Eating habits of East Asian people and transmission of taeniasis

Culture, eating behavior, and infectious disease control and prevention

Humans need to obtain nutrients from foods for survival and health. Culture and belief play important roles in food selection and intake. Throughout human history, dietary factor has been one of the important factors inducing and causing outbreaks of infectious diseases. If unhealthy eating behavior, like eating raw/undercooked food or meat and products from wild animals, are not abandoned, foodborne infectious diseases will remain an important risk factor of outbreaks and epidemics. The misconception of dietary culture is one of the important factors that triggers unhealthy eating behavior. Therefore, it is vital to change people’s conceptions and knowledge about what is healthy to eat, in order to completely eliminate unhealthy eating behavior and prevent the recurrence of foodborne infectious diseases. Meanwhile, many factors such as family, society, region, and religion should be involved in.

Towards a cysticercosis-free tropical resort island: A historical overview of taeniasis/cysticercosis in Bali

Taeniasis and cysticercosis are known to be endemic in several Indonesian islands, although relatively little recent epidemiological data are available. As most Indonesian people are Muslims, taeniasis/cysticercosis caused by the pork tapeworm, Taenia solium, has a restricted presence in non-Muslim societies and is endemic only among some Hindu communities on the island of Bali. Bali has long been known to be endemic for taeniasis/cysticercosis; almost a century ago levels of cysticercosis of 20-30% were described in cattle and 2-3% in pigs. Few studies of taeniasis/cysticercosis were undertaken in Bali prior to a series of research programs commenced since the 1990s. Both Taenia saginata and T. solium continue to be endemic in Bali. Molecular studies have revealed that all T. saginata-like tapeworms detected in Bali are T. saginata. No evidence has been found for the presence of Taenia asiatica in Bali. Economic, sanitary and education improvements across much of the island over the past decades have been associated with a decline in the amount of transmission of T. solium such that the parasite now seems to be restricted to the eastern part of the island, a small area on the northeastern slope of Mt. Agung, the highest mountain in Bali. The living environment including sanitation and hygiene condition in this endemic area remains relatively poor especially during the half-year dry season, and pigs continue to roam freely. In this review, historical records and ongoing projects towards elimination of taeniasis/cysticercosis in Bali are reviewed to provide a better understanding of the present situation of taeniasis/cysticercosis in Bali towards a future, cysticercosis-free tropical resort island.

A Review of Zoonotic Infection Risks Associated with the Wild Meat Trade in Malaysia

The overhunting of wildlife for food and commercial gain presents a major threat to biodiversity in tropical forests and poses health risks to humans from contact with wild animals. Using a recent survey of wildlife offered at wild meat markets in Malaysia as a basis, we review the literature to determine the potential zoonotic infection risks from hunting, butchering and consuming the species offered. We also determine which taxa potentially host the highest number of pathogens and discuss the significant disease risks from traded wildlife, considering how cultural practices influence zoonotic transmission. We identify 51 zoonotic pathogens (16 viruses, 19 bacteria and 16 parasites) potentially hosted by wildlife and describe the human health risks. The Suidae and the Cervidae families potentially host the highest number of pathogens. We conclude that there are substantial gaps in our knowledge of zoonotic pathogens and recommend performing microbial food safety risk assessments to assess the hazards of wild meat consumption. Overall, there may be considerable zoonotic risks to people involved in the hunting, butchering or consumption of wild meat in Southeast Asia, and these should be considered in public health strategies.

Epidemiology and genetic diversity of Taenia asiatica: a systematic review

Taenia asiatica has made a remarkable journey through the scientific literature of the past 50 years, starting with the paradoxical observation of high prevalences of T. saginata-like tapeworms in non-beef consuming populations, to the full description of its mitochondrial genome. Experimental studies conducted in the 1980s and 1990s have made it clear that the life cycle of T. asiatica is comparable to that of T. saginata, except for pigs being the preferential intermediate host and liver the preferential location of the cysts. Whether or not T. asiatica can cause human cysticercosis, as is the case for Taenia solium, remains unclear. Given the specific conditions needed to complete its life cycle, in particular the consumption of raw or poorly cooked pig liver, the transmission of T. asiatica shows an important ethno-geographical association. So far, T. asiatica has been identified in Taiwan, South Korea, Indonesia, the Philippines, Thailand, south-central China, Vietnam, Japan and Nepal. Especially this last observation indicates that its distribution is not restricted to South-East-Asia, as was thought so far. Indeed, the molecular tools developed over the last 20 years have made it increasingly possible to differentiate T. asiatica from other taeniids. Such tools also indicated that T. asiatica is related more closely to T. saginata than to T. solium, feeding the debate on its taxonomic status as a separate species versus a subspecies of T. saginata. Furthermore, the genetic diversity within T. asiatica appears to be very minimal, indicating that this parasite may be on the verge of extinction. However, recent studies have identified potential hybrids between T. asiatica and T. saginata, reopening the debate on the genetic diversity of T. asiatica and its status as a separate species.

