A quantitative microbial risk assessment for meatborne Toxoplasma gondii infection in The Netherlands

Research gaps and priorities for quantitative microbial risk assessment (QMRA)

The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose-response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.

Comparison of Direct and Indirect Detection of Toxoplasma gondii in Ovine Using Real-Time PCR, Serological and Histological Techniques

Toxoplasma gondii is a zoonotic pathogen and the ingestion of tissue cysts by consumption of lamb or mutton has been identified as a possible cause of infection in humans. Many serological surveys in sheep have been performed, showing relevant serological rates; however, while the detection of antibodies indicates an exposure to T. gondii, this does not necessarily imply the presence of tissue cysts in edible tissue. The current study aims to provide further understanding on the occurrence of T. gondii in sheep muscles and the strength of correlation between serological positivity and presence of the parasite in sheep. From 349 sheep, samples (i.e., blood, heart and diaphragm) were collected and subjected to ELISA tests, real-time PCR and histological tests. Despite the high seroprevalence, T. gondii DNA was detected in the heart and/or the diaphragm from 13 out of the 349 tested sheep (3.7%); all were adults (13/191). Furthermore, the histological tests did not reveal the presence of T. gondii tissue cysts in any of the examined portions of interventricular septum. It should be considered that the likelihood of detecting genetic material of the parasite is probably influenced by the uneven distribution of the tissue cysts in the carcass as well as the methodology applied. The findings of this study support the importance of describing the uncertainty associated with the data used for risk assessment to reduce inaccurate estimation or risk overestimation.

In vitro assay to determine inactivation of Toxoplasma gondii in meat samples

Consumption of raw and undercooked meat is considered as an important source of Toxoplasma gondii infections. However, most non-heated meat products contain salt and additives, which affect T. gondii viability. It was our aim to develop an in vitro method to substitute the mouse bioassay for determining the effect of salting on T. gondii viability. Two sheep were experimentally infected by oral inoculation with 6.5 × 104 oocysts. Grinded meat samples of 50 g were prepared from heart, diaphragm, and four meat cuts. Also, pooled meat samples were either kept untreated (positive control), frozen (negative control) or supplemented with 0.6 %, 0.9 %, 1.2 % or 2.7 % NaCl. All samples were digested in pepsin-HCl solution, and digests were inoculated in duplicate onto monolayers of RK13 (a rabbit kidney cell line). Cells were maintained for up to four weeks and parasite growth was monitored by assessing Cq-values using the T. gondii qPCR on cell culture supernatant in intervals of one week and ΔCq-values determined. Additionally, 500 μL of each digest from the individual meat cuts, heart and diaphragm were inoculated in duplicate in IFNγ KO mice. Both sheep developed an antibody response and tissue samples contained similar concentrations of T. gondii DNA. From all untreated meat samples positive ΔCq-values were obtained in the in vitro assay, indicating presence and multiplication of viable parasites. This was in line with the mouse bioassay, with the exception of a negative mouse bioassay on one heart sample. Samples supplemented with 0.6 %-1.2 % NaCl showed positive ΔCq-values over time. The frozen sample and the sample supplemented with 2.7 % NaCl remained qPCR positive but with high Cq-values, which indicated no growth. In conclusion, the in vitro method has successfully been used to detect viable T. gondii in tissues of experimentally infected sheep, and a clear difference in T. gondii viability was observed between the samples supplemented with 2.7 % NaCl and those with 1.2 % NaCl or less.

Observational longitudinal study on Toxoplasma gondii infection in fattening beef cattle: serology and associated haematological findings

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is a globally distributed zoonotic infection with significant implications for human and animal health. This study investigated the prevalence of T. gondii infection in a population of beef cattle at three different stages of their productive lifespan and examined the impact of T. gondii serological status on blood parameters. A commercial beef fattening unit in Italy was the setting for this research, which involved a biosecurity assessment upon cattle arrival, blood sampling at three time points and Toxoplasma-specific serological testing using indirect fluorescent antibody tests (IFAT). Results revealed a dynamic pattern of T. gondii seropositivity in cattle, with an initial prevalence of 30.6% at arrival (T0) that increased to 44.6% at 14 days (T1) and then decreased slightly to 39.3% at slaughter after 5 months (T2). Interestingly, seroconversion was observed during the study, indicating ongoing infections, and antibody waning occurred in some animals. In terms of blood parameters, seropositive cattle exhibited significantly lower mean corpuscular volume (MCV) and a higher neutrophil-lymphocyte (N/L) ratio, suggesting an activation of the innate immune response. Furthermore, cattle with higher antibody titres displayed higher neutrophil counts. However, all blood parameters with a statistical significance were within the reference range. This study provides for the first time a longitudinal investigation on the serological status for T. gondii in naturally exposed beef cattle. These findings provide valuable insights into the clinico-pathological aspects of natural T. gondii exposure in cattle and underscore the importance of monitoring and managing T. gondii infection in livestock production systems.

A Review of Toxoplasma gondii in Animals in Greece: A FoodBorne Pathogen of Public Health Importance

Toxoplasma gondii is a zoonotic protozoon with a complex life cycle and the second most important foodborne pathogen in Europe. Surveillance of toxoplasmosis is based on national considerations since there are no mandatory controls along the food chain in the European Union, and underreporting of meat is still a problem in many countries like Greece. The current review provides an overview of T. gondii prevalence, associated risk factors, and surveillance in animals in Greece, focusing on the transmission role of meat and highlighting the control measures that should be adopted by consumers. Sows, wild boars, hares, equines, and cats had lower, while sheep and goats generally had higher seroprevalence than their respective pooled European and global values. Seroprevalence in chickens was similar between Greece and Europe, while there was high variation in cattle studies, with no data regarding dairy products. Though a comprehensive meat safety assurance system is the most effective approach to control the principal biological hazards associated with meat, such as T. gondii, the prerequisite risk categorisation of farms and abattoirs based on EFSA's proposed harmonised epidemiological indicators has not materialised as yet in Greece. Therefore, comprehensive control strategies are still required to ensure food safety and safeguard public health.

Seroprevalence of Toxoplasma gondii infection in sheep and cattle in Shanxi Province, North China

Toxoplasmosis is a worldwide zoonotic disease caused by infection with the intracellular protozoan parasite Toxoplasma gondii, posing significant economic losses to the livestock industry. As a major livestock province, little is known of the prevalence of T. gondii infection in sheep and cattle in Shanxi Province, North China. In this study, a total of 1962 blood samples from cattle (n = 978) and sheep (n = 984), collected from 11 administrative cities in Shanxi Province, were examined for antibodies against T. gondii by using the indirect enzyme linked immunosorbent assay (ELISA) kits commercially available. The results showed that antibodies to T. gondii were detected in 306 of the 978 cattle serum samples (31.29%, 95% CI 28.38-34.19), ranging from 12.64% to 60.00% among the different cities. The overall seroprevalence of T. gondii in sheep was 17.78% (175/984, 95% CI 15.40-20.17), ranging from 2.22% to 41.11% among the different administrative cities. The T. gondii seroprevalence was associated with the management mode and geographical location. This is the first report of T. gondii seroprevalence in cattle and sheep in Shanxi Province, North China, which provides baseline data to plan future control strategies for T. gondii infection in this province.

