Screening for neurocysticercosis in internationally adopted children

Yield, cost and performance of serological tests, Italy, 2001 to 2016

Lorenzo Zammarchi, Andrea Angheben, Teresa Fantoni, Elena Chiappini, Antonia Mantella, Luisa Galli, Valentina Marchese, Giorgio Zavarise, Zeno Bisoffi, Alessandro Bartoloni

Research output: Contribution to journalArticle

Abstract

Introduction: Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.

Original languageEnglish
Article number1700709
JournalEurosurveillance
Volume23
Issue number40
DOIs
Publication statusPublished - Oct 4 2018

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Neurocysticercosis
Serologic Tests
Italy
Costs and Cost Analysis
Cysticercosis
Enzyme-Linked Immunosorbent Assay
Epilepsy
Enzymes
Seroepidemiologic Studies
Confidence Intervals
Pediatrics
Sensitivity and Specificity

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Virology

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Screening for neurocysticercosis in internationally adopted children : Yield, cost and performance of serological tests, Italy, 2001 to 2016. / Zammarchi, Lorenzo; Angheben, Andrea; Fantoni, Teresa; Chiappini, Elena; Mantella, Antonia; Galli, Luisa; Marchese, Valentina; Zavarise, Giorgio; Bisoffi, Zeno; Bartoloni, Alessandro.

In: Eurosurveillance, Vol. 23, No. 40, 1700709, 04.10.2018.

Research output: Contribution to journalArticle

Zammarchi, Lorenzo ; Angheben, Andrea ; Fantoni, Teresa ; Chiappini, Elena ; Mantella, Antonia ; Galli, Luisa ; Marchese, Valentina ; Zavarise, Giorgio ; Bisoffi, Zeno ; Bartoloni, Alessandro. / Screening for neurocysticercosis in internationally adopted children : Yield, cost and performance of serological tests, Italy, 2001 to 2016. In: Eurosurveillance. 2018 ; Vol. 23, No. 40.
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abstract = "Introduction: Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0{\%}) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6{\%}) by ELISA, and 998 (33.6{\%}) by both tests. The seroprevalence of cysticercosis ranged between 1.7{\%} and 8.9{\%} according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4{\%} (95{\%} confidence interval (CI): 0.2–0.6{\%}). Among the 168 seropositive children, only seven (4.2{\%}) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5{\%}, 98.6{\%}, 14.6{\%}, 99.8{\%} for EITB and 22.2{\%}, 91.1{\%}, 1.4{\%}, 99.5{\%} for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.",
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T1 - Screening for neurocysticercosis in internationally adopted children

T2 - Yield, cost and performance of serological tests, Italy, 2001 to 2016

AU - Zammarchi, Lorenzo

AU - Angheben, Andrea

AU - Fantoni, Teresa

AU - Chiappini, Elena

AU - Mantella, Antonia

AU - Galli, Luisa

AU - Marchese, Valentina

AU - Zavarise, Giorgio

AU - Bisoffi, Zeno

AU - Bartoloni, Alessandro

PY - 2018/10/4

Y1 - 2018/10/4

N2 - Introduction: Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.

AB - Introduction: Neurocysticercosis (NCC) is one of the leading causes of epilepsy worldwide. The majority of cases in Europe are diagnosed in immigrants. Currently in Italy, routine serological screening for cysticercosis is recommended for internationally adopted children (IAC) coming from endemic countries. Methods: We retrospectively analyse the results of the serological screening for cysticercosis in IAC 16 years old or younger, attending two Italian third level paediatric clinics in 2001–16. Results: Of 2,973 children included in the study, 2,437 (82.0%) were screened by enzyme-linked immune electro transfer blot (EITB), 1,534 (51.6%) by ELISA, and 998 (33.6%) by both tests. The seroprevalence of cysticercosis ranged between 1.7% and 8.9% according to EITB and ELISA, respectively. Overall, 13 children were diagnosed with NCC accounting for a NCC frequency of 0.4% (95% confidence interval (CI): 0.2–0.6%). Among the 168 seropositive children, only seven (4.2%) were diagnosed with NCC. Of these children, three were asymptomatic and four presented epilepsy. Among seronegative children (n = 2,805), seven presented with neurological symptoms that lead to the diagnosis of NCC in six cases. The sensitivity, specificity, positive and negative predictive value for the diagnosis of NCC were 54.5%, 98.6%, 14.6%, 99.8% for EITB and 22.2%, 91.1%, 1.4%, 99.5% for ELISA. The yield of the screening programme was 437 NCC cases per 100,000. The number needed to screen to detect one NCC case was 228. The cost per NCC case detected was EUR 10,372. Conclusion: On the base of our findings we suggest the ongoing serological screening for cysticercosis to be discontinued, at least in Italy, until further evidence in support will be available.

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