, to small numbers of control pigs. Concurrent administration of the TSOL18 and OFZ cleared infection among assessed pigs whereas infection remained after treatment with OFZ only. Further studies including larger sample sizes would be required for more definitive conclusions. A One Health approach is recommended for rapid and sustainable impact., Competing Interests: The authors have declared that no competing interests exist.

Background: Taenia solium taeniasis/cysticercosis is a disease of substantial economic and public health importance particularly in low-income countries. The disease was reported to be endemic in Mbeya Rural and Mbozi districts, in the southern highlands of Tanzania, the major pig production area in the country. In 2008, using B158/B60 antigen detection enzyme-linked immunosorbent assay (Ag-ELISA), porcine cysticercosis prevalence of up to 32% was reported in the districts. A number of interventions have been implemented in selected villages including an integrated approach consisting of improving pig confinement and selective treatment of pigs with oxfendazole. Mass drug administration with praziquantel targeting schistosomiasis, with an expected effect on T. solium, was also provided to school-age children in the area. This study aimed at providing an update on prevalence and intensities of porcine cysticercosis; and assessing farmers' knowledge, attitudes and practices which could be associated to disease transmission in the area. The study involved a questionnaire survey conducted using face-to-face household interviews with 890 consenting farmers; and carcass dissections performed on 282 pigs randomly selected from the surveyed households., Results: Twenty-six pigs (9.2%) were infected with T. solium; of which two-thirds (65.4%) had light to moderate infection intensities (1-1000 cysticerci), and one-third (34.6%) had heavy intensities (> 1000 cysticerci). Questionnaire results showed that only 5.7% of the respondents perceived T. solium cysticercosis to be an important disease in pigs. About 18.5% of the respondents were aware of T. solium taeniasis, but 32% of them were unaware of how the infection is acquired. Half of the respondents had seen cysticerci in pork, of whom 61% were not aware that consumption of infected pork could cause taeniasis. Latrines were observed to often (90%) lack doors with 45% considered accessible to pigs., Conclusions: This study provided an evidence that the disease was still endemic in the area. Poor knowledge of farmers, attitudes, and risky practices responsible for disease perpetuation were also revealed. A One Health approach targeting the whole area incorporating improvement of farmer knowledge regarding disease transmission needs to be trialed as a feasible approach to control.

Background: Taenia saginata is an important zoonotic parasite, causing taeniosis in humans and cysticercosis in bovines, the latter being a significant concern for the global beef industry. Many countries in East, Southeast and South Asia are experiencing rapid economic growth, and an increasing number of people in these countries are dependent on the livestock industry. Currently, however, an overview of the prevalence of T. saginata in this region is lacking. In this review, we analysed the available literature on T. saginata taeniosis and bovine cysticercosis for East, Southeast and South Asia., Methods: A systematic review was conducted, based on both published and grey literature. Articles published between 1990 and 2017 were mined for information on the occurrence, prevalence, and geographical distribution of T. saginata taeniosis and bovine cysticercosis in East, Southeast and South Asia., Results: The presence of T. saginata was described in 15 of 27 countries of the region, including Afghanistan, Cambodia, China, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Nepal, Pakistan, Philippines, South Korea, Thailand and Vietnam. The only country that reported an absence of T. saginata is Japan, although sporadic reports of imported cases and unconfirmed reports of autochthonous infections were identified. Nationwide surveys of taeniosis with systematic sample collection and high sample numbers were available for Cambodia, China, Lao PDR, and South Korea, although speciation of Taenia was not always performed. Regional prevalence of taeniosis and bovine cysticercosis in endemic regions ranged between 0.02-42.6%, and 0.76-46.7%, respectively. However, data for bovine cysticercosis were only available for five countries (Japan, Lao PDR, Mongolia, Pakistan and Vietnam)., Conclusions: The data indicate a widespread occurrence of T. saginata throughout East, Southeast and South Asia. Identification of Taenia spp. in human infections was frequently not performed, leading to gaps in knowledge about the distribution of human tapeworm infections, mainly in regions where different human Taenia species co-occur. A high prevalence of T. saginata taeniosis and bovine cysticercosis may reflect insufficiencies in sanitation, limited health education standards, and insufficient food safety measures. Therefore, there is a need to improve local surveillance, notification, and overall control systems.

The cestode Taenia solium is responsible for a considerable cross-sectoral health and economic burden due to human neurocysticercosis and porcine cysticercosis. The 2012 World Health Organization (WHO) roadmap for neglected tropical diseases called for the development of a validated strategy for control of T. solium ; however, such a strategy is not yet available. In 2019, WHO launched a global consultation aimed at refining the post-2020 targets for control of T. solium for a new roadmap for neglected tropical diseases. In response, two groups working on taeniasis and cysticercosis mathematical models (cystiSim and EPICYST models), together with a range of other stakeholders organized a workshop to provide technical input to the WHO consultation and develop a research plan to support efforts to achieve the post-2020 targets. The workshop led to the formation of a collaboration, CystiTeam, which aims to tackle the population biology, transmission dynamics, epidemiology and control of T. solium through mathematical modelling approaches. In this paper, we outline developments in T. solium control and in particular the use of modelling to help achieve post-2020 targets for control of T. solium. We discuss the steps involved in improving confidence in the predictive capacities of existing mathematical and computational models on T. solium transmission, including model comparison, refinement, calibration and validation. Expanding the CystiTeam partnership to other research groups and stakeholders, particularly those operating in different geographical and endemic areas, will enhance the prospects of improving the applicability of T. solium transmission models to inform taeniasis and cysticercosis control strategies., ((c) 2020 The authors; licensee World Health Organization.)

