Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 12, Number 9—September 2006
Letter

Perinatal Toxoplasmosis, Northern Taiwan

On This Page
Tables
Article Metrics
6
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Toxoplasmosis is caused by a protozoan parasite known as Toxoplasma gondii, which is found in animals worldwide and is readily transmitted to humans. The prevalence of T. gondii–specific immunoglobulin G (IgG) antibodies in women ranges from ≈15% in the United States (1) to ≈55% in Europe (2). Rate of transmission to a fetus in the first, second, and third trimesters is 8%, 25%, and 60%, respectively (3). The rate of congenital toxoplasmosis in the United States is 1–10 per 10,000 live births (4). Most infants infected in utero are born without obvious signs of toxoplasmosis, and learning or visual disabilities do not develop in up to 80% until their second or third decade of life (5,6).

In 1985 in Taiwan, the prevalence rates of T. gondii–specific IgG, as determined by ELISA, for pregnant women and their neonates were 10.2% and 11.6%, respectively. No samples from mothers or neonates were screened for IgM titers (7). During the past 20 years, however, the lifestyle, socioeconomic environment, and healthcare system have changed substantially in Taiwan. Overseas traveling has become more convenient, and Taiwan residents often travel to toxoplasmosis-endemic areas. The number of babies born to immigrant mothers has also recently increased in Taiwan. Our objective was to estimate the seroprevalence of perinatally transmitted T. gondii in northern Taiwan.

We tested sera collected from consecutive samples of women and their neonates (live births only) at 1 medical center, 1 local hospital, and 2 obstetric clinics in northern Taiwan from April 2004 through January 2005, which was 1 investigation of the Taiwan Birth Panel Study. Informed consent was obtained from either parent before enrollment in the study. Serum samples from cord blood of 483 neonates and paired samples from their mothers were analyzed for T. gondii–specific IgG and IgM titers by ELISA (Diagnostic Products Corporation, Los Angeles, CA, USA) (IgG sensitivity 94%, specificity 100%; IgM sensitivity 96.9%, specificity 91%) (8). Samples from the mothers were tested within 2 days of delivery. Additional data about health measures and conditions were collected by trained interviewers using structured questionnaires.

Among the study population, 93% were Taiwanese, 0.6% were Taiwanese aboriginals, 2.5% were mainland Chinese, and 3.9% were immigrants from southeastern Asia. Of the 483 mothers, 0.6% worked as farmers, 76% were 25–35 years of age, >50% had a university-level education, 77.7% encountered pets daily, and 9.7% owned cats. Of the 483 infants, the male:female ratio was 50.8:49.2, delivery was premature for 8.6%, and 5.8% had a low birthweight. For the mothers, the T. gondii–specific IgG prevalence rate was 9.1% (95% confidence interval [CI] 6.5%–11.7%), and 5 mothers (1.0%; 95% CI 0.1%–1.9%) were IgM positive. The T. gondii–specific IgG prevalence rate for the neonates was 9.3% (95% CI 6.7%–11.9%), and 1 neonate (0.2%; 95% CI 0%– 0.6%) was IgM positive (Table).

We identified 2 risk factors for seropositive mothers: being from mainland People's Republic of China (odds ratio [OR] 13.42; 95% CI 1.29–19.49] and being an agricultural worker (OR 59.53; 95% CI 4.45–79.67). Incidence of positive IgG titers was higher for mothers who owned cats than for mothers who did not own cats, but not significantly higher. The neonates who had positive T. gondii–specific IgM had negative IgM results at the age of 3 months. No significant differences in gestational age, birthweight, and neurodevelopment were identified between seropositive and seronegative groups of infants.

