**3. Traditional control measures**

#### **3.1 Health education and promotion**

As with other infectious diseases, the transmission of *T. solium* taeniasis/cysticercosis requires three key links, such as infectious source, route of transmission, and susceptible population which are correlated [21]. Health education and promotion primarily target the susceptible population and infected individuals (**Table 2**). In view of the serious harm to human health and animal husbandry for taeniasis and cysticercosis of swine, the "Qu Tao Mie Nang" movement had been extensively carried out in the endemic areas from 1970s to 1990s in Chinese mainland.

Taenia solium *Taeniasis and Cysticercosis Prevalence and Control Practice in China DOI: http://dx.doi.org/10.5772/intechopen.110628*

#### **Figure 2.**

*Three national surveys on human taeniasis/cysticercosis in China (adapted from [3]). Different colors represent different prevalence of taeniasis during three national surveys. The darker color (red) indicates the higher prevalence rate, and the lighter color (green) indicates the lower prevalence rate. Theridion solium cysticercosis was historically prevalent in northeastern, southwestern, and central China, and three national surveys claimed that the frequency of taeniasis has decreased considerably in most areas of China. However, infections have been high in areas of Southwest China with poor socioeconomic conditions, particularly in Chinese Tibet, Sichuan, and Yunnan.*

#### **Figure 3.**

*Case records from hospitalized patients with taeniasis/cysticercosis in China.*

*Field prevalence investigations of human taeniasis/cysticercosis (a) and porcine cysticercosis (b) in the past decades by regional distributions. The prevalence of porcine cysticercosis has been noticeably declining, according to a comparison of the documented cases during the slaughter quarantine for various years in the same region.*

Taenia solium *Taeniasis and Cysticercosis Prevalence and Control Practice in China DOI: http://dx.doi.org/10.5772/intechopen.110628*


**Table 2.**

*Health education and promotion for Theridion solium taeniasis/cysticercosis in China (adapted from [34]).*

The main objective of the movement was the treatment of the human taeniasis and elimination of pig cysticercosis. The strategy of the same movement was the early treatment of taeniasis in patients once diagnosed, carry out extensive pork quarantine in urban and rural areas to ensure the quality of meat products, speed up the transformation of rural toilets, and improve the environmental sanitation to obstacle the disease transmission routes, and treatment of human patients and pigs with cysticercosis with the application of effective drugs. It refers to a comprehensive social and political process that includes not only improving individual knowledge, lifestyle, and life skills, but also changing societal, environmental, and economic conditions to reduce the negative effects of parasitism on individuals and communities [20, 21].

#### **3.2 Meat inspection**

Pork contaminated with cysticercus is a major source of human *T. solium* taeniasis and cysticercosis transmission. Inspection of pork at slaughter is an important public health measure to prevent the transmission of *T. solium* to humans [16]. However, meat inspection is usually only effective in detecting heavily infected carcasses and is not much reliable in detecting lightly infected carcasses because it depends on the expertise of the meat inspector [35]. Cysticerci can be confused with sarcocystis, milk spots, hydatid cysts, and even unstructured fat and muscle fasciae [35, 36].

Unfortunately, in some parts of China, national pork inspection guidelines are insufficient for detecting cysticercosis. In particular, illegal slaughters occur frequently when pigs are suspected of having cysticercosis in order to avoid economic loss due to the fear of infected pigs likely to be confiscated [16]. Another example is the consumption of raw or under-cooked pork as a traditional way of life in some areas, particularly in/from Sichuan, Yunnan, and Guangxi, China, where pigs are raised in substandard conditions [28, 30, 31, 33, 37, 38]. These days, great strides have been made in health education and promotion.

### **3.3 Chemotherapy**

For the current chemotherapy, it is now possible to actively identify and treat parasite-infected patients, and even to perform mass chemotherapy due to the availability of effective anthelmintic drugs, such as praziquantel (PZQ ), niclosamide, albendazole, and others [8, 20, 39, 40]. Therefore, the possible sources of infections could be minimized to the greatest extent possible, and the transmission of *T. solium* taeniasis/cysticercosis could be controlled.

The treatment of cysticercosis must be tailored to the location of the lesions, the stage of disease progression, and the host's immune response [41]. In most cases, antiparasitic drugs should be used to destroy live or degenerating cysticerci [9]. It has been reported that the therapeutic effects of albendazole and praziquantel treatments for cerebral cysticercosis are well understood, and the combination treatment using albendazole and praziquantel treatments can increase the therapeutic efficacy for cerebral cysticercosis [20]. However, due to their high toxicity, these drugs are used at concentrations that inhibit parasite growth and reproduction rather than killing them [42]. Thus, novel targets and compound classes with low toxicity and high efficacy at low doses are urgently needed for disease prevention, control, and intervention. Recently, a combination of pumpkin seeds and areca nut has been investigated against taeniasis, while praziquantel and albendazole are administrated concurrently against cysticercosis with promising efficacy and low side effects [3].

While adult worm infestations are largely asymptomatic, living in the intestine without causing harm, the larval stages, particularly cysts, can cause symptomatic pathologic symptoms, often leading to serious life-threatening conditions as they spread to other body parts such as the brain, muscles, or other organs including the liver. Depending on the patient's condition and cyst location, NCC is traditionally treated with chemotherapy or surgery. In severe cases, such as for NCC, surgery is required to lower intracranial pressure and resolve hydrocephalus [43, 44]. It is performed when cysts lodge in such areas of the brain that may cause CSF obstruction, resulting in hydrocephalus. Given the advances in minimally invasive techniques, minimally invasive neurosurgery can be successfully applied in cases of mild NCC (i.e., only a few cysts), especially in the case of a single cyst [45]. Surgery is the only option for ocular cysticercosis due to the risk of blindness from antiparasitic reactions, and asymptomatic subcutaneous or intramuscular cysticerci do not require treatment [3].

Surgical treatments are needed in some patients afflicted with cerebral cysticercosis with very high intracranial tension, but not all the cysticercus can be removed completely. Antiparasitic therapy cannot be substituted. Therefore, antiparasitic drugs are still required after surgery [20].