The cystiSim model was used to compare strategies for the control of Taenia solium. A three-monthly intervention in pigs for 3 years was substantially more effective than biannual treatment for taeniasis in the human population for 5 years. The intervention period could be shortened further by combining pig and human interventions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The zoonotic tapeworm Taenia saginata, although causing only minor discomfort in humans, is responsible for considerable economic losses in the livestock sector due to condemnation or downgrading of infected beef carcasses. An overview of current knowledge on the distribution and prevalence of this parasite in West and Central Africa is lacking., Methods: We conducted a systematic review, collecting information on published and grey literature about T. saginata taeniosis and bovine cysticercosis from 27 countries/territories in West and Central Africa, published between January 1st, 1990 and December 31st, 2017., Results: The literature search retrieved 1672 records, of which 51 and 45 were retained for a qualitative and quantitative synthesis, respectively. Non-specified human taeniosis cases were described for Nigeria, Cameroon, Senegal, Burkina Faso, Democratic Republic Congo, Guinea, and Ivory Coast (seven out of 27 countries/territories), while T. saginata taeniosis specifically was only reported for Cameroon. Most prevalence estimates for taeniosis ranged between 0-11%, while three studies from Nigeria reported prevalence estimates ranging between 23-50%. None of the studies included molecular confirmation of the causative species. The presence of bovine cysticercosis was reported for Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Democratic Republic Congo, Ghana, Guinea, Ivory Coast, Mali, Niger, Nigeria, Senegal, and Tristan da Cunha (14 out of 27 countries/territories). Prevalence estimates ranged between 0-29%., Conclusions: Our systematic review has revealed that human taeniosis and bovine cysticercosis are seriously understudied in West and Central Africa. The high prevalence estimates of both conditions suggest an active dissemination of this parasite in the region, calling for a concerted One Health action from public health, veterinary health and food surveillance sectors.

Background: Despite Taenia solium taeniosis/cysticercosis (TSTC) having been put high on the global agenda of neglected tropical diseases (NTDs), which over the last years has received a lot of attention, there has been no control programmes in place in sub-Saharan Africa, a highly endemic region. This could be attributed to lack of awareness of many stakeholders on the burden and impact of T. solium. This information is essential in guiding TSTC policies, practices and research agendas as well as encouraging cross-sectoral collaboration in the control of this important zoonotic parasite using a One Health approach. National elimination of the parasite is the foundation for global eradication. This will require that substantial country-level information is provided to all key stakeholders. We have mapped out TSTC research evidence in Tanzania to inform on disease burden and potential for integrated control measures., Methodology/principal Findings: A scoping review of all TSTC studies undertaken in Tanzania and published up to December 2018 was conducted. The articles were searched from PUBMED, AJOL, Google Scholar and Google in general. Fifty-one (51) articles met the inclusion criteria and were reviewed. Prevalence of taeniosis of 2.3% - 5.2% was estimated based on copro-antigen ELISA while human cysticercosis of >16% was estimated based on serum antigen ELISA (Ag-ELISA) or IgG Western Blot. Neurocysticercosis (NCC) contributed significantly to epilepsy in adults. Farm prevalence of porcine cysticercosis were 6.0% - 17.4% (lingual examination) and 1.5% - 33.3% (Ag-ELISA). Slaughter-slab prevalence were 0% - 18.2% (routine meat inspection). Lacking latrines, watering pigs with river or pond water, and feeding pigs with potato peels were associated with porcine cysticercosis prevalence. Washing hands by dipping method increased the risk of human cysticercosis. In 2012, the number of DALYs/1000 person-years for NCC-associated epilepsy was 0.7 (95% UI, 0.2-1.6), around 5 million USD (95% UI, 797,535-16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960-5,366,038) were potentially lost due to porcine cysticercosis. Three rounds of annual treatment of school-age children with praziquantel significantly reduced prevalence of taeniosis and porcine cysticercosis. Health education was efficacious in improving knowledge and attitudes favourable for control of TSTC while a single dose of oxfendazole 30 mg/kg body weight was efficacious in eliminating T. solium cysticerci from pig musculature., Conclusions/significance: The observed high burden of TSTC and the significant contribution of NCC to epilepsy in Tanzania warrant urgent interventions. Evaluation of best control options should make use of disease transmission dynamics models such as cystiSim, taking into account findings from the field based intervention studies. In addition, locally adapted management guidelines for people suffering from NCC are urgently needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Taenia solium is a zoonotic tapeworm widely distributed across sub-Saharan Africa. Specific health education is regarded as a central element in controlling T. solium. In 2014, an electronic health education tool called 'The Vicious Worm', which was concerned with prevention of T. solium was introduced to health and agricultural professionals in Mbeya, Tanzania, an endemic setting. Introduction to ´The Vicious Worm' of 1.5 hours significantly improved the participants' knowledge. This study revisited the same study subjects one year later to assess persistence of knowledge regarding T. solium taeniosis/cysticercosis and to assess if the health education had changed work practices for the participants and the public., Methods: The study was conducted in Tanzania between June and August 2015, with a fixed population of health and agricultural professionals recruited from a previous study testing 'The Vicious Worm'. The study used a test, a questionnaire survey, as well as semi-structured group and individual interviews., Results: The 79 study subjects, all health or agricultural professionals, had within one year relocated from Mbeya to 16 of 21 administrative regions of Tanzania. Sixty-four agreed to participate in the test and 48 to an interview. The test showed significant improvement in knowledge regarding T. solium taeniosis/cysticercosis, compared with the baseline knowledge level of the participants. Interview data found that the participants had used 'The Vicious Worm' as an educational tool and applied the knowledge from the program to implement new practices consisting of by-laws and practical workshops on building latrines, pig pens and hand washing stations in their communities., Conclusion: Introduction to 'The Vicious Worm' led to changed practices and persistence in knowledge regarding T. solium. Incorporating health education as a specific health intervention tool should be encouraged and implemented at national or programmatic level., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The zoonotic parasite Taenia saginata transmits between humans, the definitive host (causing taeniosis), and bovines as the intermediate host (causing cysticercosis). Central and western Asia and the Caucasus have large cattle populations and beef consumption is widespread. However, an overview of the extent of human T. saginata infection and bovine cysticercosis is lacking. This review aims to summarize the distribution of T. saginata in this region., Methods: A systematic review was conducted, that gathered published and grey literature, and official data concerning T. saginata taeniosis and bovine cysticercosis in central and western Asia and the Caucasus published between January 1st, 1990 and December 31st, 2018. Where no data were available for a country within this period, published data from 1985-1990 were also accessed., Results: From 10,786 articles initially scanned, we retrieved 98 full-text articles from which data were extracted. In addition, two unpublished datasets were provided on the incidence of human taeniosis. Data for human taeniosis and bovine cysticercosis were found for all countries except Turkmenistan. Human taeniosis prevalence varied from undetected to over 5.3%, with regional variations. Where bovine cysticercosis was detected, prevalences varied from case reports to 25%., Conclusions: The public health burden of T. saginata is assumed to be small as the parasite is of low pathogenicity to humans. However, this review indicates that infection continues to be widespread and this may result in a large economic burden, due to the resources utilized in meat inspection and condemnation or processing with subsequent downgrading of infected carcasses.

