Abstract
Toxoplasma gondii (T. gondii) is an important human disease-causing parasite. In the USA, T. gondii infects >10% of the population, accrues economic losses of US$3.6 billion/year, and ranks as the second leading culprit of foodborne illness-related fatalities. We assessed toxoplasmosis risk among the Old Order Amish, a mostly homogenous population with a high prevalence of T. gondii seropositivity, using a questionnaire focusing on food consumption/preparation behaviours and environmental risk factors. Analyses were conducted using multiple logistic regression. Consuming raw meat, rare meat, or unpasteurised cow or goat milk products was associated with increased odds of seropositivity (unadjusted Odds Ratios: 2.192, 1.613, and 1.718 , respectively). In separate models by sex, consuming raw meat, or consuming unpasteurised cow or goat milk products, was associated with increased odds of seropositivity among women; washing hands after touching meat with decreased odds of seropositivity among women (adjusted OR (AOR): 0.462); and cleaning cat litterbox with increased odds of seropositivity among men (AOR: 5.241). This is the first study to assess associations between behavioural and environmental risk factors and T. gondii seropositivity in a US population with high seroprevalence for T. gondii. Our study emphasises the importance of proper food safety behaviours to avoid the risk of infection.
Highlights
The apicomplexan parasite Toxoplasma gondii (T. gondii) infects one-third of the world’s population, disproportionately affects socio-economically disadvantaged groups, and ranks among five neglected parasitic infections targeted in the USA by the Centers for Disease Control (CDC) for public health action [1, 2]
This study found that members of the Old Order Amish (OOA) community of Lancaster, Pennsylvania have a high seroprevalence of T. gondii antibodies, with over 56% of study participants testing seropositive, exceeding the levels reported in many other US populations, similar to levels reported in Java, Indonesia (62.5%) [24] and among the Nunavik Inuit of Canada (59.8%) [27]
This study found T. gondii seropositivity among more than half of the participants from a unique OOA community with culturally specific meal preparation practices
Summary
The apicomplexan parasite Toxoplasma gondii (T. gondii) infects one-third of the world’s population, disproportionately affects socio-economically disadvantaged groups, and ranks among five neglected parasitic infections targeted in the USA by the Centers for Disease Control (CDC) for public health action [1, 2]. Some estimates indicate that in the USA, ∼170 000 new toxoplasmosis cases occur annually and that 1.1 million are currently infected, amounting to infection among 13.2% (age-adjusted: 12.4%) of the population > 6 years of age [3]. Other sources note that >40 million men, women and children in the USA may harbour the parasite without symptoms because the immune system prevents the occurrence of the full-blown illness, consequences of infection can be severe for the immunocompromised and for women infected during or shortly before pregnancy [2]. According to Scallan et al (2011), 2.6% of US-acquired foodborne T. gondii infections will result in hospitalisations, and 0.02% will result in death, leading to an estimated 327 deaths annually, making toxoplasmosis the second leading cause of foodborne illness fatality in the USA [5]. The parasite has three infectious stages [6,7,8,9,10,11,12,13,14,15]: sporulated oocysts that contain sporozoites, tachyzoites that invade and multiply rapidly within non-intestinal
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