Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada

Janna M. Schurer Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Canada.

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Ellen Rafferty School of Public Health, University of Saskatchewan, Saskatoon, Canada.

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Michael Schwandt Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Canada.

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Wu Zeng Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts.

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Marwa Farag School of Public Health, University of Saskatchewan, Saskatoon, Canada.

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Emily J. Jenkins Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Canada.

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Toxoplasma gondii and Toxocara 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.

Author Notes

* Address correspondence to Janna M. Schurer, Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan, Canada. E-mail: jschurer@gmail.com
† These authors contributed equally to this work.

Financial support: Graduate student funding for Janna Schurer was provided by the Canadian Institutes of Health Research (CIHR) Strategic Training Program in Public Health and the Agricultural Rural Ecosystem (PHARE), and a Natural Sciences and Engineering Research Council (NSERC) Collaborative Research and Training Experience (CREATE) grant to the University of Saskatchewan for an Integrated Training Program in Infectious Diseases, Food Safety and Public Policy (ITraP). The Zoonotic Parasite Research Unit at the University of Saskatchewan is funded through grants from the Canadian Foundation for Innovation, Saskatchewan Health Research Foundation, and NSERC. Graduate student funding for Ellen Rafferty was provided by the University of Saskatchewan's Dean Scholarship and NSERC CREATE–ITraP.

Authors' addresses: Janna M. Schurer and Emily J. Jenkins, Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Canada, E-mails: jschurer@gmail.com and emily.jenkins@usask.ca. Ellen Rafferty and Marwa Farag, School of Public Health, University of Saskatchewan, Saskatoon, Canada, E-mails: err593@mail.usask.ca and marwa.farag@usask.ca. Michael Schwandt, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada, and Population and Public Health Services, Saskatoon Health Region, Saskatoon, Canada, E-mail: michael.schwandt@usask.ca. Wu Zeng, Schneider Institutes for Health Policy, Brandeis University, Waltham, MA, E-mail: wuzengcn@brandeis.edu.

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