Background: The cestode Taenia solium causes the neglected (zoonotic) tropical disease cysticercosis, a leading cause of preventable epilepsy in endemic low and middle-income countries. Transmission models can inform current scaling-up of control efforts by helping to identify, validate and optimise control and elimination strategies as proposed by the World Health Organization (WHO)., Methodology/principal Findings: A systematic literature search was conducted using the PRISMA approach to identify and compare existing T. solium transmission models, and related Taeniidae infection transmission models. In total, 28 modelling papers were identified, of which four modelled T. solium exclusively. Different modelling approaches for T. solium included deterministic, Reed-Frost, individual-based, decision-tree, and conceptual frameworks. Simulated interventions across models agreed on the importance of coverage for impactful effectiveness to be achieved. Other Taeniidae infection transmission models comprised force-of-infection (FoI), population-based (mainly Echinococcus granulosus) and individual-based (mainly E. multilocularis) modelling approaches. Spatial structure has also been incorporated (E. multilocularis and Taenia ovis) in recognition of spatial aggregation of parasite eggs in the environment and movement of wild animal host populations., Conclusions/significance: Gaps identified from examining the wider Taeniidae family models highlighted the potential role of FoI modelling to inform model parameterisation, as well as the need for spatial modelling and suitable structuring of interventions as key areas for future T. solium model development. We conclude that working with field partners to address data gaps and conducting cross-model validation with baseline and longitudinal data will be critical to building consensus-led and epidemiological setting-appropriate intervention strategies to help fulfil the WHO targets., Competing Interests: The authors have declared that no competing interests exist.

Background: The zoonotic parasite Taenia saginata utilizes bovines as an intermediate host (causing cysticercosis) and humans as the definitive host (causing taeniosis). The public health burden of T. saginata is assumed to be low, but the economic burden is large, due to the resources utilized in the detection and condemnation of infected carcasses and carcass parts. As part of a collaborative effort to synthesize worldwide epidemiological data on this parasite, we present here the results of a systematic review on the distribution of T. saginata taeniosis and bovine cysticercosis in the Middle East and North Africa (MENA)., Methods: Information on the occurrence and prevalence of T. saginata taeniosis and cysticercosis in the MENA region was obtained through a systematic review of published and grey literature, including OIE reports, published between January 1st, 1990 and December 31st, 2017., Results: A total of 63 publications were retrieved across the 21 MENA countries. Taenia saginata taeniosis was reported in 11 of these countries, whereas unspecified taeniosis was reported for a further seven. Microscopy-based prevalence values ranged between 0.02-8.6%. Bovine cysticercosis prevalence estimates based on meat inspection were only reported for Egypt and Israel, with prevalence data ranging between 0.2-20% and 0.1-9.1% for cattle and buffaloes, respectively. The presence of bovine cysticercosis could be confirmed for 10 additional countries through OIE reports., Conclusions: Human taeniosis occurrence was confirmed for 86% (18/21) of the countries in the MENA region, although in several of these countries the species responsible was not specified. Religious prohibitions on the consumption of pork and the limited extent of pig farming across much of this region, however, suggest that many reported taeniosis cases are likely to be attributable to T. saginata rather than Taenia solium or Taenia asiatica. There was a paucity of data regarding both the prevalence and economic impact of bovine cysticercosis. More detailed epidemiological data on both T. saginata taeniosis and bovine cysticercosis could be obtained by adopting an integrated "One Health" approach, considering the characteristics (e.g. ecosystem related and sociopolitical aspects) of the MENA region. Compared with more conventional approaches, this could lead to an enhanced performance and cost-effectiveness of surveillance systems.

Background: Taenia solium taeniosis/cysticercosis is a public health and agricultural problem, especially in low-income countries, and has been ranked the top foodborne parasitic hazard globally. In 2012, the World Health Organization published a roadmap that called for a validated strategy for T. solium control and elimination by 2015. This goal has not been met, and validated evidence of effective control or elimination in endemic countries is still incomplete. Measuring and evaluating success of control programmes remains difficult, as locally acceptable targets have not been defined as part of the 2012 roadmap nor from other sources, and the performance of tools to measure effect are limited., Discussion: We believe that an international agreement supported by the tripartite World Health Organization, Food and Agriculture Organization of the United Nations, and World Organisation for Animal Health is needed to facilitate endemic countries in publicising SMART (Specific, Measurable, Achievable/attainable, Relevant, Time-bound) country-level control target goals. These goals should be achievable through locally acceptable adoption of options from within a standardised 'intervention tool-kit', and progress towards these goals should be monitored using standardised and consistent diagnostics. Several intervention tools are available which can contribute to control of T. solium, but the combination of these - the most effective control algorithm - still needs to be identified. In order to mount control efforts and ensure political commitment, stakeholder engagement and funding, we argue that a stepwise approach, as developed for Rabies control, is necessary if control efforts are to be successful and sustainable., Conclusions: The stepwise approach can provide the framework for the development of realistic control goals of endemic areas, the implementation of intervention algorithms, and the standardised monitoring of the evaluation of the progress towards obtaining the control target goals and eventually elimination.