Taeniases and cysticercosis in Indonesia: past and present situations

The main aim of this study is to overview the past and present situations of human taeniases and cysticercosis in Indonesia and including future perspectives. Through joint projects from 1996, we have confirmed the occurrence ofTaenia saginata(beef tapeworm) in Bali, ofTaenia solium(pork tapeworm) mainly in Papua and sporadically in Bali, and ofTaenia asiaticain North Sumatra. These taeniases were caused through eating uncooked pork and pig viscera forT. soliumandT. asiatica, respectively, and beef forT. saginata. The distribution of these tapeworms in Indonesia is basically highly restricted by the traditional cultural and religious backgrounds in each island.T. saginatais relatively common in Bali although people consume pork ‘lawar’more than beef ‘lawar’. Taeniases due toT. saginataorT. asiaticaandT. soliumand cysticercosis due toT. soliumhave also been sporadically reported in some other islands. Among these species,T. soliumis exceptional since humans can be infected not only by larval stages (cysticerci) in pork but also by eggs released from human tapeworm carriers. Cysticercosis has been confirmed in Indonesia in humans, pigs and even dogs.

The economic impact of pig-associated parasitic zoonosis in Northern Lao PDR

The parasitic zoonoses human cysticercosis (Taenia solium), taeniasis (other Taenia species) and trichinellosis (Trichinella species) are endemic in the Lao People's Democratic Republic (Lao PDR). This study was designed to quantify the economic burden pig-associated zoonotic disease pose in Lao PDR. In particular, the analysis included estimation of the losses in the pork industry as well as losses due to human illness and lost productivity. A Markov-probability based decision-tree model was chosen to form the basis of the calculations to estimate the economic and public health impacts of taeniasis, trichinellosis and cysticercosis. Two different decision trees were run simultaneously on the model's human cohort. A third decision tree simulated the potential impacts on pig production. The human capital method was used to estimate productivity loss. The results found varied significantly depending on the rate of hospitalisation due to neurocysticerosis. This study is the first systematic estimate of the economic impact of pig-associated zoonotic diseases in Lao PDR that demonstrates the significance of the diseases in that country.

Molecular evidence of host influences on the evolution and spread of human tapeworms

The taeniasis/cysticercosis complex is included in the list of neglected zoonotic diseases by the World Health Organization due to its significant impact on public health in tropical areas. Cysticercosis is still endemic in many regions of Asia, Africa and Latin America. Long absent in Europe and in other developed countries, cysticercosis has recently re-emerged in the United States and Canada, due to immigration, travel and local transmission. This has encouraged the use of molecular data to understand better the influence of animal and human hosts on the emergence and spread of Taenia species. The increasing number of mitochondrial sequences now available from human tapeworms and recent advances in computational tools has enabled reconstruction of the biogeography and evolutionary history of these organisms. New molecular data have provided insights into the biogeography of T. solium, T. asiatica and T. saginata. A Bayesian statistical framework using variable evolutionary rates from lineage to lineage has allowed an improved timescale analysis of human tapeworms. The dates of divergence obtained were compared to the timing of evolutionary events in the history of their hosts, based on the hypothesis that Taenia spp. and their hosts share a common history. Herein, we review changes in the definitive and secondary hosts and human interactions that underlie the differentiation and evolution of tapeworms. Species diversification of Taenia seems to be closely linked with the evolution of intermediate hosts in response to climatic events during the Pleistocene. Different genotypes of T. solium emerged when European and Asian wild boar Sus spp. populations diverged. Taenia saginata emerged when wild cattle Bos primigenius evolved and when zebu Bos indicus and taurine Bos taurus ancestors separated. Humans through migrations and later with the development of farming and animal husbandry may have had a significant impact on the spread and diversification of tapeworms. Migrations of Homo erectus from Africa to Asia and later of Homo sapiens facilitated the diversification and dispersal of T. solium and T. saginata populations. The development of animal husbandry, making Sus scrofa and Bos taurus preferential intermediate hosts, led to the worldwide distribution of parasites. New molecular data combined with an innovative dating method allow us to explain the ways in which ancient human migrations promoted the emergence and spread of taeniasis and cysticercosis around the world. Another intriguing phenomenon explained better by our approach is the influence of human settlement on the spread of these parasites in recently inhabited areas. The diverse nature of T. solium currently observed in Madagascar may correspond to multiple imports of the parasite during Austronesian migrations, while in Mexico a recent influence of humans during the colonial period is more likely. Human activities, especially food preparation and husbandry methods, remain responsible for the transmission and persistence of these parasites.

Neurocysticercosis: Current knowledge and advances

Neurocysticercosis is the most common cause of acquired seizures worldwide. Most cases of this larval stage infection of the pork tapeworm Taenia solium occur in the developing world, although increasing numbers of cases are being recognized in the United States, particularly among Hispanic immigrants. The ability of the pathogen to persist for years within the host is the subject of immunologic and biochemical investigation. The major presenting symptom is seizures, although symptoms of obstructive hydrocephalus occur if cysts are located near the ventricles or in the subarachnoid spaces. Diagnosis is dependent on clinical, radiologic, and serologic data. Therapy with antiparasitic agents, especially albendazole, is effective in large burden disease or disease within sensitive neuraxis sites (the ventricles, the subarachnoid spaces). When patients with radiologically enhancing disease are given cysticidal therapy, there appears to be a reduction in seizure recurrences. Surgery is indicated for disease in selected anatomic sites. Long-term prevention requires attention to pork husbandry and general sanitation, including the potential use of mass human chemotherapy and porcine vaccination.

