Volume 95, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



and spp. are zoonotic parasites with potentially severe long-term consequences for those infected. We estimated incidence and investigated distribution, risk factors, and costs associated with these parasites by examining hospital discharge abstracts submitted to the Canadian Institute for Health Information (2002–2011). Annual incidence of serious toxoplasmosis and toxocariasis was 0.257 (95% confidence interval [CI]: 0.254–0.260) and 0.010 (95% CI: 0.007–0.014) cases per 100,000 persons, respectively. Median annual health-care costs per serious case of congenital, adult-acquired, and human immunodeficiency virus (HIV)–associated toxoplasmosis were $1,971, $763, and $5,744, respectively, with an overall cost of C$1,686,860 annually (2015 Canadian dollars). However, the total economic burden of toxoplasmosis is likely much higher than these direct health-care cost estimates. HIV was reported as a comorbidity in 40% of toxoplasmosis cases and accounted for over half of direct health-care costs associated with clinical toxoplasmosis. A One Health approach, integrating physician and veterinary input, is recommended for increasing public awareness and decreasing the economic burden of these preventable zoonoses.


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  1. Barry MA, Weatherhead JE, Hotez PJ, Woc-Colburn L, , 2008. Childhood parasitic infections endemic to the United States. Pediatr Clin North Am 60: 471485.[Crossref]
  2. Lee R, Moore L, Bottazzi M, Hotez P, , 2004. Toxocariasis in North America: a systematic review. PLoS Negl Trop Dis 8: e3116.[Crossref]
  3. Tenter A, Heckeroth A, Weiss L, , 2000. Toxoplasma gondii: from animals to humans. Int J Parasitol 30: 12171258.[Crossref]
  4. Hill D, Dubey J, , 2002. Toxoplasma gondii: transmission, diagnosis and prevention. Clin Microbiol Infect 8: 634664.[Crossref]
  5. Carter A, Frank J, , 1986. Congenital toxoplasmosis. Can Med Assoc J 135: 618623.
  6. Roberts T, Murrell K, Marks S, , 1994. Economic losses caused by foodborne parasitic diseases. Parasitol Today 10: 419423.[Crossref]
  7. Montoya J, Remington J, Mandell G, Bennet J, Dolin R, , 2000. Toxoplasmosis. , eds. Principles and Practices of Infectious Diseases. Philadelphia, PA: Churchill Livingstone, 28582888.
  8. Jones J, Roberts J, , 2012. Toxoplasmosis hospitalizations in the United States, 2008, and trends, 1993–2008. Clin Infect Dis 54: e58e61.[Crossref]
  9. Thomas M, Murray R, Flockhart L, Pintar K, Pollari F, Fazil A, Nesbitt A, Marshall B, , 2013. Estimates of the burden of foodborne illness in Canada for 30 specified pathogens and unspecified agents, circa 2006. Foodborne Pathog Dis 10: 639648.[Crossref]
  10. Messier V, Levesque B, Proulx J-F, Rochette L, Libman M, Ward B, Serhir B, Couillard M, Ogden NH, Dewailly E, Hubert B, Dery S, Barthe C, Murphy D, Dixon B, , 2009. Seroprevalence of Toxoplasma gondii among Nunavik Inuit (Canada). Zoonoses Public Health 56: 188197.[Crossref]
  11. Jenkins E, Castrodale L, de Rosemond S, Dixon B, Elmore S, Gesy K, Hoberg E, Polley L, Schurer JM, Simard M, Thompson RCA, , 2013. Tradition and transition: parasitic zoonoses in people and animals in northern North American and Greenland. Adv Parasitol 82: 33204.[Crossref]
  12. Jones J, Kruszon-Moran D, Won K, Wilson M, Schantz P, , 2008. Toxoplasma gondii and Toxocara spp. co-infection. Am J Trop Med Hyg 78: 3539.
  13. Smith H, Holland C, Taylor M, Magnaval J-F, Schantz P, Maizels R, , 2009. How common is human toxocariasis? Towards standardizing our knowledge. Trends Parasitol 25: 182188.[Crossref]
  14. Embil J, Tanner C, Pereira L, Staudt M, Morrison E, Gualazzi D, , 1988. Seroepidemiologic survey of Toxocara canis infection in urban and rural children. Public Health 102: 129133.[Crossref]
  15. Won K, Druszon-Moran D, Schantz P, Jones J, , 2008. National seroprevalence and risk factors for zoonotic Toxocara spp. infection. Am J Trop Med Hyg 79: 552557.
  16. Schurer J, Ndao M, Skinner S, Irvine J, Elmore S, Epp T, Jenkins EJ, , 2013. Parasitic zoonoses: One Health surveillance in northern Saskatchewan. PLoS Negl Trop Dis 7: e2141.[Crossref]
  17. Torgerson P, Macpherson C, , 2011. The socioeconomic burden of parasitic zoonoses: global trends. Vet Parasitol 182: 7995.[Crossref]
  18. Torgerson P, Budke C, Holland C, Smith H, , 2006. Economic impact of Toxocara spp. , eds. Toxocara: The Enigmatic Parasite, 1st edition. Wallingford, United Kingdom: CABI, 281.
