Erious neurological signs and/or death after mass drug administration during which antihelminthic drugs are used at lower doses [praziquantel 40 mg/kg (single dose; frequency depending on endemicity level: maximum once a year) for schistosomiasis and 5 mg/kg/year (single dose) fortaeniosis; albendazole as a 400 mg single dose for both soil-transmitted helminths and order Vorapaxar lymphatic filariasis (frequency depending on endemicity level: maximum every 6 months)] have also been noted.32?5 Neurological side effects associated with imaging-confirmed exacerbation of NCC have been noted in a 12-year-old girl after a one ff intake of praziquantel at a dose as low as 5 mg/kg during mass treatment against human taeniosis for the control of cysticercosis34,36 and in a young woman after self-medication for taeniosis with a single dose of 400 mg albendazole.35 In 2010, 82 800 490 people received albendazole for lymphatic filariasis, 92 300 833 for soil-transmitted helminths and 27 811 183 people were given praziquantel for schistosomiasis.37 Approximately 20 million people received praziquantel in areas co-endemic for taeniosis/cysticercosis (countries endemic for taeniosis/cysticercosis;27 praziquantel distribution in these endemic countries: WHO 2011: `Informal Consultation Meeting on Schistosomiasis and SoilTransmitted Helminthes’). Assuming that 1? of the population in a taeniosis/cysticercosis endemic area harbour asymptomatic cysticerci in their brains,30,38 200 000?00 000 people alone would be at potential risks of developing neurological side effects after praziquantel distribution. This does not take into account the distribution of albendazole which is not only given for lymphatic filariasis to communities in many countries of eastern and western Africa, but also to school children for soil-transmitted helminths in most African countries and in addition most times is co-administered with praziquantel. According to WHO, in 2010 albendazole was given to 57.5 million people in areas co-endemic for lymphatic filariasis and taeniois/cysticercosis (countries endemic for taeniosis/ cysticercosis;27 albendazole distribution in these endemic countries39). In view of the large-scale distribution of these drugs reports of precipitation of neurological symptoms/signs are of concern. In national schistosomiasis programmes no neurological signs to date have been routinely reported (personal communication Professor Alan Fenwick and Dr Wendy Harrison, Schistosomiasis Control Initiative, Imperial Trichostatin A price College, London), although no large-scale study on the side effect of mass drug administration in carriers of latent cysticerci have as yet been performed. Such studies are desperately needed to evaluate the risk of symptomatic NCC in asymptomatic carriers of cerebral cysticerci in sub-Saharan Africa.Symptomatic NCC in people with epilepsyData on sub-Saharan prevalence rates of NCC in people with epilepsy/epileptic seizures come from few countries only with results of over 40 (Cameroon) depending on the serological tests used.11,20,40 Details on countries excluding South Africa are summarizedPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan Africain Winkler et al.22 A recent meta-analysis that only included African studies showed a significant association between epilepsy and cysticercosis with an odds ratio of 3.4.41 More details on the prevalence of NCC (serology and imaging) are available from South African studies.11 The highest imaging-bas.Erious neurological signs and/or death after mass drug administration during which antihelminthic drugs are used at lower doses [praziquantel 40 mg/kg (single dose; frequency depending on endemicity level: maximum once a year) for schistosomiasis and 5 mg/kg/year (single dose) fortaeniosis; albendazole as a 400 mg single dose for both soil-transmitted helminths and lymphatic filariasis (frequency depending on endemicity level: maximum every 6 months)] have also been noted.32?5 Neurological side effects associated with imaging-confirmed exacerbation of NCC have been noted in a 12-year-old girl after a one ff intake of praziquantel at a dose as low as 5 mg/kg during mass treatment against human taeniosis for the control of cysticercosis34,36 and in a young woman after self-medication for taeniosis with a single dose of 400 mg albendazole.35 In 2010, 82 800 490 people received albendazole for lymphatic filariasis, 92 300 833 for soil-transmitted helminths and 27 811 183 people were given praziquantel for schistosomiasis.37 Approximately 20 million people received praziquantel in areas co-endemic for taeniosis/cysticercosis (countries endemic for taeniosis/cysticercosis;27 praziquantel distribution in these endemic countries: WHO 2011: `Informal Consultation Meeting on Schistosomiasis and SoilTransmitted Helminthes’). Assuming that 1? of the population in a taeniosis/cysticercosis endemic area harbour asymptomatic cysticerci in their brains,30,38 200 000?00 000 people alone would be at potential risks of developing neurological side effects after praziquantel distribution. This does not take into account the distribution of albendazole which is not only given for lymphatic filariasis to communities in many countries of eastern and western Africa, but also to school children for soil-transmitted helminths in most African countries and in addition most times is co-administered with praziquantel. According to WHO, in 2010 albendazole was given to 57.5 million people in areas co-endemic for lymphatic filariasis and taeniois/cysticercosis (countries endemic for taeniosis/ cysticercosis;27 albendazole distribution in these endemic countries39). In view of the large-scale distribution of these drugs reports of precipitation of neurological symptoms/signs are of concern. In national schistosomiasis programmes no neurological signs to date have been routinely reported (personal communication Professor Alan Fenwick and Dr Wendy Harrison, Schistosomiasis Control Initiative, Imperial College, London), although no large-scale study on the side effect of mass drug administration in carriers of latent cysticerci have as yet been performed. Such studies are desperately needed to evaluate the risk of symptomatic NCC in asymptomatic carriers of cerebral cysticerci in sub-Saharan Africa.Symptomatic NCC in people with epilepsyData on sub-Saharan prevalence rates of NCC in people with epilepsy/epileptic seizures come from few countries only with results of over 40 (Cameroon) depending on the serological tests used.11,20,40 Details on countries excluding South Africa are summarizedPathogens and Global HealthVOL .NO .WinklerNeurocysticercosis in sub-Saharan Africain Winkler et al.22 A recent meta-analysis that only included African studies showed a significant association between epilepsy and cysticercosis with an odds ratio of 3.4.41 More details on the prevalence of NCC (serology and imaging) are available from South African studies.11 The highest imaging-bas.
