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The prevalence of Toxoplasma gondii exposure in Inuit living in Nunavut (20%) is twice that of the US (11%); however, routes of exposure for Inuit communities in North America are unclear. Exposure to T. gondii in humans has been linked with consumption of raw or undercooked shellfish that can accumulate environmentally resistant oocysts. Bivalve shellfish, such as clams, are an important, nutritious, affordable and accessible source of food in many Northern Communities. To date, presence of T. gondii in clams in Northern Canada has not been reported. In this study, we tested for T. gondii presence in clams (Mya truncata) that were harvested in Iqaluit, Nunavut over a 1-week period in September 2016. Of 390 clams, eight (2.1%) were confirmed to contain T. gondii DNA (≥99.7% identity), as determined using polymerase chain reaction (PCR) and sequence confirmation. Additionally, three clams (0.8%) were confirmed to contain Neospora caninum-like DNA (≥99.2% identity). While N. caninum is not known to be a zoonotic pathogen, its presence in shellfish indicates contamination of the nearshore with canid faeces, and the potential for marine mammal exposure through marine food webs. Notably, the PCR assay employed in this study does not discriminate between viable and non-viable parasites. These findings suggest a possible route for parasite exposure through shellfish in Iqaluit, Nunavut. Future research employing viability testing will further inform public health messaging on the infectious potential of T. gondii in shellfish., (© 2021 Wiley-VCH GmbH.)

Toxoplasma gondii is a globally distributed parasitic protozoan that infects humans and other warm-blooded vertebrates. Felids are the only definitive host for T. gondii, and they excrete oocysts in their faeces. The national prevalence in humans is declining in the United States. This zoonotic organism is of particular interest due to its importance in pregnant women, in individuals with altered immune systems, and in reactivated ocular infections. Exposure to the parasite in humans is usually associated with consumption of raw or undercooked meat or by accidental ingestion of oocysts. It was hypothesized that veterinary students would have a greater chance at exposure to the parasite than an average population of undergraduate students due to increased contact with cats who are infected. A commercially available ELISA was used to examine serum samples from 336 students (252 veterinary students and 84 undergraduate students) at Virginia Polytechnic Institute and State University and the Virginia-Maryland Regional College of Veterinary Medicine for serum IgG antibodies to T. gondii antigen. The prevalence of T. gondii in these subjects was 5.6% in veterinary school students (n = 252) and 2.4% in undergraduates (n = 84). There was no significant difference (P > 0.05) in the prevalence of T. gondii antibodies in veterinary versus undergraduate students. The overall prevalence of 4.8% in all students in this study reflects the continuing decline of antibodies to T. gondii in humans in the United States., (© 2015 Blackwell Verlag GmbH.)

Seropositivity among pregnant woman in Austria has decreased from 48% to 50% at the end of the 1970s to 35% in recent years. Despite this decrease, knowledge of possible sources and risk factors for Toxoplasma infection remains important. We reviewed seroepidemiological studies that were undertaken to assess the roles of undercooked meat and oocysts in cat faeces as potential sources of infection in pregnant women. Improved management and hygiene in pig herds raised in confinement have resulted in less contact of pigs with cats and a decrease of infected pigs within one decade from 14% in 1982 to 0.9% in 1992. In Austrian wild boar populations, however, seroprevalences remained essentially unchanged during the same decade (18% in 1983 and 19% in 1990-1993). Austrian sheep and goats are usually kept on small farms where cats abound and are predominantly seropositive (66% in sheep and 69% in goats). The seroprevalence in cats has decreased from approximately 81% in 1987 to 59% in 1996; presumably because of cats' increased consumption of processed food. Despite the decrease of infection in pregnant women via the cat-to-pig pathway, it may be offset by a recent concomitant increase in mutton consumption. Free-ranging chickens are a good indicator of the prevalence of T. gondii oocysts in the soil because chickens are ground feeders. Antibodies to T. gondii, as evaluated by the modified agglutination test, were found in 36% of chickens from 12 Austrian 'biofarms'. Because Austrians rarely consume raw pork, the fraction of human T. gondii infections associated with pig meat consumption is likely small. As meat consumption and lifestyle patterns change in Austria, the risk of human infection with T. gondii via different pathways needs re-evaluation and targeted educational efforts to control transmission.

Fourteen case-control studies evaluating the importance of different risk factors for infection of humans with Toxoplasma gondii were identified. Surprisingly, up to two-thirds of infections could not be explained by risk factors such as consuming raw or undercooked meat or poor kitchen hygiene. Few studies reported population attributable risk, and when reported, it was low. Protocols including questionnaires used for collecting data, age and socio-economic groups studied, and sample sizes varied among studies. There is a need for carefully planned, case-control studies to identify sources of infection with T. gondii in humans. New risk factors, such as the manufacture of organic meat, and possible ways to sterilize meat to inactivate T. gondii tissue cysts are discussed.

