Taeniasis/cysticercosis situation in Nepal

The zoonotic pork tapeworm, Taenia solium, is becoming an increasing problem in Nepal with high prevalences of porcine cysticercosis and human taeniasis/cysticercosis detected in epidemiological studies undertaken in different parts of the country. Pig farming and marketing have increased dramatically in the country in recent years due to increased consumer demand for pork as the country's caste system has become relaxed. Postmortem surveys of pigs at slaughter establishments in Kathmandu and Dharan municipality showed 14% (34/250) of pigs positive for cysticercosis. Antemortem detection of T. solium infection of pigs in a Syangja District community indicated 32% (136/419) of pigs positive by lingual examination while 24% (48/201) was serologically positive by Enzyme-linked Immunoelectro Transfer Blot (EITB) and 6% (12/201) showed evidence of old infection or exposure with 42 kDa and 50 kDa. A human helminthological survey in Syangja District in central Nepal indicated a very high prevalence of taeniasis, with 43% positive (77/180), while in Tanahun District 18% were positive (28/152). Taeniasis infection appears directly related to the ethnic groups surveyed and their food habits, literacy rates, and hygiene and sanitation. The prevalence of taeniasis among the ethnic groups surveyed, ie Magars, Sarkies, Darai, and Bote, was found to be 50, 28, 10, and 30%, respectively. Magar people are known for rearing pigs and eating much more pork than other ethnic groups, while the Sarkies are the poorest of the ethnic groups and are known to consume rotting cattle carcasses. At this time, the species of Taenia infecting these different ethnic groups has not been identified. Human cysticercosis cases were reviewed on the basis of hospital-based data. During the past five years, records from Patan Hospital, Bir Hospital, and Kanti Children's Hospital reported 62, 4, and 11 cysticercosis cases in Kathmandu, respectively. These hospitals had different standards with regard to diagnostic capacity, reporting, and recording systems. At the time of the study, there were only six neurosurgeons and six CAT scanners active in Nepal, all of which, except for one CAT scanner in Dharan, were located in Kathmandu. Neurocysticercosis cases from Nepal are also being diagnosed and treated at hospitals and clinics in India. This preliminary evidence suggests that taeniasis/cysticercosis is a serious and growing problem in Nepal, requiring urgent attention. A proper and thorough risk assessment of the situation involving both the health and agriculture sectors is needed, to determine whether and how the T. solium situation in Nepal should be managed.