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Background Individuals diagnosed with neurocysticercosis often present with epilepsy and sometimes with progressively worsening severe chronic headaches (WSCH). While cross-sectional associations between seropositivity to cysticercal antigens and epilepsy have been reported, few large scale studies have been conducted in West Africa and none have measured the association between seropositivity to cysticercal antigens and headaches. This study aimed at filling these knowledge gaps by estimating the strength of the cross-sectional association between seropositivity to cysticercal antigens and the prevalence of epilepsy and WSCH in 60 villages of Burkina Faso, West Africa. Methodology/Principal findings Baseline data from a cluster randomized controlled trial collected from January 2011 to February 2012 in 60 villages across three provinces in Burkina Faso were used. Between 78 and 80 individuals were screened for epilepsy and WSCH in each village, and those screened positive were confirmed by a physician. Seventy-five percent of all participants were asked to provide a blood sample to test for Taenia solium cysticercus circulating antigens. Hierarchical multivariable logistic models were used to measure the association between seropositivity to cysticercal antigens and epilepsy (lifetime and active) as well as WSCH. Among 3696 individuals who provided a blood sample, 145 were found to have epilepsy only, 140 WSCH only and 19 both. There were positive associations between seropositivity to cysticercal antigens and active epilepsy (prevalence odds ratio (POR): 2.40 (95%CI: 1.15–5.00)) and WSCH (POR: 2.59 (1.34–4.99)). Conclusions/Significance Our study is the first to demonstrate a cross-sectional association between seropositivity to cysticercal antigens and WSCH in a large community-based study conducted in West Africa. The measured cross-sectional association had a strength similar to the ones previously observed between seropositivity to cysticercal antigens and lifetime or active epilepsy. As a result, preventing new cysticercosis cases in communities may reduce the prevalence of these two important neurological disorders., Author summary Taenia solium is a parasite that can be transmitted between humans and pigs in areas with poor sanitation and pig management practices. When this parasite infects the human brain, it can cause epilepsy or severe headaches. Our study aimed to measure the association between being seropositive to cysticercal antigens and having epilepsy (lifetime and active) or severe headaches in 60 villages of Burkina Faso. We found that active epilepsy and severe headaches were associated with seropositivity to cysticercal antigens. These results confirm prior studies which suggested an association between being seropositive for cysticercal antigens and these two neurological symptoms. Preventing cysticercosis could reduce new cases of these two neurological symptoms from occurring.

International audience; 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 with Sanguie), 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.

Summary Background The effectiveness of drug-free interventions in controlling human cysticercosis is not well known. We aimed to estimate the effectiveness of a community-based educational intervention in reducing the frequency of human cysticercosis in Burkina Faso. Methods We did a cluster-randomised controlled trial between 2011 and 2014. 60 eligible villages from three provinces (Boulkiemde, Sanguie, and Nayala) were randomly allocated to the intervention or control group. Villages raising pigs, that were not a regional capital or located on a main road, that were more than 20 km from Ouagadougou or 5 km from one another, were eligible. In each village, 60 participants were asked for blood samples at baseline, 18 months later (before randomisation), and 18 months after randomisation. Villages were block randomised (1:1) by pig-raising department immediately after the pre-randomisation visit. The intervention aimed to improve knowledge of Taenia solium transmission and control through screening and structured discussion of a 52-min movie, and to increase community self-efficacy through a Self-esteem, Associative strengths, Resourcefulness, Action planning, Responsibility (SARAR) approach via the Participatory Hygiene and Sanitation Transformation (PHAST) model. The primary outcome was active cysticercosis, defined as the presence of circulating antigens detected by use of B158/B60 ELISA. Effectiveness measured at the village level was estimated by use of three Bayesian hierarchical models. This study is registered with ClinicalTrials.gov, number NCT0309339. Findings Two villages in the same randomisation block were excluded, resulting in a final sample size of 58 villages. Overall, the intervention tended towards a decrease in the cumulative incidence of active cysticercosis from baseline to after randomisation (adjusted cumulative incidence ratio 0·65, 95% Bayesian credible interval [95% CrI] 0·39–1·05) and a decrease in active cysticercosis prevalence from baseline to after randomisation (adjusted prevalence proportion ratio 0·84; 95% CrI 0·59–1·18). The intervention was shown to be effective in Nayala and Sanguie but not in Boulkiemde. Interpretation Community-engaged participatory interventions can be effective at reducing the incidence and prevalence of cysticercosis in some low-resource settings. Funding US National Institutes of Health (National Institute of Neurological Disorders and Stroke, Fogarty International Center, and National Institute of General Medical Sciences).

