Programs for control of congenital toxoplasmosis.

Congenital toxoplasmosis can cause miscarriage and neurological and/or eye damage to the fetus. Since Austria and France established the prenatal screening, the prevalence of toxoplasmosis has declined from 50% to 35% and 84% to 44%, respectively. Other countries, such as the United Kingdom, have educational practices to reduce the risk of infection in seronegative pregnant women. In Brazil, prenatal screening is carried out in the states of Mato Grosso do Sul and Minas Gerais and the cities of Curitiba and Porto Alegre. In Londrina, state of Parana, the "Health Surveillance Program for Toxoplasmosis Acquired during Pregnancy and Congenital Toxoplasmosis" was established, which is based on serological screening, advising on prevention measures and quarterly serological monitoring in pregnant women that are initially seronegative, in addition to the monitoring of pregnant women and children with acute infection and case notification. In the first four years of implementation, the program evaluation showed a 63% reduction in the number of pregnant women and 42% in the number of children referred to reference services, resulting in the opening of vacancies for the care of patients with other diseases. As for medications, there was a 62% reduction in consumption of folic acid and 67% of sulfadiazine. Moreover, the definition of the protocols resulted in the standardization of care and safety for the decision-making by physicians. Therefore, as there are several protocols individualized in various departments and regions, the establishment of an ideal, consensual conduct with technical support, will result in implementing measures that will certainly save public resources, with the decrease in congenital toxoplasmosis.

Programas de controle da toxoplasmose congênita / Programs for control of congenital toxoplasmosis

A toxoplasmose congênita pode causar aborto e danos neurológicos e/ou oculares ao feto. Desde que a Áustria e a França estabeleceram a triagem pré-natal, a prevalência da toxoplasmose caiu de 50 por cento para 35 por cento e de 84 por cento para 44 por cento, respectivamente. Outros países, como o Reino Unido, adotam práticas educativas para reduzir o risco de infecção em gestantes soronegativas. No Brasil, a triagem pré-natal é realizada nos estados do Mato Grosso do Sul e Minas Gerais e nas cidades de Curitiba e Porto Alegre. Em Londrina, Paraná, foi implantado o "Programa de Vigilância da Toxoplasmose Adquirida na Gestação e Congênita", que se baseia na triagem sorológica, com orientação sobre as medidas de prevenção e monitoramento sorológico trimestral nas gestantes inicialmente soronegativas, além do acompanhamento das gestantes e crianças com infecção aguda e notificação dos casos. Nos primeiros quatro anos da implantação, a avaliação do programa demonstrou uma redução de 63 por cento no número de gestantes e de 42 por cento no número de crianças encaminhadas aos serviços de referência, resultando na liberação de vagas para o atendimento de pacientes com outras doenças. Quanto aos medicamentos, houve redução de 62 por cento no consumo de ácido folínico e de 67 por cento de sulfadiazina. Além disso, a definição dos protocolos resultou na padronização do atendimento e segurança para a tomada de decisões por parte dos médicos. Portanto, como existem diversos protocolos individualizados nos diversos serviços e regiões, o estabelecimento de uma conduta ideal e consensual, com respaldo técnico, implicará na adoção de medidas que, certamente, ocasionarão economia aos cofres públicos, com a diminuição da toxoplasmose congênita.

Congenital toxoplasmosis can cause miscarriage and neurological and/or eye damage to the fetus. Since Austria and France established the prenatal screening, the prevalence of toxoplasmosis has declined from 50 percent to 35 percent and 84 percent to 44 percent, respectively. Other countries, such as the United Kingdom, have educational practices to reduce the risk of infection in seronegative pregnant women. In Brazil, prenatal screening is carried out in the states of Mato Grosso do Sul and Minas Gerais and the cities of Curitiba and Porto Alegre. In Londrina, state of Parana, the "Health Surveillance Program for Toxoplasmosis Acquired during Pregnancy and Congenital Toxoplasmosis" was established, which is based on serological screening, advising on prevention measures and quarterly serological monitoring in pregnant women that are initially seronegative, in addition to the monitoring of pregnant women and children with acute infection and case notification. In the first four years of implementation, the program evaluation showed a 63 percent reduction in the number of pregnant women and 42 percent in the number of children referred to reference services, resulting in the opening of vacancies for the care of patients with other diseases. As for medications, there was a 62 percent reduction in consumption of folic acid and 67 percent of sulfadiazine. Moreover, the definition of the protocols resulted in the standardization of care and safety for the decision-making by physicians. Therefore, as there are several protocols individualized in various departments and regions, the establishment of an ideal, consensual conduct with technical support, will result in implementing measures that will certainly save public resources, with the decrease in congenital toxoplasmosis.

[Knowledge of toxoplasmosis among pregnant women, midwifes, medical students and obstetricians]. / Ocena stanu wiedzy dotyczacej toksoplazmozy wsród ciezarnych, poloznych, studentów medycyny i lekarzy polozników.

BACKGROUND: Knowledge of toxoplasmosis has been assessed among obstetricians, medical students, midwifes and pregnant women. The aims of the study were as follows: 1) evaluation of intra- and inter-group variation in correct answers to the questions included in the questionnaire used as a study tool; 2) evaluation of inter-group variation in answers to specialist and non-specialist questions; and 3) intra-group evaluation of self-assessed difficulty in completing the questionnaire. MATERIALS AND METHODS: In the prospective study, 310 participants were included: 109 pregnant women, 116 midwifes 85 physicians (including 69 specialists in OB/GYN) and 16 medical students. The anonymous questionnaire consisted of 26 questions, with four answers proposed for each question of which one was correct. RESULTS: There was no difference between correct answers among midwifes, physicians and medical students (p = 0.20), but the difference was found between the group of physicians and medical students and pregnant women as well as between midwifes and pregnant women (p < 0.001). Physicians, medical students and midwifes gave best answers to the non-specialist questions (p < 0.001), and midwifes obtained higher scores than pregnant women (p < 0.001). The mean percentage of correct answers to the specialist questions was among pregnant women (29%) showing a high level of randomness. The best answers to the non-specialist questions were found for physicians and midwifes (p = 0.93). However, there was a difference between the group of physicians and medical students and pregnant women and between midwifes and pregnant women in self-assessment of difficulty in completing the questionnaire (p < 0.001). CONCLUSIONS: Pregnant women assessed their knowledge of toxoplasmosis as least adequate, whereas midwifes, as most adequate. Pregnant women's knowledge about toxoplasmosis is poor. The group of physicians and medical students yielded evidently better score than pregnant women. There is a need for the improvement among prenatal care providers in both patient education and self-education.

Screening for toxoplasmosis in pregnant women: presentation of a screening programme in the former "East"-Germany, and the present status in Germany.

The results of the screening programme (including the examination of fetal IgM) in East-Germany, related to the efficiency of therapy (pyrimethamine/sulfonamid) of the fetal infection risk are presented. For comparison the results of a prospective study of toxoplasmosis in pregnancy (n = 1697) without therapy, and follow up of the connatal infected infants to the age of 9/10 years old are shown. Recommendations for the diagnostic and therapeutical management in Germany for the future are presented.

Screening programme for congenital toxoplasmosis in France.

The high prevalence of Toxoplasma gondii infection in France led to the establishment of a national screening programme. Preventive measures were progressively introduced, and these became compulsory in 1978 with the result that the incidence of congenital toxoplasmosis is now markedly reduced. Further improvements may include more systematic sampling from women before pregnancy, better and adequate health education and centralized notification of both maternal and congenital cases of toxoplasmosis.