Globally, congenital toxoplasmosis remains a significant cause of morbidity and mortality, and outbreaks of infection with T. gondii represent a significant, emerging public health burden, especially in the developing world. This parasite is a threat to public health. Disease often is not recognized and is inadequately managed. Herein, we analyze the status of congenital toxoplasmosis in Morocco, Colombia, the United States, and France. We identify the unique challenges faced by each nation in the implementation of optimal approaches to congenital toxoplasmosis as a public health problem. We suggest that developed and developing countries use a multipronged approach, modeling their public health management protocols after those in France. We conclude that education, screening, appropriate treatment, and the development of novel modalities will be required to intervene successfully in caring for individuals with this infection. Gestational screening has been demonstrated to be cost-effective, morbidity-sparing, and life-saving. Recognition of the value and promise of public health interventions to prevent human suffering from this emerging infection will facilitate better patient and societal outcomes.

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Abstract. The Moroccan Health Ministry launched a Process of Eliminating Schistosomiasis in 1994. During 2005-2009, the epidemiologic status showed a clear interruption of disease transmission at the national level; only a few residual cases were recorded. Our present study is the first systematic serologic survey to evaluate the transmission status in remaining disease-endemic foci. A study population of 2,382 children born after the date of the last autochthonous cases were selected from provinces with histories of high schistosomiasis transmission (Tata, Chtouka Ait Baha, Errachidia, El Kelaa Des Sraghna, and Beni Mellal). To identify the presence of disease, specific antibodies directed against Schistosoma haematobium adult worm microsomal antigens were detected by using an enzyme-linked immunoelectrotransfer blot assay. The results showed an absence of antibodies in all serum samples. Consequently, our findings confirm either a low transmission status or an interruption of schistosomiasis transmission within the last disease endemic foci.

BackgroundAfter alleged stop of transmission of schistosomiasis and further down the line in post elimination settings, sensitive tools are required to monitor infection status to prevent potential re-emergence. In Rahala, where transmission cycle of Schistosoma haematobium is interrupted since 2004 but where 30% of snails are still infected by S. bovis, potential human S. bovis infection can’t be excluded. As methods based on egg-counts do not provide the required sensitivity, antibody or antigen assays are envisaged as the most appropriate tools for this type of monitoring.MethodsIn this pilot study, the performances of three assays were compared: two commercially available antibody tests (ELISA and haemagglutination format) indicating exposure, and an antigen test (lateral flow strip format) demonstrating active infection. All 37 recruited study participants resided in Rahala (Akka, province Tata, Morocco). Participants had been diagnosed and cured from schistosomiasis in the period between 1983 and 2003. In 2015 these asymptomatic participants provided fresh clinical samples (blood and urine) for analysis with the aforementioned diagnostics tests.ResultsNo eggs were identified in the urine of the 37 participants. The haemagglutination test indicated 6 antibody positives whereas the ELISA indicated 28 antibody positives, one indecisive and one false positive. ELISA and haemagglutination results matched for 18 individuals, amongst which 5 out of 6 haemagglutination positives. With the antigen test (performed on paired serum and urine samples), serum from two participants (cured 21 and 32 years ago) indicated the presence of low levels of the highly specific Schistosoma circulating anodic antigen (CAA), demonstrating low worm level infections (less than 5 pg/ml corresponding to probably single worm pair). One tested also CAA positive with urine. ELISA indicated the presence of human anti-Schistosoma antibodies in these two CAA positive cases, haemagglutination results were negative.ConclusionsTo prevent reemergence of schistosomiasis in Morocco current monitoring programs require specific protocols that include testing of antibody positives for active infection by the UCP-LF CAA test, the appropriate diagnostic tool to identify Schistosoma low grade infections in travelers, immigrants and assumed cured cases. The test is genus specific will also identify infections related to S. bovis.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0289-z) contains supplementary material, which is available to authorized users.

Au Maroc, bien que très peu d'études aient été réali-sées sur la séroprévalence de la toxoplasmose, aucune évaluation des facteurs de risque n'a été publiée à ce jour. Mekouar, en 1972, avait estimé la séroprévalence de la toxoplasmose à 51,5 %. Une prévalence similaire de 50,6 % a été rapportée par El Mansouri et al. (2007) dans la région de Rabat. Ce taux est élevé par comparaison aux 32 % rapportés par Chouchane et al. dans leur étude préliminaire réalisée dans la région de Sétif (Algérie). Plusieurs facteurs interviennent dans la contamination toxoplasmique et leur maîtrise contribue à prévenir la maladie. L'objectif de notre étude a donc été de déter-miner les facteurs de risque impliqués dans l'acquisition de cette infection. Cette étude transversale à visée analytique a porté sur 1 020 femmes enceintes, adressées par leurs médecins généralistes et gynécologues à l'Institut National d'Hygiène de Rabat, dans le cadre d'un suivi sérologique pendant la grossesse. L'échantil-lonnage a été effectué d'une façon systématique et sa taille a été calculée en fonction d'une prévalence théo-rique, avec un intervalle de confiance de 95 % et un niveau de risque d'erreur de 5 %. Durant la période d'étude, chaque femme a répondu volontairement au questionnaire portant sur l'âge, la consommation de viande mal cuite, le niveau d'étude, les connaissances sur la toxoplasmose, le contact avec la terre (jardinage, activités agricoles) et les chats. La recherche des anticorps anti Toxoplasma a été réalisée chez toutes ces femmes par la technique ELISA (Biorad, France) et les titres en IgG ont été exprimés en unités internationales (UI/ml). L'analyse statistique des résultats a été faite à l'aide du logiciel Epiinfo 2000. Après ajustement des rapports, une analyse bivariée a servi à comparer les variables