Seroprevalence of Toxoplasma gondii and associated risk factors for infection in the Netherlands: third cross-sectional national study

A third nationally representative serosurvey was performed to study the changes in Toxoplasma gondii (T. gondii) seroprevalence in the Netherlands over a 20-year time span and to identify and confirm risk factors for acquired toxoplasmosis. This cross-sectional study (conducted in 2016/2017) was designed similarly to the previous two studies (1995/1996 and 2006/2007) and included a questionnaire and serum sampling among Dutch residents. Factors associated with seropositivity for T. gondii were determined using multivariable analysis of the questionnaire-derived data. The earlier observed decrease in T. gondii seroprevalence between 1995/1996 and 2006/2007 (from 40.5% to 26.0%) did not continue into 2016/2017 (29.9%). Similarly to the previous studies, the seroprevalence increased with age and varied among regions. In all studies, higher T. gondii seropositivity was associated with increasing age, lower educational level, not living in the Southeast, and eating raw or semi-cooked pork. The incidence of congenital toxoplasmosis was estimated at 1.3/1000 (95% CI 0.9-1.8) live-born children in 2017. As the seroprevalence of T. gondii in the Netherlands did not decrease over the last decade, an increase in public health awareness is needed and prevention measures may need to be taken to achieve a further reduction in T. gondii infections in the Netherlands.

Quantitative Risk Assessment of Oocyst Versus Bradyzoite Foodborne Transmission of Toxoplasma gondii in Brazil

Toxoplasma gondii is a globally distributed zoonotic protozoan parasite. Infection with T. gondii can cause congenital toxoplasmosis in developing fetuses and acute outbreaks in the general population, and the disease burden is especially high in South America. Prior studies found that the environmental stage of T. gondii, oocysts, is an important source of infection in Brazil; however, no studies have quantified this risk relative to other parasite stages. We developed a Bayesian quantitative risk assessment (QRA) to estimate the relative attribution of the two primary parasite stages (bradyzoite and oocyst) that can be transmitted in foods to people in Brazil. Oocyst contamination in fruits and greens contributed significantly more to overall estimated T. gondii infections than bradyzoite-contaminated foods (beef, pork, poultry). In sensitivity analysis, treatment, i.e., cooking temperature for meat and washing efficiency for produce, most strongly affected the estimated toxoplasmosis incidence rate. Due to the lack of regional food contamination prevalence data and the high level of uncertainty in many model parameters, this analysis provides an initial estimate of the relative importance of food products. Important knowledge gaps for oocyst-borne infections were identified and can drive future studies to improve risk assessments and effective policy actions to reduce human toxoplasmosis in Brazil.

Estimations of the number people with mental diseases associated with toxoplasmosis and identification of risk factors by continent

Strong evidence exists based on metanalysis of the relationship between toxoplasmosis and many psychiatric diseases: schizophrenia, bipolar disorder, and suicidal behavior. Herein, we estimate the number of cases based on the attributable fraction due to toxoplasmosis on these diseases. The population attributable fraction of mental disease associated with toxoplasmosis was 20,4% for schizophrenia; 27,3% for bipolar disorder; and 0,29% for suicidal behavior (self-harm). The lower and upper estimated number of people with mental disease associated with toxoplasmosis was 4'816.491 and 5'564.407 for schizophrenia; 6'348.946 and 7'510.118,82 for bipolar disorder; and 24.310 and 28.151 for self-harm; for a global total lower estimated number of 11'189.748 and global total upper estimated number of 13'102.678 people with mental disease associated with toxoplasmosis for the year 2019. According to the prediction through the Bayesian model of risk factors for toxoplasmosis associated with mental disease, these varied in importance geographically; thus, in Africa, the most important risk factor was water contamination and in the European region, the cooking conditions of meats. Toxoplasmosis and mental health should be a research priority given the enormous potential impact of reducing this parasite in the general population.

Toxoplasma gondii in Foods: Prevalence, Control, and Safety

Toxoplasma gondii is an obligate intracellular parasite that causes toxoplasmosis, with approximately one third of the population around the world seropositive. The consumption of contaminated food is the main source of infection. These include meat products with T. gondii tissue cysts, and dairy products with tachyzoites. Recently, contamination has been detected in fresh products with oocysts and marine products. Despite the great health problems that are caused by T. gondii, currently there are no standardized methods for its detection in the food industry. In this review, we analyze the current detection methods, the prevalence of T. gondii in different food products, and the control measures. The main detection methods are bioassays, cell culture, molecular and microscopic techniques, and serological methods, but some of these do not have applicability in the food industry. As a result, emerging techniques are being developed that are aimed at the detection of multiple parasites simultaneously that would make their application more efficient in the industry. Since the prevalence of this parasite is high in many products (meat and milk, marine products, and vegetables), it is necessary to standardize detection methods, as well as implement control measures.

Seroprevalence and Risk Factors for Toxoplasma gondii and Neospora caninum in Cattle in Portugal

Simple Summary

Neospora caninum and Toxoplasma gondii are apicomplexan parasites with a worldwide distribution and both infect cattle. While the importance of N. caninum is mainly linked to reproductive losses, concern has been raised about the role of beef as a source of food-borne toxoplasmosis in humans. Little is known about the prevalence of these parasites in cattle in Portugal. This study aimed to evaluate the seroprevalence and risk factors for N. caninum and T. gondii in naturally exposed cattle from different geographical areas in the country. Results point to a low but widespread seroprevalence of T. gondii, while that of N. caninum was found to be in the same range as reported in other Mediterranean countries. Distribution of both parasites may be explained by common climate factors and management practices identified as significant predictors of infection in the study.

Abstract

Neospora caninum has a worldwide economic impact as an important cause of abortion in cattle, while Toxoplasma gondii, another abortifacient pathogen, is globally a major foodborne zoonotic threat. The study aimed to evaluate the seroprevalence and risk factors for the two parasites in cattle in Portugal. A total of 612 sera from 35 farms were tested by an in-house p30 ELISA for T. gondii and p38 ELISA for N. caninum. T. gondii positive and suspicious sera were confirmed by p30 Western blot or IFAT. T. gondii and N. caninum animal seroprevalence was 9.2% (95%CI 7.1–11.7) and 17.2% (95% CI 14.4–20.4) and herd seroprevalence was 51.4% (95% CI 35.6–67.0) and 68.6% (95% CI 52.0–81.5), respectively. At the univariable level, climate area and precipitation of wettest month, driest month, driest quarter, and warmest quarter were significant predictors of seropositivity for both. N. caninum seropositivity was more likely in the region Norte, densely populated areas, and intensive production, and the probability of T. gondii seropositivity decreased with herd size. Results confirm the need to consider neosporosis in the differential diagnosis of cattle reproductive disorders in Portugal and may be valuable to inform source attribution models for human toxoplasmosis.