Prevalence of intestinal parasite infections on a national scale among primary schoolchildren in Laos

In order to investigate the epidemiological situation of intestinal parasite infections in Laos, parasitological surveys were carried out on a national scale including 17 provinces and the Vientiane Municipality. A total of 29,846 stool specimens were collected from primary schoolchildren from May 2000 to June 2002 and examined once with the cellophane thick smear technique. The cumulative egg positive rate for intestinal helminths was 61.9%. By species, the rate for Ascaris lumbricoides was 34.9%, hookworm 19.1%, Trichuris trichiura 25.8%, Opisthorchis viverrini 10.9%, Taenia spp. 0.6% and Hymenolepis spp. 0.2%. The northern mountainous regions such as Phongsaly, Huaphan or Saysomboune Province showed a higher prevalence (over 70%) of soil- transmitted helminths. The regions along the Mekong River such as Khammuane, Saravane or Savannakhet Province showed a higher prevalence (over 20%) of fish-borne parasites. On the other hand, Schistosoma mansoni eggs were detected in 1.7% of schoolchildren only in Champassak Province, a previously endemic area. The highest prevalence was noted in Phongsaly Province (96.0%) and the lowest in Bolikhamxay Province (27.5%). An additional small-scale survey by cellophane anal swab detected Enterobius vermicularis eggs in 35.7% of 451 schoolchildren aged 6-8 years in Khammuane, Vientiane, Champassak Province and the Vientiane Municipality. Meanwhile, the mean blood haemoglobin level of hookworm-infected children was not lower than that of children not infected with hookworm, suggesting that nutritional factors are more important than parasite infection per se. Nevertheless, the above results indicate that a nationwide parasite control project is necessary to reduce possible morbidity due to parasitic diseases in the country.

Seroepidemiology of Toxoplasma gondii infection among two mountain aboriginal populations and Southeast Asian laborers in Taiwan

A seroepidemiological survey of Toxoplasma gondii infection among Atayal and Paiwan mountain aborigines and Southeast Asian laborers in Taiwan was assessed from February 1998 to July 2000 using a latex agglutination test. To determine risk factors for T. gondii infection among Taiwan aborigines, the consumption of raw meat and valley water were given particular attention in a self-administered questionnaire. The overall seroprevalence of T. gondii infection was 19.4% for Atayal, 26.7% for Paiwan, 42.9% for Indonesian, 14.7% for Thai, and 11.3% for Filipinos. No significant gender difference in seroprevalence was found among Atayals, Paiwans, Indonesians, and Filipinos (P > 0.05). In the Thai group, however, males had a higher seroprevalence than females (P < 0.001). Results of the multiple logistic regression analysis indicate a higher odds ratios (OR) with age in both aboriginal groups. In contrast, the OR was lower among older Indonesians and Thais. Those Atayals and Paiwans with a history of eating raw meat seemed more susceptible to T. gondii infection than those who had never consumed raw meat. Ethnically, a significant difference in seroprevalence was observed between Indonesians and Paiwans, Atayals, Thais, and Filipinos (P < 0.001).

Rodent model for long-term maintenance and development of the viable cysticerci of Taenia saginata asiatica

Although oncospheres of Taenia saginata asiatica can develop into cysticerci in immunodeficiency, immunosuppressed, and normal mice, no detailed information on the development features of these cysticerci from SCID mice is available. In the present study, the tumor-like cyst was found in the subcutaneous tissues of each of 10 SCID mice after 38-244 days inoculation with 39,000 oncospheres of T. s. asiatica. These cysts weighed 2.0-9.6 gm and were 1.5-4.3 cm in diameter. The number of cysticerci were collected from these cysts ranged from 125 to 1,794 and the cysticercus recovery rate from 0.3% to 4.6%. All cysticerci were viable with a diameter of 1-6 mm and 9 abnormal ones each with 2 evaginated protoscoleces were also found. The mean length and width of scolex, protoscolex, and bladder were 477 x 558, 756 x 727, and 1,586 x 1,615 microns, respectively. The diameters of suckers and rostellum were 220 microns and 70 microns, respectively. All cysticerci had two rows of rostellar hooks. These findings suggest that the SCID mouse model can be employed as a tool for long-term maintenance of the biological materials for advanced studies of immunodiagnosis, vaccine development, and evaluation of cestocidal drugs which would be most benefit for the good health of the livestocks.

Asian (Taiwan) Taenia: Species or strain?

Recent studies on the epidemoiological pattern of taenisis in Southeast Asia have indicated the existence of a third form of human Taenia which is distinguishable from Taenia saginata and T. solium. Don McManus and Josephine Bowles here review how new genetic evidence supports earlier conclusions that the Asian Taenia is a distinct entity but is closely related T. saginata, and suggests its taxonomic classification as a subspecies or strain of T. saginata is more appropriate than formal designation as a new species.