  19. Statistics Canada, 2009. Urban Core, Urban Fringe and Rural Fringe. Available at: https://www12.statcan.gc.ca/census-recensement/2006/ref/dict/geo050a-eng.cfm. Accessed June 21, 2014.
  20. Statistics Canada, 2006. 2006 Census of Population. Available at: https://www12.statcan.gc.ca/census-recensement/2006/index-eng.cfm. Accessed June 17, 2014.
  21. Advisory Committee on the Microbiological Safety of Food, 2012. Risk Profile in Relation to Toxoplasma in the Food Chain. Available at: http://www.food.gov.uk/sites/default/files/multimedia/pdfs/committee/acmsfrtaxopasm.pdf. Accessed December 10, 2015.
  22. Burnett A, Shortt S, Isaac-Renton J, King A, Werker D, Bowie W, , 1998. Multiple cases of acquired toxoplasmosis retinitis presenting in an outbreak. Ophthalmology 105: 10321037.[Crossref]
  23. Government of Alberta, 2015. Medical Procedure List as of 01 April 2015. Available at: http://www.health.alberta.ca/professionals/SOMB.html. Accessed January 26, 2016.
  24. McDonald J, Gyorkos T, Alberton B, MacLean J, Richer G, Juranek D, , 1990. An outbreak of toxoplasmosis in pregnant women in northern Québec. J Infect Dis 161: 769774.[Crossref]
  25. Jones J, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley J, , 2001. Toxoplasma gondii infection in the United States: seroprevalence and risk factors. Am J Epidemiol 154: 357365.[Crossref]
  26. Public Health Agency of Canada, 2014. HIV/AIDS Epi Updates: National HIV Prevalence and Incidence Estimates for 2011. Available at: http://www.phac-aspc.gc.ca/aids-sida/publication/epi/2010/1-eng.php. Accessed October 5, 2015.
  27. Public Health Agency of Canada, 2011. Estimates of HIV Prevalence and Incidence in Canada. Available at: http://www.acch.ca/resources/Summary%20HIV%20Prevalence%20and%20Incidence%20in%20Canada,%202011.pdf. Accessed February 23, 2015.
  28. Montoya J, Liesenfeld O, , 2004. Toxoplasmosis. Lancet 363: 19651976.[Crossref]
  29. BC Centre for Excellence in HIV/AIDS, 2009. Opportunistic Infections Therapeutic Guidelines. Available at: http://www.cfenet.ubc.ca/therapeutic-guidelines/opportunistic-infection. Accessed September 22, 2014.
  30. Cook A, Gilbert R, Buffolano W, Zufferey J, Petersen E, Jenum P, Foulon W, Semprini AE, Dunn DT, , 2000. Sources of Toxoplasma infection in pregnant women: European multicentre case-control study. BMJ 321: 142147.[Crossref]
  31. Scharff R, , 2012. Economic burden from health losses due to foodborne illness in the United States. J Food Prot 75: 123131.[Crossref]
  32. Mangen MJ, Bouwknegt M, Friesema I, Haagsma J, Kortbeek L, Tariq L, Wilson M, van Pelt W, Havelaar AH, , 2014. Cost-of-illness and disease burden of food-related pathogens in The Netherlands, 2011. Int J Food Microbiol 196: 8493.[Crossref]
  33. Roberts T, Frenkel J, , 1990. Estimating income losses and other preventable costs caused by congenital toxoplasmosis in people in the United States. J Am Vet Med Assoc 196: 249256.
  34. Boyer K, Holfels E, Roizen N, Swisher C, Mack D, Remington J, Withers S, Meier P, McLeod R, , 2005. Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: implications for prenatal management and screening. Am J Obstet Gynecol 192: 564571.[Crossref]
  35. Lavoie E, Levesque B, Proulx JF, Grant J, Ndassebe A, Gingras S, Hubert B, Libman M, , 2008. Evaluation of the efficacy of the Toxoplasma gondii screening program among pregnant women in Nunavik, 1994–2003. Can J Public Health 99: 397400.
  36. Montoya J, Remington J, , 2008. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 15: 554566.[Crossref]
  37. Wilson J, Jungner G, , 1968. Principles and Practice of Screening for Disease. Report no: 34. Geneva, Switzerland: World Health Organization, 163.
  38. Gollub E, Leroy V, Gilbert R, Chene G, Wallon M, European Toxoprevention Study Group (EUROTOX), , 2008. Effectiveness of health education on Toxoplasma-related knowledge, behaviour, and risk of seroconversion in pregnancy. Eur J Obstet Gynecol Reprod Biol 136: 137145.[Crossref]
  39. Carter A, Gelmon S, Wells G, Toepell A, , 1989. The effectiveness of a prenatal education programme for the prevention of congenital toxoplasmosis. Epidemiol Infect 103: 539545.[Crossref]
  40. Hotez P, Wilkins P, , 2009. Toxocariasis: America's most common neglected infection of poverty and a helminthiasis of global importance? PLoS Negl Trop Dis 3: e400.[Crossref]
  41. Lim J, , 2008. Toxocariasis of the liver: visceral larva migrans. Abdom Imaging 33: 151156.[Crossref]

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  • Received : 07 Oct 2015
  • Accepted : 20 Mar 2016

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