Seroprevalence and risk factors of Toxoplasma gondii in cattle from Unai, Minas Gerais state, Brazil

Toxoplasma gondii is a widespread protozoan parasite that causes infections in animals and humans. The presence of tissue cysts in cattle musculature evidences their epidemiological significance in transmission to humans. The present study aimed to evaluate the seroprevalence of and risk factors of T. gondii seropositivity in beef cattle in the municipality of Unaí, Minas Gerais state, Brazil. Bovine blood samples (n = 612) were collected from 31 herds. Risk factors associated with the animal-level and herd-level seroprevalence were analysed using a questionnaire that investigates the epidemiological aspects of toxoplasmosis. A search for anti-T. gondii antibodies was performed by means of an indirect fluorescent antibody test (IFAT). Analysis of 612 samples showed 369 animals positive for anti-T. gondii antibodies (IFAT ≥64), with a seroprevalence of 60.29% (95% confidence interval (CI): 56.35-64.10). The herd-level seroprevalence was 96.77% (95% CI: 79.00-99.58). Applying a multivariate logistic regression analysis, a test of the association between seroprevalence of T. gondii infection and the potential predictors showed that cats (domestic or wild) with access to the drinking water of cattle were a significant (P = 0.001) predictor. The seroprevalence of T. gondii in cattle destined for human consumption is widely distributed throughout the entire study area. Thus, integrated control measures and strategies are suggested to prevent T. gondii infection in cattle.

High prevalence of anti-Toxoplasma gondii antibodies in beef cattle in Midwestern Brazil

The present study aimed to determine the seroprevalence of anti-Toxoplasma gondii antibodies using an indirect immunofluorescence assay (IFA-IgG) in 3,814 cows aged ≥ 24 months belonging to 353 beef farms in the Mato Grosso state. Additionally, we aimed to identify the possible risk factors associated with seropositivity in Mato Grosso, which encompasses three biomes (Amazon, Cerrado, and Pantanal) of Brazil. Analysis of 3,814 samples observed that 1,307 animals were positive for anti-T. gondii antibodies (IFA-IgG ≥ 64), with an animal-level seroprevalence of 34.27%. Herd-level seroprevalence was 92.07%. In the animal-level model, cows raised in the Amazon and Pantanal biomes and breed studies on European and Zebu or hybrid were found to be at risk for T. gondii seropositivity. Prevalence of anti-T. gondii antibodies in cows destined for human consumption was found to be widely distributed throughout the entire study area. Further studies are required to assess the impact of beef in the possible transmission of toxoplasmosis to humans residing in the region and establish additional control measures for this protozoan mainly on beef herds raised in the Amazon and Pantanal biomes, where the highest values of seroprevalence were observed.

National perinatal survey demonstrates a decreasing seroprevalence of Toxoplasma gondii infection among pregnant women in France, 1995 to 2016: impact for screening policy

Background

Toxoplasmosis during pregnancy can result in congenital anomalies or fetal death. Universal antenatal screening is recommended in France, a strategy in place since the 1970s.

Aim

We determined the seroprevalence of toxoplasmosis among pregnant women participating in the 2016 national perinatal survey (ENP), compared results with previous ENPs, and investigated factors associated with Toxoplasma gondii infection.

Methods

Using the 2016 ENP data, which contain sociodemographic and clinical information from all women giving birth during a one week period, we calculated adjusted prevalence ratios (aPR) by sociodemographic factors. Using available data from prior ENPs (1995, 2003 and 2010), we calculated age-standardised seroprevalences and aPRs for French women.

Results

In 2016, seroprevalence was 31.3% overall. Among French women, associations with increasing age (aPR: 1.54; 95% CI: 1.39–1.70), residence in Paris (aPR: 1.19; 95% CI: 1.08–1.31) or south-western regions (aPR: 1.19; 95% CI: 1.08–1.31), and higher professional status (aPR: 1.12; 95%CI 1.04–1.21) were observed. An association with increasing age was also evident among women from North Africa and sub-Saharan Africa. Age-standardised seroprevalence decreased from 55.0% in 1995 to 33.7% in 2016. Among French women, significant associations with age, Paris and south-west regions persisted across all ENPs.

Conclusion

Higher prevalences in older women may reflect a higher past risk of exposure while persistent geographical differences may reflect dietary or environmental differences. Toxoplasma seroprevalence among pregnant women continues to fall and will impact screening effectiveness. This warrants a comprehensive review to determine the appropriate future of prevention in France.

Toxoplasma gondii infection in domestic and wild felids as public health concerns: a systematic review and meta-analysis

Felidae as definitive hosts for Toxoplasma gondii play a major role in transmission to all warm-blooded animals trough oocysts dissemination. Therefore the current comprehensive study was performed to determine the global status of T. gondii infection in domestic and wild felids aiming to provide comprehensive data of interest for further intervention approaching the One Health perspective. Different databases were searched by utilizing particular key words for publications related to T. gondii infecting domestic and wild feline host species, worldwide, from 1970 to 2020. The review of 337 reports showed that the seroprevalence of T. gondii in domestic cats and wild felids was estimated in 37.5% (95% CI 34.7-40.3) (I² = 98.3%, P < 0.001) and 64% (95% CI 60-67.9) (I² = 88%, P < 0.0001), respectively. The global pooled prevalence of oocysts in the fecal examined specimens from domestic cats was estimated in 2.6% (95% CI 1.9-3.3) (I² = 96.1%, P < 0.0001), and that in fecal samples from wild felids was estimated in 2.4% (95% CI 1.1-4.2) (I² = 86.4%, P < 0.0001). In addition, from 13,252 examined soil samples in 14 reviewed studies, the pooled occurrence of T. gondii oocysts was determined in 16.2% (95% CI 7.66-27.03%). The observed high rates of anti-T. gondii antibodies seroprevalence levels and oocyst excretion frequency in the felids, along with soil (environmental) contamination with oocysts may constitute a potential threat to animal and public health, and data will result of interest in further prophylaxis programs.

Digging into Toxoplasma gondii infections via soil: A quantitative microbial risk assessment approach

Soil has been identified as an important source of exposure to a variety of chemical and biological contaminants. Toxoplasma gondii is one of those potential biological contaminants associated with serious health effects in pregnant women and immunocompromised patients. Gardening or consumption of homegrown vegetables may present an important route of T. gondii infection via accidental ingestion of soil. In the Netherlands, there is quantitative information on the risk of T. gondii infection via meat products, but not on the risk of infection through soil. The objective of this study was to develop a quantitative microbial risk assessment (QMRA) model for estimating the risk associated with T. gondii exposure via accidental soil ingestion in the Netherlands. In order to obtain the needed information, a magnetic capture method for detection of T. gondii oocysts in soil samples was developed, and T. gondii DNA was detected using qPCR targeting the 529 bp repeat element. The method was shown to provide 95% probability of detection (95% CI: 88-100%) when at least 34 oocysts are present in 25 g of soil. T. gondii DNA was detected in 5 of 148 soil samples with interpretable results (3%, 95% CI: 1.5-7.7%). Results for 18 samples were not interpretable due to PCR inhibition. The estimated amount of oocysts presented in qPCR positive samples was quantified by a linear model, and the amount varied from 8 to 478 in 25 g of soil. The estimated incidence rate of T. gondii infection from the QMRA model via soil varied from 0.3 to 1.8 per 1000 individuals per day. Several data gaps (e.g., soil contamination/ingestion and oocysts viability) have been identified in this study, the structure of the model can be applied to obtain more accurate estimates of the risk of T. gondii infection via soil when data become available.