Background: Russia is traditionally an endemic area for Taenia saginata infection, where a programme for the prevention of infection has been implemented for sixty years. This paper aims, therefore, to review the recent epidemiology data of Taenia saginata infection in the Russian Federation., Methods: We undertook a systematic review of published and grey literature, and official data for information on the incidence, prevalence and distribution of Taenia saginata taeniosis and cysticercosis in the Russian Federation between 1st January 1991 and 31st December 2017., Results: From the 404 records returned by our search strategy, we identified 17 official county reports, 17 papers and one meeting abstract on the occurrence of taeniosis or cysticercosis from the Russian Federation, eligible for inclusion in this study. In the Russian Federation, Taenia saginata infection has been continuously present and notifiable in the study period between 1991-2016. In the same area, a continuous decrease in the incidence of human taeniosis cases was observed, from 1.4 to 0.04 cases per 100,000 inhabitants, as well as a reduction in the territory where the infection is reported. The prevalence of bovine cysticercosis, ranging between 0.1-19.0%, generally has a declining trend, especially after 2005., Conclusions: Importance of Taenia saginata infection as a medical and veterinary problem has been decreasing in the 21st century but it is still an infection with health and economic impact in the Russian Federation.

Background: Due to the relative short life span and the limited spatial movement, porcine cysticercosis is an excellent indicator of current local active transmission. The aim of this study was to map at province-level, the occurrence of T. solium and T. asiatica in pigs and areas at risk of transmission to pigs in East and Southeast Asia, based on the density of extensive pig production systems and confirmed reports of porcine cysticercosis., Methods: This study covered East and Southeast Asia, which consist of the following countries: Brunei, Cambodia, China, East Timor, Indonesia, Japan, Laos, Malaysia, Mongolia, Myanmar, North Korea, Philippines, Singapore, South Korea, Thailand and Vietnam. Literature searches were carried out to identify current epidemiological data on the occurrence of porcine cysticercosis caused by T. solium and T. asiatica infections. Modelled densities of pigs in extensive production systems were mapped and compared to available data on porcine cysticercosis., Results: Porcine cysticercosis was confirmed to be present during the period 2000 to 2018 in eight out of the 16 countries included in this study. Taenia solium porcine cysticercosis was confirmed from all eight countries, whereas only one country (Laos) could confirm the presence of T. asiatica porcine cysticercosis. Province-level occurrence was identified in five countries (Cambodia, Indonesia, Laos, Myanmar, and Vietnam) across 19 provinces. Smallholder pig keeping is believed to be widely distributed throughout the region, with greater densities predicted to occur in areas of China, Myanmar, Philippines and Vietnam., Conclusions: The discrepancies between countries reporting taeniosis and the occurrence of porcine cysticercosis, both for T. solium and T. asiatica, suggests that both parasites are underreported. More epidemiological surveys are needed to determine the societal burden of both parasites. This study highlights a straightforward approach to determine areas at risk of porcine cysticercosis in the absence of prevalence data.

Background: The beef tapeworm, Taenia saginata, causing cysticercosis in bovines and taeniosis in humans, is thought to have a global distribution. In eastern and southern Africa, cattle production plays a crucial role in the economy, but a clear overview of the prevalence of T. saginata in the region is still lacking. This review aims to summarize existing knowledge on T. saginata taeniosis and bovine cysticercosis distribution in eastern and southern Africa., Methods: A systematic review was conducted, that gathered published and grey literature, including OIE reports, concerning T. saginata taeniosis and bovine cysticercosis in eastern and southern Africa published between January 1st, 1990 and December 31st, 2017., Results: A total of 1232 records were initially retrieved, with 78 full text articles retained for inclusion in the database. Unspecified taeniosis cases were reported for Angola, Ethiopia, Kenya, Madagascar, Malawi, South Africa, Tanzania, Uganda and Zambia, whereas T. saginata taeniosis cases were found for Ethiopia, Kenya, South Africa, Tanzania, Zambia and Zimbabwe. The prevalence of taeniosis ranged between 0.2-8.1% based on microscopy, and between 0.12-19.7% based on coproAg-ELISA. In Ethiopia, the percentage of tapeworm self-reporting was high (45.0-64.2%), and a substantial number of anthelmintic treatments were reported to be sold in towns. The presence of bovine cysticercosis was reported in all 27 countries/territories included in the study, except for Rwanda and Somalia, Comoros, Madagascar, Mauritius, Mayotte, Seychelles and Socotra. The prevalence of cysticercosis ranged between 0.02-26.3% based on meat inspection, and between 6.1-34.9% based on Ag-ELISA., Conclusions: Although T. saginata has been reported in the majority of countries/territories of the study area, T. saginata taeniosis/cysticercosis remains a largely ignored condition, probably due to the absence of symptoms in cattle, the lack of data on its economic impact, and the fact that human taeniosis is considered a minor health problem. However, the occurrence of bovine cysticercosis is a clear sign of inadequate sanitation, insufficient meat inspection, and culinary habits that may favour transmission. Measures to reduce transmission of T. saginata are therefore warranted and the infection should be properly monitored.

