Abstract
BACKGROUND: Toxoplasmosis is a prevalent protozoan infection with a complex lifecycle and wide profile of risk factors. The impact of congenital infection is well documented; however, there is increasing evidence of a much broader range of potential health outcomes and the need to improve our understanding of the transmission patterns and infection sources in the overall population. This study examined the epidemiology of toxoplasmosis in distinct community types from a highly endemic area of Chile. METHODS: A cross-sectional serosurvey was carried out in households from urban slums, rural villages, and farms which included collection of blood samples, as well as data on sociodemographic, behavioral, and spatial variables. Blood samples were analyzed for the presence of T. gondii-specific IgG antibodies. Avidity index was obtained for IgG-positive samples. Mixed-effects regression modeling was used to identify associations with relevant risk factors. RESULTS: Crude seroprevalence was 55.9% (95% CI: 52.6-59.1%) with no difference by community type. Results are indicative of early exposure to the parasite, including 40% of 13- to 17-year olds who were already seropositive. Sociodemographic factors associated with seropositivity included age, occupations, and income. However, sex modified the effect of occupation as well as of income. Practices associated with increased seropositivity were consumption of sheep and locally produced vegetables as well as cleaning household barns or sheds. Boiling water for household use was a protective factor. Living on a sloped terrain without vegetation was a protective factor, while living in an area with high flow accumulation index was a risk factor. CONCLUSIONS: Seroprevalence of infection was high in both rural and urban slum communities with unique risk factor profiles for each community type. Findings highlight the role of the household and the community environment as influential factors in the epidemiology of the infection. Increasing awareness is needed at the health care and public health levels to establish disease burden and options for suitable control programs.