Global prevalence of Toxoplasma gondii infection in the aborted fetuses and ruminants that had an abortion: A systematic review and meta-analysis

Toxoplasma gondii (T. gondii) is a zoonotic apicomplexan protozoan that can cause reproductive losses in ruminants across the world. Therefore, a meta-analysis was conducted to estimate the worldwide prevalence of T. gondii infection in the aborted fetuses and stillbirths of sheep, goat, and cattle. Moreover, it attempted to evaluate the prevalence rate of T. gondii infection in ruminants that had abortions using serological methods. Based on the keywords, a systematic search of six databases was conducted to retrieve cross-sectional articles in English-language. Data were synthesized to calculate the overall prevalence of T. gondii infection worldwide using the random-effects model with a 95 % confidence interval (CI). Moreover, the present study includes sensitivity analysis, publication bias test, and quality assessment of the studies. The final analyses included 37, 19, and 8 studies conducted on sheep (4383 aborted fetuses and stillbirths as well as 1940 abortive sheep), goat (248 aborted fetuses and stillbirths and 533 abortive goats), and cattle (460 aborted fetuses and stillbirths and 165 abortive cattle). The overall prevalence rates of T. gondii infection in aborted fetuses and stillbirths globally were 42 % (95 % CI: 17 %-67 %), and 31 % (95 % CI: 11 %-51 %) using molecular methods for sheep and goats, as well as 16 % (95 % CI: 11 %-22 %) and 27 % (95 % CI: 1 %-54 %) using serological tests for sheep and goats, respectively. In addition, the overall prevalence rates of T. gondii infection in sheep and goats that had abortions were 56 % (95 % CI: 35 %-76 %) and 50 % (95 % CI: 6 %-94 %), respectively. These analyses could not be performed in cattle due to the small number of studies and the small number of animals under study. According to the high prevalence of T. gondii infection in sheep and goats that had an abortion, T. gondii could be a potential factor of causing reproductive failures in ruminants worldwide. So, effective control measures and strategies are needed to reduce the rate of abortion in sheep and goats as well as reduce the economic damage to the livestock industry.

Public Health Significance of Toxoplasma gondii Infections in Cattle: 2009-2020

Toxoplasma gondii infections are common in humans and animals worldwide. The ingestion of food or water contaminated with oocysts excreted by infected cats or ingesting uncooked or undercooked meat containing tissue cysts of T. gondii are the 2 major modes of transmission of T. gondii. Viable T. gondii is more prevalent in pork and lamb than in beef. In the past decade, there have been many articles on the high seroprevalence in cattle, particularly from China. There is a report of an outbreak of acute toxoplasmosis in humans suspected to be linked to the ingestion of Artisan fresh cheese from cow's milk. There are conflicting reports concerning the rate of congenital transmission of T. gondii in cattle, especially from Brazil. In a report from Brazil, viable T. gondii was isolated from the blood of 1 of 60 pregnant cows slaughtered at an abattoir and from 1 fetus. The role of beef in the epidemiology of T. gondii infections is still not clear. Here, we review prevalence, persistence of infection, clinical disease, epidemiology, and public health risks of T. gondii infections in cattle from beef and cow's milk worldwide for the past decade.

Seroprevalence of Toxoplasma gondii in cattle in China from 2010 to 2019: A systematic review and meta-analysis

Toxoplasma gondii can infect almost all warm-blooded animals, including cattle, causing serious disease to animals and humans. Because cattle provide milk and meat for humans, an increasing number of people are raising cattle as a source of income. However, T. gondii may be transmitted to humans through the meat and milk of cattle. Although substantial relevant studies have been performed, overall data on the seroprevalence of T. gondii in cattle is still lacking. In this meta-analysis, 71 relevant studies were included from five databases that investigated the seroprevalence of T. gondii in cattle in China from 2010 to 2019. The overall pooled T. gondii seroprevalence in cattle was 10.1% (4217/39,274) in China. The seroprevalence of T. gondii was highest in southwestern China (21.6%, 727/3117) and lowest in northern China (4.5%, 185/1966). Due to the implementation of disease control measures during 2012 to 2020, the lowest positive rate was seen in the post-2017 subgroup of sampling years (5.8%, 170/3022). In the cattle breeds subgroups, the seroprevalence was highest in yaks (14.3%, 1695/10,777). Cattle aged ≥12 months (9.6%, 1248/12,438) had a higher seroprevalence than those <12 months (6.7%, 226/3132). Female cattle had a slightly higher seroprevalence (12.5%, 793/6670) than male cattle (11.7%, 418/3856). The seroprevalence in summer (11.8%, 517/4744) was the highest of all seasons. The present study shows that T. gondii is common in cattle in China. Therefore, monitoring measures and further research are needed to control T. gondii and improve public health.

Detection of Toxoplasma gondii in retail meat samples in Scotland

Toxoplasma gondii is a globally important zoonotic parasite ranked as one of the most significant causes of disease burden among the major foodborne pathogens. Consumption of undercooked meat is a well-known risk factor for infection so the aim of this study was to investigate the presence of T. gondii in meat samples from retail outlets in Scotland. In Sampling Period 1, 300 meat samples (39 beef, 21 chicken, 87 lamb, 71 pork and 82 venison) were purchased from butchers', farmers' markets, farm shops and supermarkets, and in Sampling Period 2, 67 pure venison samples only were purchased from farmers' markets, farm shops and supermarkets. DNA was extracted and screened for T. gondii using a quantitative PCR targeting the 529 bp repeat element, and any positive samples were genotyped using PCR-RFLP targeting 10 markers. Meat juice was screened for T. gondii antibodies using a commercial ELISA or modified agglutination assay. Toxoplasma gondii DNA was detected in 0/39 (0%) beef samples, 1/21 (4.8%) chicken samples, 6/87 (6.9%) lamb samples, 3/71 (4.2%) pork samples and 29/82 (35.4%; Sampling Period 1) and 19/67 (28.4%; Sampling Period 2) venison samples. Partial PCR-RFLP genotyping revealed both clonal and non-clonal genotypes. Antibodies to T. gondii were detected in the meat juice of 2/38 (5.3%) beef samples, 3/21 (14.3%) chicken samples, 14/85 (16.5%) lamb samples, 2/68 (2.9%) pork samples and 11/78 (14.1%; Sampling Period 1) and 8/50 (16%; Sampling Period 2) venison samples. This is the first study to report the presence of T. gondii in retail meat products in Scotland and has highlighted venison as a potentially high risk meat. Further work is required to determine viability of parasites in this particular meat product.