Background: The distribution of Taenia saginata in the Americas is unclear. Establishing the distribution, economic burden, and potentials for control of bovine cysticercosis is increasingly important due to the growing demand for beef. This paper aims to take the first step and reviews the recent distribution of T. saginata taeniosis and bovine cysticercosis on a national level within the Americas., Methods: We undertook a systematic review of published and grey literature for information on the occurrence, prevalence, and geographical distribution of bovine cysticercosis and human taeniosis in the 54 countries and territories of the Americas between January 1st, 1990 and December 31st, 2017. Data on bovine cysticercosis from OIE reports from 1994 to 2005 were also included., Results: We identified 66 papers from the Americas with data on the occurrence of taeniosis or bovine cysticercosis and an additional 19 OIE country reports on bovine cysticercosis. Taeniosis was reported from 13 countries, with nine of these countries reporting specifically T. saginata taeniosis, and four countries reporting non-species specific taeniosis. The reported prevalence of taeniosis ranged between 0.04-8.8%. Bovine cysticercosis was reported from 19 countries, nine identified through the literature search, and an additional 10 identified through the OIE country reports for notifiable diseases. The reported prevalence of bovine cysticercosis ranged between 0.1-19%. Disease occurrence was restricted to 21 countries within the Americas, the majority from the mainland, with the only island nations reporting either bovine cysticercosis or taeniosis being Cuba, Haiti, and the US Virgin Islands., Conclusions: Taenia saginata is widely distributed across 21 of the 54 countries in the Americas, but insufficient epidemiological data are available to estimate the subnational spatial distribution, prevalence, incidence and intensity of infections. This needs to be addressed through active surveillance and disease detection programmes. Such programmes would improve the data quantity and quality, and may enable estimation of the economic burden due to bovine cysticercosis in the region in turn determining the requirement for and cost-effectiveness of control measures.

Background: This study aimed to map the occurrence of Taenia solium taeniosis/cysticercosis at national level within Central America and the Caribbean basin, and to map the distribution of porcine cysticercosis at first-level administrative subdivision level (department level) and the porcine population at risk. This zoonotic parasite is believed to be widely endemic across most of Latin America. However, there is little information readily available for Central America and the Caribbean basin. Taenia solium has been ranked the most important foodborne parasitic hazard globally and within endemic areas is a common cause of preventable epilepsy., Methods: We conducted a structured literature search in PubMed, supplemented and crossed-referenced with relevant academic databases, grey literature, and active searches in identified literature, to identify all records of T. solium presence in Central America and the Caribbean basin between 1986 and April 2017. To retrieve grey literature, government entities, researchers and relevant institutions across the region were contacted in an attempt to cover all countries and territories. Identified records containing data on porcine cysticercosis were geo-referenced to identify department level distribution and compared to modelled distributions of pigs reared under extensive production systems., Results: We identified 51 records of T. solium at the national level, covering 13 countries and an additional three countries were included based on World Organisation for Animal Health (OIE) reports, giving a total of 16 countries out of 41 with evidence of the parasite's presence. Screening records for porcine cysticercosis data at the departmental level confirmed porcine cysticercosis presence in 11 departments across six countries (Colombia, Guatemala, Honduras, Mexico, Nicaragua and Venezuela)., Conclusions: When comparing these results to areas where pigs were kept in extensive production systems and areas where no information on porcine cysticercosis exists, it is apparent that porcine cysticercosis is likely to be underreported, and that a substantial part of the regional pig population could be at risk of contracting porcine cysticercosis. More detailed information on the distribution of T. solium and accurate burden estimations are urgently needed to grasp the true extent of this zoonotic parasite and the public health and agricultural problems it potentially poses.

This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with 'track and treat' of taeniosis cases in the general population on the copro-antigen (Ag) prevalence of taeniosis. The study was conducted in 14 villages in Mbozi and Mbeya district, Tanzania. SAC made up 34% of the population and received MDA with praziquantel (40mg/kg) in 2012 (both districts) and in 2013 (Mbozi only). Three cross-sectional population-based surveys were performed in 2012 (R0), 2013 (R1), and 2014 (R2). In each survey approximately 3000 study subjects of all ages were tested for taeniosis using copro-Ag-ELISA. In total 9064 people were tested and copro-Ag-ELISA positive cases were offered treatment 6-8 months after sampling. The copro-Ag prevalence of taeniosis was significantly higher (Χ 2 -test, p=0.007) in Mbozi (3.0%) at R0 compared to Mbeya (1.5%). Twelve months after MDA in both districts (R1), the copro-Ag prevalence had dropped significantly in both Mbozi (2.0%, p=0.024) and in Mbeya (0.3%, p=0.004), but the significant difference between the districts persisted (Χ 2 -test, p<0.001). Ten months after the second round of MDA in Mbozi and 22 month after the first MDA (R2), the copro-Ag prevalence had dropped significantly again in Mbozi (0.8%, p<0.001), but had slightly increased in Mbeya (0.5%, p=0.051), with no difference between the two districts (Χ 2 -test, p=0.51). The taeniosis cases tracked and treated between round R0 and R2 represented 9% of the projected total number of taeniosis cases within the study area, based on the copro-Ag prevalence and village population data. Among SAC in Mbozi, infection significantly decreased at R1 (p=0.004, OR 0.12, CI: 0.02-0.41) and R2 (p=0.001, OR 0.24, CI: 0.09-0.53) when comparing to R0. In Mbeya infection significant decreased at R1 (p=0.013, OR 0.14, CI: 0.02-0.55), but no difference was found for R2 (p=0. 089), when comparing to R0 among SAC. This study showed that school-based MDA with praziquantel in combination with 'track and treat' of taeniosis cases significantly reduced the copro-Ag prevalence of taeniosis, and that annual MDA was significantly better than single MDA. The persistence of taeniosis cases illustrates that a One Health approach must be emphasized for effective control., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The World Health Organization announced in November 2014 at the fourth international meeting on 'the control of neglected zoonotic diseases - from advocacy to action', that intervention tools for eliminating Taenia solium taeniosis/cysticercosis (TSTC) are in place. The aim of this work was to elucidate theoretical outcomes of various control options suggested for TSTC elimination in sub-Saharan Africa (SSA) over a 4-year period. Our current knowledge regarding T. solium epidemiology and control primarily builds on studies from Latin America. A simple transmission model - built on data from Latin America - has been used to predict the effect of various interventions such as mass treatment of humans, vaccination and treatment of pigs, and health education of communities, potentially leading to change in bad practices and reducing transmission risks. Based on simulations of the transmission model, even a 4-year integrated One Health approach fails to eliminate TSTC from a small community and in all simulations, the prevalence of human taeniosis and porcine cysticercosis start to rise as soon as the programmes end. Our current knowledge regarding transmission and burden of TSTC in SSA is scarce and while claiming to be tool ready, the selection of diagnostic and surveillance tools, as well as the algorithms and stepwise approaches for control and elimination of TSTC remain major challenges.

