Verifying Elimination Programs with a Special Emphasis on Cysticercosis Endpoints and Postelimination Surveillance

Methods are needed for determining program endpoints or postprogram surveillance for any elimination program. Cysticercosis has the necessary effective strategies and diagnostic tools for establishing an elimination program; however, tools to verify program endpoints have not been determined. Using a statistical approach, the present study proposed that taeniasis and porcine cysticercosis antibody assays could be used to determine with a high statistical confidence whether an area is free of disease. Confidence would be improved by using secondary tests such as the taeniasis coproantigen assay and necropsy of the sentinel pigs. 1. Introduction Neglected tropical diseases (NTDs) are the most common infections of the world’s poorest people and the leading causes of chronic disability and poverty in low- and middle-income countries [1, 2]. As a result, global health policy makers have identified NTD control as a key element central to any strategy designed to achieve the United Nations millennium development goals (MDGs) for sustainable poverty reduction [2]. Several large-scale interventions to control and then to eliminate lymphatic filariasis, leprosy, onchocerciasis, schistosomiasis, helminthiasis, trachoma, and yaws have been conducted [1]. Molyneux et al. [3] defined control as the reduction of disease incidence, elimination as the reduction to zero incidence of a specified disease in a defined geographical area, and eradication as the permanent reduction to zero of the worldwide incidence of infection. However, the methods to measure disease reduction, elimination, or eradication are not established for many NTDs [1]. For lymphatic filariasis and schistosomiasis campaigns, antibody detection has been proposed as a measure of program success [3–6]. Cysticercosis, caused by Taenia solium, is one of the parasitic diseases that has been deemed eradicable [6]. Strategies for the elimination of cysticercosis have been tested extensively in Peru. Some of the variables evaluated included mass treatment of taeniasis cases, treatment of pigs, and pig vaccination [7–13]. Successful elimination of cysticercosis will probably require that two conditions reach the zero level: the prevalence of human taeniasis and porcine cysticercosis (Figure 1). Once the interventions are deemed effective, the next step is the selection of methods to measure program success. An extensive array of laboratory tests exists for the detection of human and porcine cysticercosis and taeniasis. The value of any of these tools for program verification is unknown. Furthermore, the