Isolation and genetic characterization of Toxoplasma gondii in Spanish sheep flocks

Background

Toxoplasma gondii is a major cause of abortion in small ruminants and presents a zoonotic risk when undercooked meat containing cysts is consumed. The aim of the present study was to investigate the genetic diversity among the T. gondii strains circulating in ovine livestock in Spain.

Methods

Selected samples collected from abortion outbreaks due to toxoplasmosis (n = 31) and from chronically infected adult sheep at slaughterhouses (n = 50) in different Spanish regions were bioassayed in mice, aiming at parasite isolation. In addition, all original clinical samples and the resulting isolates were genotyped by multi-nested PCR-RFLP analysis of 11 molecular markers and by PCR-DNA sequencing of portions of the SAG3, GRA6 and GRA7 genes.

Results

As a result, 30 isolates were obtained from 9 Spanish regions: 10 isolates from abortion-derived samples and 20 isolates from adult myocardial tissues. Overall, 3 genotypes were found: ToxoDB#3 (type II PRU variant) in 90% (27/30) of isolates, ToxoDB#2 (clonal type III) in 6.7% (2/30), and ToxoDB#1 (clonal type II) in 3.3% (1/30). When T. gondii-positive tissue samples (n = 151) were directly subjected to RFLP genotyping, complete restriction profiles were obtained for 33% of samples, and up to 98% of the specimens belonged to the type II PRU variant. A foetal brain showed a clonal type II pattern, and four specimens showed unexpected type I alleles at the SAG3 marker, including two foetal brains that showed I + II alleles as co-infection events. Amplicons of SAG3, GRA6 and GRA7 obtained from isolates and clinical samples were subjected to sequencing, allowing us to confirm RFLP results and to detect different single-nucleotide polymorphisms.

Conclusions

The present study informed the existence of a predominant type II PRU variant genotype (ToxoDB#3) infecting domestic sheep in Spain, in both abortion cases and chronic infections in adults, coexisting with other clonal (ToxoDB#1 and ToxoDB#2), much less frequent genotypes, as well as polymorphic strains as revealed by clinical sample genotyping. The use of multilocus sequence typing aided in accurately estimating T. gondii intragenotype diversity.

Distribution of Toxoplasma gondii Tissue Cysts in Shoulder Muscles of Naturally Infected Goats and Lambs

ABSTRACT

Toxoplasmosis has been recognized as a major public health problem worldwide. The consumption of uncooked or undercooked meat infected with Toxoplasma gondii tissue cysts is one of the main means of transmission of this parasite. Although sheep, goats, and pigs are commonly infected with T. gondii, little information is available on the distribution of T. gondii tissue cysts in naturally infected meat. In this study, we investigated the distribution of viable T. gondii tissue cysts in shoulder muscles of naturally infected lambs and goats. Hearts and shoulders of 46 lambs and 39 goats from a local grocery store were tested for T. gondii infection. Animals were evaluated for the presence of anti-T. gondii antibodies in heart blood and clots by the modified agglutination test. Fourteen of the 85 animals (seven lambs and seven goats) were seropositive. Six to 12 samples weighing 5, 10, and 50 g were obtained from shoulder muscles of each seropositive animal and used for bioassay in mice. The distribution of viable T. gondii differed according to the size of the sample analyzed, but in general larger sample sizes resulted in higher isolation rates (P < 0.05). Results of the study revealed an uneven distribution of T. gondii in muscle samples of lambs and goats and that T. gondii can be transmitted by consumption of very small servings (5 and 10 g) of meat when it is consumed raw or is undercooked.

HIGHLIGHTS

Toxoplasma gondii infection in slaughtered pigs and cattle in Poland: seroprevalence, molecular detection and characterization of parasites in meat

Background

Toxoplasma gondii infection may pose a severe medical problem especially in a congenital form and as an acquired infection in immunocompromised persons. Raw and undercooked meat of slaughtered animals is regarded as an important source of parasite infection; however, data concerning this issue in Poland are still insufficient. The aim of this study was to estimate the prevalence of T. gondii infection in pigs and cattle slaughtered for human consumption in Poland using serological and molecular methods.

Methods

Sera of 3111 pigs and 2411 cattle from 16 regions (voivodeships) of the country were examined for the presence of anti-T. gondii IgG using the direct agglutination test (DAT). Pepsin-digested samples of diaphragm and heart of seropositive animals were examined for the presence of T. gondii DNA (B1 gene) by nested PCR and real-time PCR, while non-digested samples were only examined by nested PCR. The B1 gene DNA samples were genotyped at 11 genetic markers using multilocus nested PCR-RFLP (Mn-PCR-RFLP) and sequencing.

Results

Seropositive DAT results were found in 11.9% of pigs and 13.0% of cattle. The highest seroprevalence was found in pigs from Podkarpackie (32.6%) and in cattle from Mazowieckie (44.6%). Data analysis showed that cattle > 5–10 years-old, as well as cattle and pigs from small farms, and pigs from farms with open production systems, had higher odds of testing seropositive (P < 0.05). Among the examined tissue samples, positive PCR results were found in samples from 12.2% and 10.2% of seropositive pigs and cattle, respectively. Among the samples successfully genotyped by Mn-PCR-RFLP and sequenced, four samples were identified as T. gondii type II and one sample as type I.

Conclusions

The presence of T. gondii antibodies in a substantial proportion of examined pigs and cattle as well as the detection of parasite DNA in their tissues highlight a potential health risk to the consumers in Poland.

Toxoplasma gondii in cattle in Brazil: a review

Toxoplasma gondii is an apicomplexan protozoan that is frequently found in both humans and animals worldwide. The aim of this review was to list important aspects of Toxoplasma gondii infection in cattle in Brazil. The frequency of occurrence of T. gondii antibodies in Brazilian cattle ranges from 1 to 89.1%, depending on the region evaluated, based on data from 1978 to 2018. However, some characteristics of T. gondii infection in cattle remain uncertain, such as the role of meat intake in transmitting the parasite to humans. Most information regarding T. gondii infection among Brazilian cattle is limited to evaluations of the frequency of occurrence of antibodies. About 70% of the diagnoses of infection in these ruminants in Brazil are made via the indirect fluorescence antibody test (IFAT). Nevertheless, little is known about the population structure of this protozoan in cattle. It is necessary to expand the studies on toxoplasmosis in cattle, in order to better understand T. gondii infection in these animals and its implications for Brazilian public health.

Seroepidemiology of Toxoplasma gondii in domestic cattle, sheep, goats and pigs from São Tomé and Príncipe

Abstract Despite the global importance of the zoonotic parasite Toxoplasma gondii, little is known regarding its infection in the Democratic Republic of São Tomé and Príncipe (DRSTP). This is the first report of antibodies to T. gondii in cattle, sheep, goats and pigs from the DRSTP. Antibodies were assessed by the modified agglutination test (MAT), with a cut-off titer of 100 for cattle and 20 for sheep, goats and pigs. The present study revealed an overall seroprevalence of 55.8%; 27.1% in 48 cattle, 68.4% in 98 sheep, 70.1% in 97 goats and 43.7% in 103 pigs. The south geographical area for cattle, the central area for sheep, and adult age and living in the central region for goats were found to be risk factors for seropositivity to T. gondii. These results support the scenario of a considerable presence of sporulated oocysts as well as of infected intermediate hosts in the local environment. Consumption of raw or undercooked meat should be considered as an important potential source of infection for animals and humans in the DRSTP.

Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Owned Domestic Cats in Australia

Ongoing surveillance of Toxoplasma gondii seroprevalence and exposure risks in owned cats is important to identify effective mechanisms to decrease the prevalence of this global zoonotic parasite. We aimed to determine the seroprevalence of T. gondii and risk factors for seropositivity in owned domestic cats in Australia. Sera, signalment data, postcode, and completed owner-questionnaires surveying diet composition and lifestyle factors were collected for cats presenting to 18 veterinary clinics across Australia. T. gondii-specific IgG was measured by enzyme-linked immunosorbent assay. Data were analyzed using univariable and multivariable logistic regression to evaluate risk factors associated with positive T. gondii IgG serology. Among 417 cats, T. gondii seroprevalence was 39%. More than two-thirds of cats tested (69%) had outdoor access and 59% were fed a diet containing raw meat. Univariable analyses identified, age (>1 year, p < 0.001), a diet containing any raw meat (p = 0.001), raw kangaroo (p = 0.008), raw chicken (p = 0.012), or raw beef (p = 0.017), and hunting (p = 0.049) as risk factors for T. gondii infection. Age (>1 year, odds ratio [OR]: 7.15) and feeding of raw meat (OR: 2.23) remained significant risk factors (p < 0.001) in multivariable analyses. T. gondii seroprevalence did not differ between cats domiciled in urban and semiurban or rural areas. Pet cats in Australia are commonly infected with T. gondii. Feeding raw meat to cats, a common practice in Australia, is associated with T. gondii infection, highlighting the need for education about the health implications for cats from feeding a diet containing raw meat.

Toxoplasma gondii Seroprevalence in Horses from Ukraine: an Investigation Using Two Serological Methods

BACKGROUND

Horses are recognized as important hosts for the zoonotic parasite Toxoplasma gondii, mainly because meat of infected horses can be a source of human T. gondii infections. However, the baseline knowledge on equine T. gondii infections is limited and lacking from many countries. This seroepidemiological study was set in Ukraine, a country where little is known about T. gondii prevalence in any host species.

METHODS

We investigated 78 serum samples from horses, collected from Kyiv and Lviv regions of Ukraine, using a commercial enzyme-linked immunosorbent assay (ELISA) and a commercial modified direct agglutination test (DAT). The ELISA is intended to detect the presence of total antibodies against T. gondii, and the DAT detects specific anti-T. gondii immunoglobulin G antibodies. The cutoff titer for DAT seropositivity was a titer of 40.

RESULTS

Two horses were omitted from statistical analyses due to disagreeing ELISA results. Altogether 16 of the remaining 76 horses were seropositive with the ELISA, yielding an apparent seroprevalence estimate of 21.1% (95% confidence interval 13.0-31.3). Five horses tested positive with both ELISA and DAT, 11 horses tested positive with ELISA only, and one with DAT only. For 64 of the 76 horses, the results of ELISA and DAT agreed; the percent agreement was 84.2 and the Kappa statistic was - 1.5208, indicating poor agreement.

CONCLUSION

Our results add to the knowledge on the global epidemiology of T. gondii and exposure level of horses to the major zoonotic parasite, as well as to the discussion of challenges of applying serology to estimate exposure to T. gondii in horses.

Critical Orientation in the Jungle of Currently Available Methods and Types of Data for Source Attribution of Foodborne Diseases

With increased interest in source attribution of foodborne pathogens, there is a need to sort and assess the applicability of currently available methods. Herewith we reviewed the most frequently applied methods for source attribution of foodborne diseases, discussing their main strengths and weaknesses to be considered when choosing the most appropriate methods based on the type, quality, and quantity of data available, the research questions to be addressed, and the (epidemiological and microbiological) characteristics of the pathogens in question. A variety of source attribution approaches have been applied in recent years. These methods can be defined as top–down, bottom–up, or combined. Top–down approaches assign the human cases back to their sources of infection based on epidemiological (e.g., outbreak data analysis, case-control/cohort studies, etc.), microbiological (i.e., microbial subtyping), or combined (e.g., the so-called ‘source-assigned case-control study’ design) methods. Methods based on microbial subtyping are further differentiable according to the modeling framework adopted as frequency-matching (e.g., the Dutch and Danish models) or population genetics (e.g., Asymmetric Island Models and STRUCTURE) models, relying on the modeling of either phenotyping or genotyping data of pathogen strains from human cases and putative sources. Conversely, bottom–up approaches like comparative exposure assessment start from the level of contamination (prevalence and concentration) of a given pathogen in each source, and then go upwards in the transmission chain incorporating factors related to human exposure to these sources and dose-response relationships. Other approaches are intervention studies, including ‘natural experiments,’ and expert elicitations. A number of methodological challenges concerning all these approaches are discussed. In absence of an universally agreed upon ‘gold’ standard, i.e., a single method that satisfies all situations and needs for all pathogens, combining different approaches or applying them in a comparative fashion seems to be a promising way forward.

A review on toxoplasmosis in humans and animals from Egypt

The present paper summarizes prevalence, epidemiology and clinical disease of natural Toxoplasma gondii infections in humans and animals from Egypt. The current situation of toxoplasmosis in Egypt is confusing. There is no central laboratory or group of researchers actively investigating toxoplasmosis in humans or animals, and no reports on the national level are available. Based on various serological tests and convenience samples, T. gondii infections appear highly prevalent in humans and animals from Egypt. Living circumstances in Egypt favour the transmission of T. gondii. Up to 95% of domestic cats, the key host of T. gondii, are infected with T. gondii; they are abundant in rural and suburban areas, spreading T. gondii oocysts. Many women have been tested in maternity clinics, most with no definitive diagnosis. Toxoplasma gondii DNA and IgM antibodies have been found in blood samples of blood donors. Clinical toxoplasmosis in humans from Egypt needs further investigations using definitive procedures. Reports on congenital toxoplasmosis are conflicting and some reports are alarming. Although there are many serological surveys for T. gondii in animals, data on clinical infections are lacking. Here, we critically review the status of toxoplasmosis in Egypt, which should be useful to biologist, public health workers, veterinarians and physicians.

Toxoplasma gondii in water buffaloes (Bubalus bubalis) from Romania: what is the importance for public health?