Taenia solium taeniasis/cysticercosis is a neglected parasitic zoonosis with significant economic and public health impacts. Control measures can be broadly grouped into community health education, improvements in hygiene and sanitary conditions, proper meat handling at household and community level, improved standards of meat inspection, pig management, treatment of individual patients and possibly human populations, and treatment and/or vaccination of porcine populations. This manuscript looks critically into currently existing control options and provides suggestions on which (combination of) tools would be most effective in the control of T. solium taeniasis/cysticercosis in sub-Saharan Africa. Field data and disease transmission simulations suggest that implementation of a single intervention control strategy will not lead to a satisfactory reduction of disease morbidity or transmission. A feasible strategy to combat T. solium taeniasis/cysticercosis would include a combination of approaches focussing on both human (health education and treatment) and animal host (management, treatment and vaccination), which can vary for different communities and different geographical locations. Selection of the specific strategy depends on cost-effectiveness analyses based on solid field data, currently unavailable, though urgently needed; as well as on health priorities and resources of the country. A One Health approach involving medical, veterinary, environmental and social sectors is essential for T. solium to be controlled and eventually eliminated. Finally the success of any intervention is largely dependent on the level of societal and political acceptance, commitment and engagement., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Health education has been recognised as a specific intervention tool for control of Taenia solium taeniosis/cysticercosis but evaluation of the efficacy of the tool remains. The aim of our study was to assess the effect of a computer-based T. solium health education tool 'The Vicious Worm' on knowledge uptake among professionals and investigate attitudes towards the program. The study was carried out between March and May 2014 in Mbeya Region, Tanzania, where T. solium is endemic. The study was a pre and post assessment of a health education tool based on questionnaire surveys and focus group discussions to investigate knowledge and attitudes. A total of 79 study subjects participated in the study including study subjects from both health- and agriculture sector. The health education consisted of 1½h individual practice with the computer program. The baseline questionnaire showed an overall knowledge on aspects of acquisition and transmission of T. solium infections (78%), porcine cysticercosis treatment (77%), human tapeworm in general (72%), neurocysticercosis in general (49%), and porcine cysticercosis diagnosis (48%). However, there was a lack of knowledge on acquisition of neurocysticercosis (15%), prevention of T. solium taeniosis/cysticercosis (28%), and relation between porcine cysticercosis, human cysticercosis, and taeniosis (32%). Overall, the study subject's knowledge was significantly improved both immediately after (p=0.001) and two weeks after (p<0.001) the health education and knowledge regarding specific aspects was significantly improved in most aspects immediately after and two weeks after the health education. The focus group discussions showed positive attitudes towards the program and the study subjects found 'The Vicious Worm' efficient, simple, and appealing. The study revealed a good effect of 'The Vicious Worm' suggesting that it could be a useful health education tool, which should be further assessed and thereafter integrated in T. solium taeniosis/cysticercosis control., (Copyright © 2016. Published by Elsevier B.V.)

Taenia solium taeniosis/cysticercosis was declared eradicable by the International Task Force for Disease Eradication in 1993, but remains a neglected zoonosis. To assist in the attempt to regionally eliminate this parasite, we developed cystiSim, an agent-based model for T. solium transmission and control. The model was developed in R and available as an R package (http://cran.r-project.org/package=cystiSim). cystiSim was adapted to an observed setting using field data from Tanzania, but adaptable to other settings if necessary. The model description adheres to the Overview, Design concepts, and Details (ODD) protocol and consists of two entities-pigs and humans. Pigs acquire cysticercosis through the environment or by direct contact with a tapeworm carrier's faeces. Humans acquire taeniosis from slaughtered pigs proportional to their infection intensity. The model allows for evaluation of three interventions measures or combinations hereof: treatment of humans, treatment of pigs, and pig vaccination, and allows for customary coverage and efficacy settings. cystiSim is the first agent-based transmission model for T. solium and suggests that control using a strategy consisting of an intervention only targeting the porcine host is possible, but that coverage and efficacy must be high if elimination is the ultimate goal. Good coverage of the intervention is important, but can be compensated for by including an additional intervention targeting the human host. cystiSim shows that the scenarios combining interventions in both hosts, mass drug administration to humans, and vaccination and treatment of pigs, have a high probability of success if coverage of 75% can be maintained over at least a four year period. In comparison with an existing mathematical model for T. solium transmission, cystiSim also includes parasite maturation, host immunity, and environmental contamination. Adding these biological parameters to the model resulted in new insights in the potential effect of intervention measures., Competing Interests: The authors have declared that no competing interests exist.

