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Factors Associated with the 18-Month Cumulative Incidence of Seroconversion of Active Infection with Taenia solium Cysticercosis: A Cohort Study among Residents of 60 Villages in Burkina Faso

Veronique Dermauw,1* H ´ el ` ene Carabin,2 Rasman ´ e Ganaba,3 Assana Ciss ´ e,4 Z ´ ekiba Tarnagda,4 Sarah Gabri ¨ el,5 Pierre Dorny,1,6 and Athanase Millogo7 1Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; 2Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; 3Agence de Formation de Recherche et d’Expertise en Sant ´ e pour l’Afrique (AFRICSant ´ e), Bobo Dioulasso, Burkina Faso; 4Institut de Recherche en Sciences de la Sant ´ e, Bobo Dioulasso, Burkina Faso;
5Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; 6Laboratory of Veterinary Parasitology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; 7Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso


Taeniasis/cysticercosis (CC) is an important disease complex with significant burden. This large-scale cohort study aimed at estimating and exploring individual- and village-level factors associated with the cumulative incidences of seroconversion (SC) and seroreversion (SR) of active human CC in three provinces of Burkina Faso. In 60 villages, blood samples were collected and interviews regarding sociodemographic variables and knowledge, attitude, and practices toward the disease complex were conducted at baseline and 18-month follow-up (N = 2,211), with the presence of active CC being determined using the B158/B60 antigen enzyme-linked immunosorbent assay (Ag-ELISA).
The 18-month Ag SC and SR were estimated at 3.3% (95% confidence interval [CI]: 2.6; 4.2%) and 35.8% (95% CI: 24.5; 48.5%), respectively. Marked provincial differences were found for the 18-month Ag SC (Boulkiemde: cumulative incidence ratio [CIR]: 2.41 (95% CI: 1.21; 4.78) and Nayala: CIR: 3.28 (95% CI: 1.37; 7.84), compared withSanguie), while not being significantly associated with other sociodemographic factors. A continued refraining from pork consumption was associated with a lower 18-month Ag SC (CIR: 0.55 [95% CI: 0.28; 1.07]), whereas at the village level, the percentage of households owning pigs was associated with a higher 18-month Ag SC (CIR: 1.03 [95% CI: 1.01; 1.05]). In conclusion, this is one of few cohort studies and the first to have enough power to assess possible causal links between individual- and village-level variables and CC in humans. Variables linked to province, pig raising, and pork consumption behaviors were found to cause Ag SC in humans. The latter results further support the importance of adopting a One Health approach to
the control of CC

The zoonotic disease complex Taenia solium taeniasis/ cysticercosis (CC) causes important monetary and nonmonetary burden in endemic areas1–5 as well as in countries
where the life cycle is unlikely to be completed, such as the United States.6 In its most severe form, T. solium cysticerci establish in the brain, causing a condition called neurocysticercosis (NCC), characterized by a range of neurological symptoms and signs, the most common being epilepsy, severe chronic headaches, and focal deficits.7 Overall, T. solium has been estimated to incur the largest number disabilityadjusted life years among foodborne parasitic infections
globally.8 In most sub-Saharan countries, including Burkina Faso, T. solium is endemic in at least some areas.9


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