title: Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada.
abstract: 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.
authors.affiliation: Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Canada. jschurer@gmail.com.
authors.forename: Janna M
authors.initials: JM
authors.lastname: Schurer
authors.affiliation: School of Public Health, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Ellen
authors.initials: E
authors.lastname: Rafferty
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon Health Region, Saskatoon, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwandt
authors.affiliation: Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts.
authors.forename: Wu
authors.initials: W
authors.lastname: Zeng
authors.affiliation: School of Public Health, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Marwa
authors.initials: M
authors.lastname: Farag
authors.affiliation: Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000191:economics / Q000469:parasitology / Q000821:virology; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology*; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D014120:Toxocariasis / Q000191:economics / Q000453:epidemiology*; D014123:Toxoplasmosis / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult; D015047:Zoonoses / Q000191:economics / Q000453:epidemiology*