Taenia solium is found throughout sub-Saharan Africa and co-endemic with schistosomiasis in many regions. Taenia solium leads to taeniosis and neurocysticercosis - the leading cause of preventable epilepsy globally. This study aimed to assess the effects of the National Schistosomiasis Control Programme on prevalence of taeniosis and porcine cysticercosis over a four year period in Tanzania. School-based mass drug administration (MDA) of praziquantel was carried out based on schistosomiasis endemicity. Four human and five porcine cross-sectional surveys were carried out from 2012 to 2015 in Mbozi and Mbeya district in Tanzania. Three rounds of school-based MDA of praziquantel were delivered in Mbozi and two in Mbeya. The prevalence of taeniosis and porcine cysticercosis was estimated annually. Stool samples were collected from humans and prevalence of taeniosis estimated by copro-Ag-ELISA. Blood samples from pigs were collected to estimate cysticercosis prevalence by Ag-ELISA. "Track-and-treat" of taeniosis cases was carried out after each survey. In total 12082 stool samples and 4579 porcine serum samples were collected. Significantly fewer children (≤ 15) from Mbozi were infected throughout the study than children from Mbeya who showed a significant decrease in copro-Ag prevalence after the first treatment only. During the final survey in Mbozi the prevalence of taeniosis in adults (1.8%) was significantly lower (p = 0.031, OR 0.40, CI: 0.17-0.89), compared to baseline (4.1%). The prevalence of porcine cysticercosis (8%) had also dropped significantly (p = 0.002, OR 0.49, CI: 0.32-0.76) in this district compared to baseline (13%), whereas no significant difference was seen in Mbeya compared to baseline. The study suggests that three rounds of MDA targeting schistosomiasis in school-aged children combined with 'track-and-treat' contributed to a reduction in prevalence of T. solium in this population, and also had a spillover effect on adults in treated areas as well as reducing the prevalence of T. solium in the intermediate pig host population. Elimination of T. solium in this area would require a One Health approach.

Few studies have been carried out in Africa to estimate the prevalence of Taenia hydatigena. With the aim to determine the prevalence of T. hydatigena in slaughtered pigs and small ruminants (goats and sheep) in Mbeya, Tanzania, two cross-sectional surveys were carried out investigating pigs in April to May 2014 and small ruminants in September 2012. In total, 243 pigs were examined post-mortem for T. hydatigena cysts which were found in 16 (6.6 %) pigs. The majority (80 %) of cysts were found on the omentum and the rest on the liver (20 %), all on the visceral surface. Two pigs were also found infected with Taenia solium but showed no signs of other infections. A total of 392 goats and 27 sheep were examined post-mortem, and the prevalence of T. hydatigena was similar in goats and sheep with 45.7 and 51.9 %, respectively. DNA sequencing of the mitochondrial cytochrome c oxidase subunit 1 gene (cox1) from a subsample of metacestodes from goats and sheep confirmed the T. hydatigena infection. The prevalence found in small ruminants was comparable to other studies conducted in Africa, but for pigs, it is one of the highest recorded to date. The present study also confirms the occurrence of T. hydatigena and T. solium in pigs from Mbeya. Further studies are needed to determine the impact of T. hydatigena on production under sub-Saharan conditions and the financial consequences for smallholder farmers.

Attempts to control Taenia solium in low-income countries have been unsuccessful or unsustainable. This could indicate a 'missing link' in our understanding of the transmission dynamics of the parasite and possibly the magnitude of environmental contamination. We aimed to identify risk factors associated with porcine cysticercosis using a case-control study design, utilising known information on persistent or multiple infections of porcine cysticercosis. The study, a combination of questionnaire interviews and observational surveys, was conducted in July 2014 in the two districts Mbeya and Mbozi, Tanzania. Study households were identified based on their status regarding porcine cysticercosis prevalence and allocated into cases or controls based on previous porcine cysticercosis presence. This resulted in 43 farmers in the case group and 50 farmers in the control group, from 20 villages. Potato peels were said to be given to pigs either raw or boiled by 46% of the farmers. Based on logistic regression porcine cysticercosis could be associated with absence or a completely open latrine (p=0.035, OR 5.98, CI: 1.33-43.02) compared to an enclosed latrine. Feeding potato peels to pigs was also associated with increased risk of infection (p=0.007, OR 3.45, CI: 1.43-8.79). Logistic analysis including the pig management system indicated pigs kept in elevated pens (p=0.049, OR 5.33, CI: 1.08-32.27) and on a dirt floor (p=0.041, OR 9.87, CI: 1.29-114.55) were more likely to be infected compared to a cemented floor. Whether potato peels are contaminated with Taenia eggs before they reach the household or whether the contamination is from water or dirty hands during the process of peeling, remains to be confirmed. This study suggests that detailed assessment of a number of areas of pig management is essential for designing effective control programmes., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: This study aimed to map the distribution of Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa. These two major neglected tropical diseases are presumed to be widely distributed in Africa, but currently the level of co-distribution is unclear., Methods: A literature search on T. solium taeniosis/cysticercosis was performed to compile all known studies on the presence of T. solium and apparent prevalence of taeniosis and porcine cysticercosis in Africa. Studies were geo-referenced using an online gazetteer. A Bayesian framework was used to combine the epidemiological data on the apparent prevalence with external information on test characteristics to estimate informed district-level prevalence of taeniosis and porcine cysticercosis. Districts with T. solium taeniosis/cysticercosis presence were cross-referenced with the Global Neglected Tropical Diseases Database for schistosomiasis presence., Results: The search strategies identified 141 reports of T. solium in Africa from 1985 to 2014 from a total of 476 districts in 29 countries, 20 with porcine cysticercosis, 22 with human cysticercosis, and 16 with taeniosis, in addition to 2 countries identified from OIE reports. All 31 countries were considered, on national scale, to have co-distribution with schistosomiasis. Presence of both parasites was confirmed in 124 districts in 17 countries. The informed prevalence of taeniosis and porcine cysticercosis were estimated for 14 and 41 districts in 10 and 13 countries, respectively., Conclusions: With the paucity of data, T. solium infection is grossly under-reported and expected to be more widespread than this study suggests. In areas where co-distribution occurs there is a need for increased emphasis on evaluation of integrated intervention approaches for these two helminth infections and allocation of resources for evaluating the extent of adverse effects caused by mass drug administration.

