Abstract
Serological screening for maternal Toxoplasma infections in pregnancy has been questioned recently. We analyze some diagnostic difficulties for routine laboratories, poor public health guidance of existing screening programs, and their mutual worsening impact on the efficacy of the programs and on toxoplasmosis research. False positive screening tests may be more likely than true maternal Toxoplasma infections and diagnosis often depends on confirmatory testing in experienced reference laboratories. Apart from clear seroconversions, any marker to assign the time point of infection to the ongoing pregnancy (IgM, IgG avidity, etc.) suffers from important limitations. With poor screening compliance, many screening alerts come from first serum samples in pregnancy that are cumbersome to test, while seroconversions are seldom observed due to missing follow-up samples in late pregnancy. From a public health perspective, inadequate epidemiological assessment and research, insufficient quality control for compliance and little consideration of diagnostic peculiarities for the design of more effective preventive programs has resulted in poor performance. These shortcomings have contributed to the present doubts about preventive Toxoplasma screening in pregnancy. We recommend that a team of public health decision makers, epidemiologists and experts from toxoplasmosis reference laboratories reevaluates the existing activities in a given country to build up a well-designed preventive program that avoids these drawbacks.
Highlights
For more than three decades, mother-child care programs have included screening for Toxoplasma infections in pregnancy by means of laboratory tests from blood samples in some countries
Toxoplasma screening in pregnancy stands at a crossroads in several countries, e.g., Austria is waiting for a decision from its Ministry of Health about whether to discontinue the eldest program that is free for the entire population
On behalf of the Ministry of Health, the Austrian Agency of Health and Food Safety (AGES) is commissioned and dedicated to the epidemiology of many zoonotic diseases in general, but interestingly not to toxoplasmosis in pregnancy. Another structural defect is the ambiguous nomination of a central reference laboratory: For many years, two laboratories at the Medical University of Vienna have competed for this function
Summary
For more than three decades, mother-child care programs have included screening for Toxoplasma infections in pregnancy by means of laboratory tests from blood samples in some countries Women who are infected for the first time in their life by the parasite (“primoinfection”) lack protective immunity In these cases, Toxoplasma gondii may cross the placental border and infect the fetus. Havelaar et al [11] compared the public health impact of congenital toxoplasmosis to salmonellosis as another important zoonotic disease The latter is much more frequent in the general population of the Netherlands, the burden of disease of both conditions has been calculated to be similar. This is due to severe and long-lasting sequels in patients suffering from congenital toxoplasmosis [11].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
