The only source of infection for humans and pigs is the human tapeworm carrier. Moreover, the adult Taenia solium tapeworm has a very high biotic potential, meaning that a single worm can infect many hosts in its surroundings. For all these reasons the tapeworm carrier is the main target of control interventions. Tapeworm carriers may be treated and cured either by case diagnosis and individualized treatment or by mass treatment of the human population with a single oral dose of either niclosamide (2 g in adults) or praziquantel (5–10 mg/kg). Diagnosis of taeniasis is usually made by stool microscopy after concentration by sedimentation, with poor sensitivity (under 70 %) (García et al. 2007a). Detection of tapeworm antigens in stools (coproantigen detection), described by Allan et al. (1990), is a much more sensitive technique but is not widely available beyond research settings.

Mass treatment is logistically easier and likely much cheaper. However, there is a theoretical risk that the administration of antihelminthic drugs to an individual who has silent neurocysticercosis could trigger seizures or other neurological symptoms. This has been reported in a few individuals after a single dose of praziquantel (Flisser et al. 1993; Johnson 1986; Torres et al. 1988) or after a single dose of the commonly used antihelminthic albendazole (García et al. 2007b; Ramos-Zuniga et al. 2013). This seems to be a rare event since praziquantel is routinely administered in mass-treatment campaigns for schistosomiasis in Africa, some of which are also endemic for cysticercosis, and reports of neurological side effects are rare (Johnson 1986). Niclosamide does not have this drawback but it is poorly available in many parts of the drug (as it also happens with praziquantel). Adding mass niclosamide or praziquantel treatment to existing mass deworming programs has been suggested as a highly cost-effective control strategy (Alexander et al. 2011).

A series of experiences with mass chemotherapy have been performed in several countries. Between 1985 and 1987, Cruz et al. (1989) de-parasitized over 10,000 individuals in Loja, Ecuador, using a single dose of 5 mg/kg of praziquantel. They found 1.6 % of taeniasis by patient’s self-report and published a reduction in porcine cysticercosis after the program. This program, however, was interrupted soon after its implementation, and a few years after stopping control, transmission returned to levels close to baseline. Díaz Camacho et al. (1991) performed mass praziquantel treatment in a village of 559 individuals in Sinaloa, Mexico. The authors reported no taeniasis cases or cysticercosis-infected pigs 1 year after the intervention and noted a marked clustering around tapeworm carriers. However, 1 year after the intervention, porcine cysticercosis detected by tongue examination had raised from 6 to 11 % (Keilbach et al. 1989). From 1991 to 1996, Sarti et al. (2000) worked in three villages in Morelos, Mexico. In one of them, mass chemotherapy with 5 mg/kg praziquantel was 67 % effective to treat human taeniasis. The prevalence of taeniasis dropped by half, and there was also a long-term drop in porcine seroprevalence and a decrease in late-onset seizures. Health education was tested in one of these villages and shown to decrease transmission of taeniasis/cysticercosis very fast after the intervention (Sarti et al. 1997). In the third community, where both health education and mass praziquantel treatment were administered together, the prevalence of human taeniasis did not show an impact along time, but porcine prevalence decreased gradually (Pawlowski et al. 2005).

Between 1994 and 1996, Allan et al. (1997) used mass niclosamide therapy in approximately 2,000 people in two villages in Guatemala and dropped the prevalence of taeniasis from 3.5 to 1 %, accompanied by a marked drop in pig seroprevalence. More recently, an educational intervention was also tested in 42 villages (827 households) in Mbulu district, Tanzania. It resulted in improved knowledge of the disease without apparent changes in observed risk practices; however, the incidence of porcine cysticercosis was significantly reduced in the intervention arm (Ngowi et al. 2008). Wide efforts in China using health education, mass chemotherapy, and environment management are reported to have reduced porcine cysticercosis by 97 % and human taeniasis by 91 % along 6 years (Wu et al. 2012).

