Epidemiology of Neurocysticercosis in Children

Incidence and Prevalence

• 50 million currently affected: NCC is a neglected tropical disease, and 50 million people in the world are estimated to have NCC. It causes about 50,000 deaths each year (7,10,21).
• Major cause of death: NCC is a leading cause of death from foodborne disease, resulting in 2.8 million disability-adjusted life years lost in 2010 (22).
• Incidence unknown: The real incidence of NCC is unknown. The lack of facilities such as CAT scanners and MRI equipment, neglected diagnosis, and underestimation of the disease impairs its evaluation.
• 0.45% prevalence in Northwest India: The prevalence of 4.5 per 1,000 population has been noted in rural Northwest India is an example of its importance as a health care issue (23).

Age Distribution

• NCC commonly affects adults: The peak incidence for NCC is between the third and fourth decades of life. Pediatric infestation is recognized in about 20% of the affected population (5).

Sex Distribution

There is no significant sex-related difference.

Geographic Distribution

Geographic distribution of Taenia solium. This map shows endemic and suspected endemic areas according WHO 2015 (70)

• Occurrence spreading with travel: NCC is endemic in some developing countries of Latin America, India, Southeast Asia, and sub-Saharan Africa but it may be found worldwide. It is increasing in nonendemic countries because of international travelers and migrants (13,25).
• Risk for North American Hispanics: In the USA, the risk is highest among Hispanics, who have a rate 35 times higher than that for the non-Hispanic white population (26).

Risk Factors:

• Rural areas: NCC has a high prevalence in rural pig breeding areas, where free roaming domestic animals are common, there is poor knowledge about transmission, there is a lack of disease control,  and inadequate sanitary conditions exist (27).
• Underdeveloped and developing countries: Lower levels of social, economic and sanitary development are risk factors for epilepsy.  Since a frequent symptom for NCC is seizures, this suggests a high incidence of NCC in areas with such socioeconomic difficulties; thus, the NCC burden is highest in South Asia, followed by Sub-Saharan Africa where the incidence of epilepsy is high. More than 80% of the world’s 50 million people who are affected by epilepsy live in developing countries, many of which are endemic for Taenia solium infections in people and pigs (19, 21).

Relationships to Other Disease States and Syndromes

• Immunodeficiency infections, such as HIV: A coinfection may alter efficacy of anthelminthic treatment or produce important drug–drug interactions. Determination of best treatment for NCC in such patients is needed (18,28,29).
• Tuberculosis infection: Patients likely to require prolonged corticosteroids treatment for their NCC.  They should be screened for latent tuberculosis and considered for chemoprophylaxis (30).
• Susceptibility to stroke: The risk of stroke is especially concerning among young and middle-aged patient. In a case-control study with 420 patients, NCC was showed to be related to stroke in univariate and multivariate analysis (OR 11.02 CI (95%) 2.5-8.4 and p<0.0001 (31).