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Identifying probable cases of neurocysticercosis at an urban community hospital in Los Angeles through active surveillance: A local application addressing the under-reporting of a WHO "major neglected disease" Jennifer Garland RN, MSN, PHN, PhD (c.) Jennifer Bradbury RN, BSN, PHN UCLA School of Nursing Results Background Neurocysticercosis (NCC) is an infection of the central nervous system caused by the presence of larval stage, Taenia solium, the pork tapeworm. It is a major cause of worldwide epilepsy and disability. The United States has seen a rise in the number of NCC cases largely due to the flood of immigrants from endemic to non-endemic areas and the improved access to neuroimaging (Serpa & White, 2012). Conclusion 191 probable neurocysticercosis cases were identified. All probable living cases were forwarded to the local county health department for follow up confirmation and contact testing Neurocysticercosis is vastly under-reported given the large number of probable cases identified by the authors within the 8 month period. Ethnicity of probable cases was comparable to existing literature. 172 (90.05%) of identified cases were Hispanic Presentation of seizure activity was significantly lower in identified hospital cases (7.33%) when compared to the literature (78.8%) (Carabin, et al. 2011). Neurocysticercosis (NCC) Hispanic vs. NonHispanic Identifying barriers to reporting must be identified and implementing strategies to overcome these barriers and improve reporting must be initiated. Reproduced from: Del Brutto, 2012, with permission. Hispanic (90.05%) Non-Hispanic (9.95%) This infection is endemic in the developing world, however, due to immigration, is being increasingly identified in immigration hub areas of developed countries. NCC is associated with acquired seizure disorder, cognitive decline, and disability (Del Brutto, 2012). Reproduced from: Del Brutto, 2012, with permission The authors noted that no cases of NCC at an urban community hospital were reported to the local health department, despite serving a largely Hispanic/Latino immigrant population, demonstrating a pervasive underreporting of disease. 126 (65.97%) cases were born in Mexico Neurocysticercosis (NCC) Born in Mexico vs. Other Countries Mexico (65.97%) Cysticercosis is a reportable disease in Los Angeles County [Title 17, California Code of Regulations (CCR), 2500] Other (34.03%) T. Solium egg References In order to identify outbreaks and prevent transmission of communicable disease; timely notification of reportable diseases is critical Methods Reproduced from: Del Brutto, 2012, with permission. The World Health Organization (WHO) has recently categorized NCC as one of several “major neglected diseases.” Methods: A pilot study was conducted at a community hospital in urban Los Angeles utilizing active surveillance to identify probable cases of NCC (defined by Del Brutto, et al. 2001) by reviewing CT Brain scan reports and the corresponding medical records from January 1, 2012 to August 18, 2012. Only 14 (7.33%) of cases had a history of seizure activity -Without something being done for the NTDs, Millenium Development Goals will not be attainable -Endemic and neighboring countries should increase awareness about cysticercosis and put up effective surveillance and reporting systems (Doyle, et al. 2002). Anonymous (2011) Report of the WHO Expert Consultation on foodborne trematode infections and Taeniasis/Cysticercosis. Geneva: World Health Organization. Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, et al. (2011) Clinical Manifestations Associated with Neurocysticercosis: A Systematic Review. PLoS Negl Trop Dis 5(5): e1152. doi:10.1371/journal.pntd.0001152 Neurocysticercosis (NCC) History of Seizures vs. No History of Seizures Coyle CM, Mahanty S, Zunt JR, Wallin MT, Cantey PT, et al. (2012) Neurocysticercosis: neglected but not forgotten. PLoS Negl Trop Dis 6: e1500. doi:10.1371/journal.pntd.0001500. Seizures (7.33%) Authors identified probable cases through verbage on CT Brain scan reports. Del Brutto OH. Diagnostic criteria for neurocysticercosis, revisited. Pathog Glob Health. 2012 Sep;106(5):299-304. No Seizures (92.67%) Examples: -Neglected tropical diseases (NTDs) are a diverse group of infections which tend to affect the poorest of the poor T. solium scolex “large calcification consistent with old cysticercosis” “probable old neurocysticercosis infection” “scattered calcifications consistent with old cycsticercosis” “punctuate calcifications consistent with neurocysticercosis” “muliple large calcifications indicating old cysticercosis infection” “scattered, punctuate calcifications consistent with neurocysticercosis” “calcified lesions indicating probable neurocysticercosis” -Plus other variations of these statements Del Brutto OH, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001 Jul 24;57(2):177-83. 7 (4.19%) cases died while hospitalized Doyle, et al. (2002). Completeness of Notifiable Infectious Disease Reporting in the United States:An Analytical Literature Review. American Journal of Epidemiology 155:866–74. Neurocysticercosis (NCC) Died vs. Survived Serpa, JA & White, AC. (2012). Neurocysticercosis in the United States. Pathog Glob Health. Sep;106(5):256-60. doi: 10.1179/2047773212Y.0000000028. Died (4.19%) Survived (95.81%) All probable living cases were forwarded to the local county health department for follow up confirmation and contact testing. Contact Information Jennifer Garland UCLA School of Nursing Box 951702 Los Angeles, CA 90095-1702 [email protected]