The aim of the study was to assess whether blood samples collected onto FTA(®) cards could be used in combination with real-time PCR for the detection of African swine fever virus (ASFV) DNA in samples from resource-poor settings under the assumption that asymptomatically (sub-clinically) infected pigs may be present. Blood samples were collected from clinically healthy pigs from Mbeya Region, Tanzania. The blood samples were stored on FTA(®) cards and analysed by real-time PCR assays in duplicate; three pigs had high levels of viral DNA (Ct values of 27-29), and three pigs had a low level of viral DNA (Ct 36-45). Four pigs were positive in one of the duplicate samples only, but clear products of the expected size were obtained when the reactions were analysed by gel electrophoresis. For comparison, blood samples from pigs experimentally infected with either a pathogenic (OURT T88/1) or a non-pathogenic (OURT T88/3) isolate of ASFV were collected, stored on FTA(®) cards and analysed in the same way. The blood from pigs infected with the OURT T88/1 isolate showed high levels of viral DNA (Ct 22-33), whereas infection with non-pathogenic OURT T88/3 isolate resulted in only low levels of viral DNA (Ct 39) in samples collected at 10-14 days after inoculation., (© 2013 Blackwell Verlag GmbH.)

Background: Porcine cysticercosis is an emerging agricultural problem in sub-Saharan Africa. This has been documented primarily through cross-sectional studies, however detailed knowledge of the transmission dynamics of this disease in sub-Saharan Africa is lacking. This study aims to describe seasonal variations in sero-prevalence of antigen ELISA positive porcine cysticercosis in an endemic area., Methods: A longitudinal study composed of three cross-sectional surveys was carried out in Mbeya Region, Tanzania; the first two six months apart (March/April 2012 and October/November 2012) and the last eight months later (July/August 2013). Venous blood was collected from pigs in 22 villages and analysed using Ag-ELISA., Results: In each survey between 800-1000 serum samples were collected. The first survey revealed a cysticercosis sero-prevalence of 15% (n = 822, 95% CI: 13-18%). The sero-prevalence had significantly increased to 24% (p < 0.001, χ2-test, n = 812, 95% CI: 21-27%) at the time of the 6 month follow-up. At 14-months the sero-prevalence had dropped to 20% (p = 0.053, χ2-test, n = 998, 95% CI: 18-23%). Overall, this was a reduction in sero-prevalence compared with a study conducted in 2007 in the same area, where 31% (186/600) of pigs were found positive., Conclusion: Confined pigs did not have a lower sero-prevalence compared to free roaming pigs in any of the three surveys. Several factors may have contributed to the observed fluctuations such as African swine fever or seasonal variation in local crop production practices. Also, as the Ag-ELISA assay used is not species specific, variation in transmission of Taenia hydatigena could potentially influence the results. The observed fluctuations contradict a theoretical model which predicts a stable equilibrium, which only considers a two-compartment (pig and human) model excluding the effect of the environment. Whether the disease has an endemic equilibrium, or undergoes fluctuations dependent on extrinsic and/or socio-economic factors remains to be elucidated.

Ignorance is a major obstacle for the effective control of diseases. To provide evidence-based knowledge about prevention and control of Taenia solium cysticercosis, we have developed a computer-based education tool: 'The Vicious Worm'. The tool targets policy makers, professionals, and laypeople, and comprises educational materials including illustrated short stories, videos, and scientific texts designed for the different target groups. We suggest that evidence-based health education is included as a specific control measure in any control programme., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A cross-sectional study was carried out in the Mbeya Region, Tanzania, with the aim of describing the distribution and diversity of ectoparasites on pigs, within confinement and free-range production systems of smallholder farms. A total of 128 farms were surveyed, with 96 practising confinement and 32 practising free-range production systems. The prevalence of ectoparasites on pigs within confinement and free-range production systems was 24% and 84%, respectively. Logistic regression analyses revealed that keeping pigs in a free-range system and the presence of neighbouring pigs were risk factors for ectoparasites. Within the confinement system, contact with neighbouring pigs and the time interval (in months) since last ectoparasitic treatment were additionally identified as risk factors. The prevalence of Haematopinus suis was 20% in confined pigs and 63% among free-range pigs. Free-ranging of pigs and presence of neighbouring pigs were also identified as risk factors for the presence of lice. Three species of fleas were identified; Tunga penetrans, Echidnophaga gallinacea and Ctenocephalides canis. The prevalence of fleas was 5% and 13% within confined and free-range, respectively. Two pigs (2%) were found infested with Sarcoptes scabiei var. suis. Ticks found belonged to four genera; Amblyomma spp., Rhipicephalus spp., Haemaphysalis spp., and Boophilus spp. The prevalence of hard ticks among the free-range pigs was 50%. Ectoparasites were more prevalent in the free-range system although highly prevalent within both production systems. Keeping pigs in a free-range system and contact with neighbouring pigs were main risk factors for the presence of ectoparasites. Confinement was highly effective as a preventive tool against hard ticks., (Copyright © 2013 Elsevier B.V. All rights reserved.)

In 2011 African swine fever virus (ASFV) genome was detected in asymptomatic pigs in field samples in Mbeya, Tanzania. The aim of this paper is to partly characterize the virus that was harbored in these pigs and furthermore to confirm, by a second sampling, the latest occurrence of ASFV in the study area. ASFV genome was detected in serum from 10 out of 127 healthy European/crossbreed pigs. ASFV DNA was polymerase chain reaction (PCR) amplified and sequenced from sera with high viral loads using primers targeting p54 or p72. Both p54 and p72 had total identity to ASFV Genotype II (Georgia 2007/1). The ASFV epidemiology in Mbeya was studied in a new collection of 804 pig sera obtained in 2012. The antibody prevalence in four age groups (3-6 months.; 7-12 months; 13-18 months or 19-36 months) was 3-5%; all antibody positive sera were analyzed by PCR with negative results. The presence of antibodies in 3-month-old pigs confirms the circulation of ASFV in Mbeya several months after our detection of ASFV in asymptomatic pigs. The initial blood samples were obtained on Whatman FTA filter papers as dried blood samples. The samples were stored under field conditions and ASFV could be sequenced in DNA eluted 10 months later, showing the use of FTA samples. Studies on the genetic breed of the pigs are needed as well as sequence studies including the variable region of ASFV to elucidate why asymptomatic pigs with high viral loads were detected., (Copyright © 2013 Elsevier B.V. All rights reserved.)