This study showed that in northern Taiwan, seroprevalence of T. gondii among pregnant women and neonates remains low and has not substantially changed during the past 20 years. The reason for such a low incidence in Taiwan is not clear but may be attributed to differences in the lifestyle, climate, cultural differences, food habits, and to the lesser consumption of raw meat in Taiwan compared with western countries. We found that the rate for T. gondii–specific IgM is higher for mainland Chinese mothers than for Taiwanese mothers (p<0.05). In Taiwan, the percentage of immigrant mothers increased from 15.7% in 1998 to 32.1% in 2003, and the percentage of neonates born to these mothers increased from 5.1% in 1998 to 13.8% in 2004 (9). Whether the lifestyle of mothers in Taiwan with a different ethnicity will influence future T. gondii seroprevalence require further investigation. This study highlights the emerging importance of toxoplasmosis as a possible perinatal infection in Taiwan. A high index of suspicion for infectious diseases among immigrant mothers is needed (10).

Top

Acknowledgment

This study was supported by the grants BHP-PHRC-92-4 and DOH93-HP-1702 from the Bureau of Health Promotion, Department of Health, Taiwan.

Top

I-Jan Hu*†, Pau-Chung Chen‡, Feng-Chiao Su‡, Chia-Jung Hsieh‡, Suh-Fang Jeng†, Hua-Fang Liao†, Yi-Ning Su*†, Shio-Jean Lin§, and Wu-Shiun Hsieh*†Comments to Author 

Author affiliations: *National Taiwan University Hospital, Taipei, Taiwan, Republic of China; †National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China; ‡National Taiwan University College of Public Health, Taipei, Taiwan, Republic of China; §National Cheng-Kung University Hospital, Tainan, Taiwan, Republic of China

Top

References

  1. Jones  JL, Kruszon-Moran  D, Wilson  M. Toxoplasma gondii infection in the United States, 1999–2000. Emerg Infect Dis. 2003;9:13714.PubMed
  2. Decavalas  G, Papapetropoulou  M, Giannoulaki  E, Tzigounis  V, Kondakis  XG. Prevalence of Toxoplasma gondii antibodies in gravidas and recently aborted women and study of risk factors. Eur J Epidemiol. 1990;6:2236. DOIPubMed
  3. Gilbert  R, Gras  L. European Multicentre Study on Congenital Toxoplasmosis. Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii. BJOG. 2003;110:11220.PubMed
  4. Centers for Disease Control and Prevention. Preventing congenital toxoplasmosis. [PMID: 15580732]. MMWR Recomm Rep. 2000;49(RR02):5775.
  5. Koppe  JG, Loewer-Sieger  DH, de Roever-Bonnet  H. Results of 20-year follow-up of congenital toxoplasmosis. Lancet. 1986;1:2546. DOIPubMed
  6. Wilson  CB, Remington  JS, Stagno  S, Reynolds  DW. Development of adverse sequelae in children born with subclinical congenital Toxoplasma infection. Pediatrics. 1980;66:76774.PubMed
  7. Yu  JC. A seroepidemiological study on Toxoplasma gondii infection among pregnant women and neonates in Taiwan. J Formos Med Assoc. 1985;84:28695.PubMed
  8. Hovanec-Burns  D, Cervantes  C, Gerstenecker  B, Soll  H-J, Janitschke  J, El Shami  AS. Detection of Toxoplasma gondii–specific IgG by IMMULITE. In: Abstracts of the 98th General Meeting of the American Society for Microbiology; Atlanta, Georgia; 1998 May 17–21; Poster 11386. Washington: American Society for Microbiology.
  9. Hsieh  W-S, Wu  H-C, Jeng  S-F, Liao  H-F, Su  Y-N, Lin  S-J, Nationwide singleton birth weight percentiles by gestational age in Taiwan, 1998–2002. Acta Paediatr Taiwan. 2006;47:2533.PubMed
  10. Khan  K, Muennig  P, Behta  M, Zivin  JR. Global drug-resistance patterns and the management of latent tuberculosis infection in immigrants to the United States. N Engl J Med. 2002;347:18509. DOIPubMed

Top

Table

Top

Cite This Article

DOI: 10.3201/eid1209.060033

Related Links

Top

Table of Contents – Volume 12, Number 9—September 2006

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Wu-Shiun Hsieh, Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd, Taipei Taiwan, Republic of China

Send To

character(s) remaining.

Comment submitted successfully, thank you for your feedback.

Top

Page created: November 17, 2011
Page updated: November 17, 2011
Page reviewed: November 17, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external