The purpose of our study was to evaluate the prevalence of Toxoplasma gondii infection in autochthonous Carpathian buffaloes from northwestern Romania by serology, PCR techniques, and mouse bioassay. Agreement between MAT and ELISA, correlation between indirect and direct detection methods, and risk factors were evaluated. The apparent overall seroprevalence of T. gondii was 8.1% by MAT and 6.6% by ELISA. The agreement between ELISA and MAT was fair. The apparent seroprevalence was significantly higher in adult buffaloes (12.5%) compared to calves (0.0%) and juveniles (1.9%) by MAT. Most of the positive adult buffaloes detected by MAT had antibodies at a low sera dilution and the highest dilution was 1:768 in a juvenile female (30 months). No viable T. gondii was detected by mouse bioassay, as no T. gondii cyst or DNA was found in the brain of mice and they did not seroconvert. However, T. gondii DNA was detected in two buffaloes: in a 30-month-old male buffalo by qPCR on the diaphragm digest and in a 252-month-old female buffalo by RE nPCR on the mesenteric lymph node. Both animals were negative in MAT and ELISA. The total prevalence of T. gondii by direct detection methods was 2.7%. There was no correlation between indirect and direct detection methods. Since no viable T. gondii was detected in buffaloes, the risk of human infection from buffalo meat is minimal. Buffaloes' biological response to a T. gondii infection appears to be very similar to the response of cattle.

A one health approach to vaccines against Toxoplasma gondii

Toxoplasmosis is a serious disease with global impact, now recognised as one of the most important food borne diseases worldwide and a major cause of production loss in livestock. A one health approach to develop a vaccination programme to tackle toxoplasmosis is an attractive and realistic prospect. Knowledge of disease epidemiology, parasite transmission routes and main risk groups has helped to target key host species and outcomes for a vaccine programme and these would be to prevent/reduce congenital disease in women and sheep; prevent/reduce T. gondii tissue cysts in food animal species and to prevent/reduce T. gondii oocyst shedding in cats. Most animals, including humans, develop good protective immunity following infection, involving cell mediated immune responses, which may explain why live vaccines are generally more effective to protect against T. gondii. Recent advances in our knowledge of parasite genetics and gene manipulation, strain variation, key antigenic epitopes, delivery systems and induction of immune responses are all contributing to the prospects of developing new vaccines which may be more widely applicable. A key area in progressing vaccine development is to devise standard vaccine efficacy models in relevant animal hosts and this is where a one health approach bringing together researchers across different disciplines can be of major benefit. The tools and technologies are in place to make a real impact in tackling toxoplasmosis using vaccination and it just requires a collective will to make it happen.

Toxoplasmosis: Overview from a One Health perspective

Toxoplasmosis is paradigmatic of the One Health approach, as the causative parasite Toxoplasma gondii infects virtually all warm-blooded animals, including humans. This makes T. gondii one of the most successful parasites on earth, infecting up to a third of the global human population. Moreover, the T. gondii disease burden has been ranked among the highest of all parasitic diseases. To reduce the disease burden of toxoplasmosis in humans, interventions are needed in the animal reservoirs, necessitating close collaboration between both the human and veterinary medical sectors. In the present special issue of FAWPAR, several of the most pertinent topics related to the impact and control of toxoplasmosis are addressed by leading experts in the field. This collection of papers highlights state-of-the-art knowledge, gaps in knowledge and future perspectives, as well as the benefits of current and proposed future activities to tackle toxoplasmosis within the One Health context.

The relationship between the presence of antibodies and direct detection of Toxoplasma gondii in slaughtered calves and cattle in four European countries

In cattle, antibodies to Toxoplasma gondii infection are frequently detected, but evidence for the presence of T. gondii tissue cysts in cattle is limited. To study the concordance between the presence of anti-T. gondii IgG and viable tissue cysts of T. gondii in cattle, serum, liver and diaphragm samples of 167 veal calves and 235 adult cattle were collected in Italy, the Netherlands, Romania and the United Kingdom. Serum samples were tested for anti-T. gondii IgG by the modified agglutination test and p30 immunoblot. Samples from liver were analyzed by mouse bioassay and PCR after trypsin digestion. In addition, all diaphragms of cattle that had tested T. gondii-positive (either in bioassay, by PCR on trypsin-digested liver or serologically by MAT) and a selection of diaphragms from cattle that had tested negative were analyzed by magnetic capture quantitative PCR (MC-PCR). Overall, 13 animals were considered positive by a direct detection method: seven out of 151 (4.6%) by MC-PCR and six out of 385 (1.6%) by bioassay, indicating the presence of viable parasites. As cattle that tested positive in the bioassay tested negative by MC-PCR and vice-versa, these results demonstrate a lack of concordance between the presence of viable parasites in liver and the detection of T. gondii DNA in diaphragm. In addition, the probability to detect T. gondii parasites or DNA in seropositive and seronegative cattle was comparable, demonstrating that serological testing by MAT or p30 immunoblot does not provide information about the presence of T. gondii parasites or DNA in cattle and therefore is not a reliable indicator of the risk for consumers.

A social cost-benefit analysis of two One Health interventions to prevent toxoplasmosis

In the Netherlands, toxoplasmosis ranks second in disease burden among foodborne pathogens with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €45 million annually. Therefore, effective and preferably cost-effective preventive interventions are warranted. Freezing meat intended for raw or undercooked consumption and improving biosecurity in pig farms are promising interventions to prevent Toxoplasma gondii infections in humans. Putting these interventions into practice would expectedly reduce the number of infections; however, the net benefits for society are unknown. Stakeholders bearing the costs for these interventions will not necessary coincide with the ones having the benefits. We performed a Social Cost-Benefit Analysis to evaluate the net value of two potential interventions for the Dutch society. We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A 'minimum scenario' and a 'maximum scenario' was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively. For both interventions, we performed different scenario analyses. The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from €10.6 million to €31 million for steak tartare and €0.6 million to €1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from €1 million to €2.5 million, due to high intervention costs and limited benefits. From a public health perspective (i.e. reducing the burden of toxoplasmosis) and the societal perspective (i.e. a net benefit for the Dutch society) freezing steak tartare and leg of mutton is to be considered.

Source Attribution and Risk Assessment of Antimicrobial Resistance

Source attribution and microbial risk assessment methods have been widely applied for the control of several foodborne pathogens worldwide by identifying (i) the most important pathogen sources and (ii) the risk represented by specific foods and the critical points in these foods' production chains for microbial control. Such evidence has proved crucial for risk managers to identify and prioritize effective food safety and public health strategies. In the context of antimicrobial resistance (AMR) from livestock and pets, the utility of these methods is recognized, but a number of challenges have largely prevented their application and routine use. One key challenge has been to define the hazard in question: Is it the antimicrobial drug use in animals, the antimicrobial-resistant bacteria in animals and foods, or the antimicrobial resistance genes that can be transferred between commensal and pathogenic bacteria in the animal or human gut or in the environment? Other important limitations include the lack of occurrence and transmission data and the lack of evidence to inform dose-response relationships. We present the main principles, available methods, strengths, and weaknesses of source attribution and risk assessment methods, discuss their utility to identify sources and estimate risks of AMR from livestock and pets, and provide an overview of conducted studies. In addition, we discuss remaining challenges and current and future opportunities to improve methods and knowledge of the sources and transmission routes of AMR from animals through food, direct contact, or the environment, including improvements in surveillance and developments in genotypic typing methods.