Current guidelines for the diagnosis of neurocysticercosis (NCC) recommend the use of the lentil lectin-bound glycoprotein enzyme-linked immunoelectrotransfer blot assay (LLGP-EITB) as the reference standard for serological testing. In response to the drawbacks involved with the use of the LLGP-EITB, a recombinant T24H antigen (rT24H) EITB assay was developed, with promising results. However, the test has yet to be evaluated among individuals from sub-Saharan Africa (SSA). The aim of the present study was to investigate the performance of the rT24H EITB assay for the detection of NCC cases in a panel of serum samples (N = 366, of which 173 patients presented with epileptic seizures and/or severe chronic headaches, and 193 matched manifestation-free participants) collected as part of a large community-based trial in Burkina Faso. A perfect agreement between the rT24H EITB and the native gp24 (and its homodimer, gp42) LLGP-EITB was found (kappa value of 1.0). Furthermore, among patients with the neurological manifestations of interest who underwent a computed tomography scan, the rT24H EITB and native antigen LLGP-EITB had a comparable ability to correctly identify NCC cases with multiple viable (rT24H: sensitivity: 80.0%), single viable (66.7%), and calcified/degenerating cysts only (25.0%), albeit for multiple viable and calcified cysts, the rT24H estimated sensitivity seemed lower, but more uncertain, than previously reported. The rT24H EITB specificity was high (98.2%) and in line with previous studies. This study confirms the value of the recombinant rT24H EITB as an alternative to the native antigen LLGP-EITB for the diagnosis of NCC in a SSA community setting.

International audience; EFECAB (Epidémiologie et Fardeau Économique de la Cysticercosis au Burkina) was initiated in 2006 with a grant funded through the Brain Disorders in the developing world - Research Across the lifespan program of the National Institutes of Health in the United States (R21NS055353) followed by a more substantial grant in 2010 (R01NS064901). The pilot grant showed that human and porcine cysticercosis were not only present in Burkina Faso, but more prevalent in two of three pilot villages. A cluster randomized controlled trial was subsequently conducted to estimate the effectiveness of a community-based educational intervention to reduce the frequency of cysticercosis in 60 villages located in 3 provinces where pigs were raised. The intervention was developed using an implementation research method which resulted in offering the Participatory Hygiene And Sanitation Transformation - Self-esteem Associative strengths Resourcefulness Action planning Responsibility approach, adapted for cysticercosis, and the viewing of a 52-minutes comedy movie explaining the disease and ways to prevent it to the 30 intervention villages. In each village, 60 of 80 participants accepted to provide a blood sample on three occasions over a three year period. Blood samples were analysed with the B158/B60 AgELISA test to detect active cysticercosis. Data were analysed using Bayesian hierarchical log-binomial models adjusting for the clustering of cysticercosis by village, the change in cysticercosis prevalence prior to randomization and the fact that the intervention was offered at the village level. The intervention reduced the prevalence and cumulative incidence of active cysticercosis in 2 provinces, but had no or little impact in the 3rd province. Answers to other research questions regarding factors associated with cysticercosis, measurement of epilepsy and headaches in resource-poor settings, and the cross-reaction of the AgELISA test with T. hydatigena in pigs will be summarized.

The dynamics of the atrazine mineralization potential in agricultural soil was studied in two soil layers (topsoil and at 35–45 cm depth) in a 3 years field trial to examine the long term response of atrazine mineralizing soil populations to atrazine application and intermittent periods without atrazine and the effect of manure treatment on those processes. In topsoil samples, 14 C-atrazine mineralization lag times decreased after atrazine application and increased with increasing time after atrazine application, suggesting that atrazine application resulted into the proliferation of atrazine mineralizing microbial populations which decayed when atrazine application stopped. Decay rates appeared however much slower than growth rates. Atrazine application also resulted into the increase of the atrazine mineralization potential in deeper layers which was explained by the growth on leached atrazine as measured in soil leachates recovered from that depth. However, no decay was observed during intermittent periods without atrazine application in the deeper soil layer. atzA and trzN gene quantification confirmed partly the growth and decay of the atrazine degrading populations in the soil and suggested that especially trzN bearing populations are the dominant atrazine degrading populations in both topsoil and deeper soil. Manure treatment only improved the atrazine mineralization rate in deeper soil layers. Our results point to the importance of the atrazine application history on a field and suggests that the long term survival of atrazine degrading populations after atrazine application enables them to rapidly proliferate once atrazine is again applied.