Treatment of the human tapeworm carrier ignores the porcine reservoir. Mathematical modeling strongly suggests that driving disease transmission to an extinction state would require multiple sustained interventions in the human population, for a very long time (Gonzalez 1997). Treatment of infected pigs would avoid future taeniasis infections and increase the likelihood of elimination. Flisser and coworkers (1990a, b) demonstrated the efficacy of praziquantel to eliminate muscle cysts in pigs. Tellez-Giron et al. (1981) reported 100 % efficacy with 10 days of flubendazole, Gonzalez et al. (1995) reported good efficacy of multiple doses of albendazole, and Peniche-Cardenas et al. (2002) reported similar effects using 8 days of intramuscular albendazole sulfoxide. Most of these regimes require multiple doses which is highly impractical in field conditions. Oxfendazole, given as a single oral dose of 30 mg/kg, is close to 100 % effective to destroy muscle cysts; it is not expensive and has no major side effects. Death of cysts usually occurs along a few weeks. The withdrawal period of oxfendazole at this dose was calculated to be 17 days. Oxfendazole treatment of pigs at 4 and 9 months of age as a single control measure was tested in two groups of 54 pigs each and 108 controls in Mozambique; significant decreases in pig infection were found, more marked when pigs were treated at 9 months of age (Pondja et al. 2012).

Combined human and pig treatment was applied by the Cysticercosis Working Group in Peru in ten villages in Huancayo, at the Peruvian central highlands. The effect was measured in pig seroincidence and demonstrated a significant decrease followed by a rapid return to levels close to baseline, quick after the intervention was stopped (García et al. 2006).

A third major pathway of intervention is the immunization of the porcine population. Molinari et al. (1993) performed a large trial of pig immunization using a crude cysticercal extract in 3,295 animals, a proportion of which were vaccinated twice. No infected animals were reported 1 year after the intervention, although it is unclear how infection status of pigs was determined. Others have demonstrated diverse degrees of protection using antigens from the scolex, the entire cyst, or from the oncosphere (Nascimento et al. 1995; Plancarte et al. 1999; Verastegui et al. 2002). Improved pig vaccines were later developed. TSOL18 is an oncospheral recombinant protein identified and developed in Australia. Two doses of TSOL18 vaccine provide almost absolute protection to further infection (Flisser et al. 2004; Gonzalez et al. 2005), a protection that was later confirmed in field trials (Assana et al. 2010). A vaccine using synthetic peptides of Taenia crassiceps antigens has been produced and applied in Mexico. This vaccine seems to obtain reductions of up to 98.7 % in the numbers of parasites but only 53 % in the proportion of infected pigs (Huerta et al. 2002). DNA vaccines have also been shown to provide diverse degrees of protection, up to 93 % (Guo et al. 2004, 2007; Wang et al. 2003).

A time-honored form to detect infected pigs in the field is to examine their tongues to see cysticerci nodules (Fig. 10.1). However, not all infected animals have a positive tongue examination. Inspection of carcasses at slaughterhouses is also a classic standard in control which, nevertheless, has limited value to detect porcine cysticercosis in endemic regions. First of all, most cysticercosis infected pigs will have less than five or ten cysts in the entire carcass, so opening the carcass and performing a few cuts in the larger muscles is likely insufficient to detect these few cysts. Furthermore, peasants will be reluctant to bring animals at risk of being infected with cysticercosis because of wrong confiscation policies with no reimbursement to the affected peasant (Cysticercosis Working Group in Peru 1993; Gemmell et al. 1983).

As noted, a major problem in rural villages of developing countries is the fact that pigs are allowed to roam free and the close relationship that they have with humans (Fig. 10.2). So, pigs get access to human feces in places with poor sewage disposal and may become infected. Confinement of pigs (pig corralling) is a logical measure (Fig. 10.3). It however collides with the requirement of investment from the farmer to feed corralled pigs, something not required if pigs are left to roam and pasture. In survival economies, farmers will be unlikely to comply with sustained corralling because of these economic reasons (Cysticercosis Working Group in Peru 1993; García et al. 2007a). Anecdotally, sometimes open latrines are placed in the backyard where pigs are corralled, allowing the cycle to complete.

Sotelo et al. (1986) reported in 1986 that freezing of infected pork will kill cysticerci in a day at −24 °C or in 4 days at −5 °C. Meat processing by gamma radiation at high doses inhibits the ability of cysticerci to evaginate. Cysticerci irradiated at lower doses may evaginate, but when they are fed to hamsters as a tapeworm infection model, they seem to have an impaired development in the hamster gut (Verster et al. 1976).

Vaccinating the human host to prevent intestinal taeniasis infection has been proposed as a potential control measure (Flisser et al. 2010; Leon-Cabrera et al. 2009), and early experimental models in rodents seem to show a degree of protection induced by Taenia solium calreticulin (Flisser et al. 2010). So far, no attempts have been made to produce a human cysticercosis vaccine.