Toxoplasma gondii was discovered by scientists working in North Africa and Brazil around 100 years ago. The parasite has since been found to be capable of infecting all warm-blooded animals including humans making it one of the most successful parasitic organisms worldwide. The pathogenic potential of T. gondii was recognized in the 1920s and 1930s, in congenitally infected children presenting with the classic triad of symptoms, namely hydrocephalus, retinochoroiditis and encephalitis. In addition, around the same time T. gondii parasites were found to be associated with severe intraocular inflammation. In the 1980s, T. gondii emerged as a major cause of death in patients with acquired immunodeficiency syndrome, illustrating the importance of the immune system in controlling T. gondii infection. T. gondii was reported as a major cause of abortion in sheep in New Zealand in the 1950s, which raised questions about potential new transmission routes for the parasite. The discovery of the cat as the definitive host in the 1960s was a very important finding as it helped to complete our understanding of the parasite's life cycle, and the oocyst stage of T. gondii shed in the faeces of infected cats was found to be an important source of infection for many intermediate hosts and helped to explain infection in herbivorous animals and people with a vegetarian diet. In addition, this stage of the parasite was very robust and could survive in the environment, depending on the climatic conditions, for up to 12-18 months. Knowledge of the parasite's life cycle, transmission routes, risk groups and host immune responses has helped in the development of strategies to control the disease, reduce transmission of the parasite and limit environmental contamination.

Cats are popular as pets worldwide because they are easy to care for and provide companionship that enriches the lives of human beings. Little attention has been focused on their potential to contaminate the environment with zoonotic pathogens. One such pathogen, the protozoan parasite Toxoplasma gondii, rarely causes clinical manifestations in cats or immunocompetent humans; however, it can have serious adverse effects on human foetuses and immunocompromised patients. Many human infections are believed to be acquired from eating undercooked or raw meat, such as pork and lamb (Tenter et al. Int. J. Parasitol., 30, 2000, 1217; Dubey et al. J. Parasitol. 91, 2005, 1082). However, the prevalence of T. gondii infection in human populations that do not consume meat or eat it well-cooked suggests that the acquisition of infection from the environment, via oocysts in soil, water or on uncooked vegetables, is also important (Rawal. Trans. Royal Soc. Trop. Med. Hyg., 53, 1959, 61; Roghmann et al. Am. J. Trop. Med. Hyg., 60, 1999, 790; Chacin-Bonilla et al. Am. J. Trop. Med. Hyg., 65, 2001, 131). In the past 20 years, two changes occurred that significantly increased the size of the cat population in the USA. Pet cat ownership grew from 50 million to 90 million animals, and animal welfare activists created feeding stations for abandoned and free-roaming cats. As many cat owners allow their cats to deposit faeces outside and cats maintained in colonies always defecate outside, ample opportunity exists for T. gondii oocysts to enter the environment and be transmitted to humans. Prevention efforts should focus on educating cat owners about the importance of collecting cat faeces in litter boxes, spaying owned cats to reduce overpopulation, reducing the numbers of feral cats and promoting rigorous hand hygiene after gardening or soil contact.

Toxoplasmosis in pregnant women can lead to congenital disease with severe neurological and ocular complications in the foetus. In 2006, we surveyed US obstetrician-gynaecologists to determine their knowledge and practices about toxoplasmosis prevention and testing. Questionnaires were mailed (four mailings) to a random sample of 1200 of the 33,354 members of the American College of Obstetricians and Gynecologists (ACOG). Of the 1200 surveyed, 502 (42%) responded. The respondents were similar to all ACOG members by gender, region of the country and practice type (P > 0.5), and age (respondents were slightly younger, mean 46 years versus 47 years). To prevent toxoplasmosis, most respondents indicated that they counsel pregnant women about cat litter (99.6%), but fewer counselled about eating undercooked meat (77.6%), handling raw meat (67.4%), gardening (65.4%) or washing fruits and vegetables (34.2%). Many (73.2%) respondents were not aware that some Toxoplasma IgM tests have had a high false positive rate, and most (91.2%) had not heard of the avidity test, which can help determine the timing of Toxoplasma gondii infection in relation to pregnancy. There is a need for more education about T. gondii serological testing, particularly the Toxoplasma avidity test. US obstetrician-gynaecologists are providing beneficial counselling to their patients, but could provide more information about undercooked meat and soil risks.

As a result of their intimate contact with the land and their nutritional habits, the Inuit of Nunavik are considered to be at risk from zoonotic infections. To better understand the risk factors for Toxoplasma gondii infection, a serosurvey was conducted in Nunavik, Québec, in September 2004. A representative sample of the Inuit adult population of Nunavik participated in this cross-sectional study (n = 917). Antibodies (IgG) against T. gondii were detected by immunoassay. Information on sociodemographic characteristics, traditional activities, domestic environment and nutrition was gathered by questionnaire and explored as variables explanatory of seropositive results. Associations found to be statistically significant in univariate analyses were assessed by multivariable logistic regression to control for confounding factors. Almost two thirds (59.8%) of the Inuit of Nunavik were found to be seropositive for T. gondii. In multivariate analyses, risk factors for seropositivity were: increasing age, gender (women > men), lower level of education, consumption of potentially contaminated water (determined by an index of risk from waterborne infections), frequent cleaning of water reservoirs, and consumption of seal meat and feathered game. There was some variation in seroprevalence between the Ungava Bay coast (52.3%) and the Hudson Bay coast (65.6%), the two main regions of Nunavik, but this variation was not significant in the multivariable logistic regression model. This cross-sectional study demonstrated high T. gondii seroprevalence in the Inuit population and revealed that age, gender, schooling and community of residence all influence serostatus in this population. Variables related to drinking water and food choices may also influence the risk of infection. These results raise important questions about T. gondii transmission in Nunavik including possible links between terrestrial and marine cycles.