Toxoplasmosis during pregnancy and infancy.

Abstract

In the Supplement entitled “Toxoplasmosis during pregnancy and infancy” [1], the Swiss Working Group on congenital Toxoplasmosis (SWGT) has recommended the cessation of testing for Toxoplasma antibodies before and during pregnancy, arguing the inefficacy of the specific treatment and the low incidence and morbidity of congenital toxoplasmosis in Switzerland. The direct consequences of this decision will be: 1) Women infected by Toxoplasma during gestation will not be tested and therefore not treated, resulting in a rise of the incidence of congenital toxoplamosis; 2) Missed detection of congenital disease by ultrasound alone without serology resulting in additional cases of congenital infection (i.e., chorioretinitis) in newborns; 3) Unknown immune status in pregnant women, 30–50% of whom will follow unnecessary primary prevention measures. A further consequence of this decision will be the irreversible lack of epidemiological data concerning the prevalence of Toxoplasma infection and the incidence of congenital toxoplasmosis in Switzerland. Due to these potential medical consequences, this change of paradigm should be supported by the most relevant epidemiological data – that means recent, complete and on a national scale. In Switzerland, in spite of recommendations released in 1995 [2], no systematic survey of congenital toxoplasmosis has been conducted to date. Some data are occasionally collected through selective studies, but such a strategy is known to underestimate the actual number of cases [3]. The SWGT claim that the prevalence of Toxoplasma infections has decreased and that the incidence of congenital toxoplasmosis is much rarer than initially expected. In order to support its conclusions, it presents data from a study conducted in Basel in 1982–1999 and from a retrospective study conducted in Lausanne (1995–2006), as well as data collected by the Swiss Paediatric Surveillance Unit (SPSU) between 1996 and 1999. Surprisingly, the only recent data (Lausanne) were cited as “personal communication” and have never been published.Moreover, no data were presented from the rest of Switzerland. We would like to present our data from Canton Geneva for the last 13 years. These data were communicated to the SWGT in September 2008, before the publication of its article.