title: Recurrent patent infections with Toxocara canis in household dogs older than six months: a prospective study.
abstract: To reduce environmental contamination with Toxocara canis eggs, the current general advice is to deworm all dogs older than six months on average four times a year. However, only a small proportion of non-juvenile household dogs actually shed T. canis eggs, and some dogs shed eggs more frequently than others. The identification of these frequent shedders and the associated risk factors is an important cornerstone for constructing evidence-based deworming regimens. The purpose of this study is to identify risk factors associated with recurrence of periods of shedding Toxocara eggs in a cohort of household dogs older than six months.
  
  
  
  We performed a prospective study (July 2011 to October 2014) on shedding Toxocara eggs in a cohort of 938 household dogs older than six months from all over the Netherlands. The median follow-up time was 14 months. Monthly, owners sent faecal samples of their dogs for Toxocara testing and completed a questionnaire. Dogs were dewormed only after diagnosis of a patent infection (PI). Survival analysis was used to assess factors influencing the time to first diagnosed PIs (FPI) and the time to recurrent PIs (RPI).
  
  
  
  The overall prevalence of PIs was 4.5 %, resulting in an estimated average incidence of 0.54 PIs/dog/year. No PI was diagnosed in 67.9 % of the dogs, 17.5 % of the dogs went through only one PI and 14.6 % had > 1 PI. Prevalence of PIs always peaked during wintertime. Increased hazards for first diagnosed PIs were associated with coprophagy, geophagy, walking off-leash for ≥ 80 % of walking time, reported worms in the faeces, feeding a commercial diet and suffering from urologic or respiratory conditions. Median time to reinfection was nine months. Factors associated with increased hazards for recurrent PIs were taking corticosteroids, changing dog's main purpose, and proxies for veterinary care-seeking behaviours.
  
  
  
  We concluded that targeted anthelmintic treatments in household dogs may be feasible as PIs tend to (re)occur in specific periods and in groups of dogs at high risk. Moreover, recurrent PIs appear to be influenced more by factors related to impaired immunity than environmental exposure to Toxocara eggs.
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, P.O. box 80.165, 3508, TD, Utrecht, The Netherlands. e.r.nijsse@uu.nl.
authors.forename: Rolf
authors.initials: R
authors.lastname: Nijsse
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, P.O. box 80.165, 3508, TD, Utrecht, The Netherlands.|National Institute for Public Health and the Environment, Centre for Infectious Disease Control (CIb), Bilthoven, The Netherlands.
authors.forename: Lapo
authors.initials: L
authors.lastname: Mughini-Gras
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, P.O. box 80.165, 3508, TD, Utrecht, The Netherlands.|Central Veterinary Institute of Wageningen UR, Lelystad, The Netherlands.
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Wagenaar
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, P.O. box 80.165, 3508, TD, Utrecht, The Netherlands.
authors.forename: Harm W
authors.initials: HW
authors.lastname: Ploeger
mesh_terms: D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use; D004283:Dog Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D004285:Dogs; D005191:Family Characteristics; D005243:Feces / Q000469:parasitology*; D010270:Parasite Egg Count / Q000662:veterinary*; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012621:Seasons; D017166:Toxocara canis / Q000276:immunology / Q000302:isolation & purification*; D014120:Toxocariasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology*
chemical_list: D000969:Antinematodal Agents
keywords: Deworming; Dogs; Longitudinal study; Recurrent patent infections; Toxocara canis