Public health risks associated with food-borne parasites

Parasites are important food‐borne pathogens. Their complex lifecycles, varied transmission routes, and prolonged periods between infection and symptoms mean that the public health burden and relative importance of different transmission routes are often difficult to assess. Furthermore, there are challenges in detection and diagnostics, and variations in reporting. A Europe‐focused ranking exercise, using multicriteria decision analysis, identified potentially food‐borne parasites of importance, and that are currently not routinely controlled in food. These are Cryptosporidium spp., Toxoplasma gondii and Echinococcus spp. Infection with these parasites in humans and animals, or their occurrence in food, is not notifiable in all Member States. This Opinion reviews current methods for detection, identification and tracing of these parasites in relevant foods, reviews literature on food‐borne pathways, examines information on their occurrence and persistence in foods, and investigates possible control measures along the food chain. The differences between these three parasites are substantial, but for all there is a paucity of well‐established, standardised, validated methods that can be applied across the range of relevant foods. Furthermore, the prolonged period between infection and clinical symptoms (from several days for Cryptosporidium to years for Echinococcus spp.) means that source attribution studies are very difficult. Nevertheless, our knowledge of the domestic animal lifecycle (involving dogs and livestock) for Echinoccocus granulosus means that this parasite is controllable. For Echinococcus multilocularis, for which the lifecycle involves wildlife (foxes and rodents), control would be expensive and complicated, but could be achieved in targeted areas with sufficient commitment and resources. Quantitative risk assessments have been described for Toxoplasma in meat. However, for T. gondii and Cryptosporidium as faecal contaminants, development of validated detection methods, including survival/infectivity assays and consensus molecular typing protocols, are required for the development of quantitative risk assessments and efficient control measures.

Consumers' preferences for freezing of meat to prevent toxoplasmosis- A stated preference approach

Consumption of raw or undercooked meat increases the risk of infection with Toxoplasma gondii. Freezing meat products can eliminate this risk. Freezing of meat may affect consumers' valuation of meat products in two different ways: it may be valued positively because of increased food safety or valued negatively because of (perceived) loss of quality. In a Discrete Choice Experiment on four different meat products we studied the difference in willingness to pay for frozen and non-frozen meat products in the Netherlands. Analyses revealed that most Dutch consumer groups prefer non-frozen meat. Price was important in consumer decisions, whereas the meat being frozen appeared to play a minor role in the decision to purchase meat products. Even though it may seem obvious that people would prefer safe food to unsafe food, in a context where consumers presume food being safe, many consumers appear unwilling to pay for freezing of meat as additional measure to reduce the risk of food borne infections such as toxoplasmosis.

Risk Assessment of Human Toxoplasmosis Associated with the Consumption of Pork Meat in Italy

Toxoplasmosis is a cosmopolitan disease and has a broad range of hosts, including humans and several wild and domestic animals. The human infection is mostly acquired through the consumption of contaminated food and pork meat has been recognized as one of the major sources of transmission. There are, however, certain fundamental differences between countries; therefore, the present study specifically aims to evaluate the exposure of the Italian population to Toxoplasma gondii through the ingestion of several types of pork meat products habitually consumed in Italy and to estimate the annual number of human infections within two subgroups of the population. A quantitative risk assessment model was built for this reason and was enriched with new elements in comparison to other similar risk assessments in order to enhance its accuracy. Sensitivity analysis and two alternative scenarios were implemented to identify the factors that have the highest impact on risk and to simulate different plausible conditions, respectively. The estimated overall average number of new infections per year among adults is 12,513 and 92 for pregnant women. The baseline model showed that almost all these infections are associated with the consumption of fresh meat cuts and preparations (mean risk of infection varied between 4.5 × 10^-5 and 5.5 × 10^-5 ) and only a small percentage is due to fermented sausages/salami. On the contrary, salt-cured meat products seem to pose minor risk but further investigations are needed to clarify still unclear aspects. Among all the considered variables, cooking temperature and bradyzoites' concentration in muscle impacted most the risk.

Seroprevalence of Toxoplasma gondii in pregnant women and livestock in the mainland of China: a systematic review and hierarchical meta-analysis

Primary Toxoplasma gondii infection in pregnant women may result in abortion, stillbirth, or lifelong disabilities of the unborn child. One of the main transmission routes to humans is consumption of raw or undercooked meat containing T. gondii tissue cysts. We aim to determine and compare the regional distribution of T. gondii seroprevalence in pregnant women and meat-producing livestock in China through a systematic literature review. A total of 272 eligible publications were identified from Medline, Scopus, Embase and China National Knowledge Infrastructure. Apparent and true seroprevalence were analysed by region using a novel Bayesian hierarchical model that allowed incorporating sensitivity and specificity of the applied serological assays. The true seroprevalence of T. gondii in pregnant women was 5.0% or less in seven regions of China. The median of the regional true seroprevalences in pigs (24%) was significantly higher than in cattle (9.5%), but it was not significantly higher than in chickens (20%) and small ruminants (20%). This study represents the first use of a Bayesian hierarchical model to obtain regional true seroprevalence. These results, in combination with meat consumption data, can be used to better understand the contribution of meat-producing animals to human T. gondii infection in China.

Detection and dissemination of Toxoplasma gondii in experimentally infected calves, a single test does not tell the whole story

Background

Although the detection of Toxoplasma gondii in bovine tissues is rare, beef might be an important source of human infection. The use of molecular techniques, such as magnetic capture qPCR (MC-qPCR), in combination with the gold standard method for isolating the parasite (mouse bioassay), may increase the sensitivity of T. gondii detection in infected cattle. The risk of transmission of the parasite to humans from undercooked/raw beef is not fully known and further knowledge about the predilection sites of T. gondii within cattle is needed. In the current study, six Holstein Friesian calves (Bos taurus) were experimentally infected with 10⁶ T. gondii oocysts of the M4 strain and, following euthanasia (42 dpi), pooled tissues were tested for presence of the parasite by mouse bioassay and MC-qPCR.

Results

Toxoplasma gondii was detected by both MC-qPCR and mouse bioassay from distinct pools (100 g) of tissues comprising: liver, tongue, heart, diaphragm, semitendinosus (hindlimb), longissimus dorsi muscle (sirloin) and psoas major muscle (fillet). When a selection of individual tissues which had been used for mouse bioassay were examined by MC-qPCR, parasite DNA could only be detected from two animals, despite all calves showing seroconversion after infection.

Conclusions

It is apparent that one individual test will not provide an answer as to whether a calf harbours T. gondii tissue cysts. Although the calves received a known number of infectious oocysts and highly sensitive methods for the detection of the parasite within bovine tissues were applied (mouse bioassay and MC-qPCR), the results confirm previous studies which report low presence of viable T. gondii in cattle and no clear predilection site within bovine tissues.

The design of a Social Cost-Benefit Analysis of preventive interventions for toxoplasmosis: An example of the One Health approach

Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate serological monitoring of pigs at slaughter followed by an audit and tailor made advice for farmers in case positive results were found. The benefits will be modelled stochastically as reduction in DALYs and monetized in Euro's following reference prices for DALYs. If the balance of total costs and benefits is positive, this will lend support to implementation of these preventive interventions at the societal level. Ultimately, the SCBA will provide guidance to policy makers on the most optimal intervention measures to reduce the disease burden of T. gondii in the Netherlands.