OPLAN BILIS-ALIS TOXOPLASMOSIS:

A PROJECT PROPOSAL FOR THE CONTROL AND PREVENTION OF TOXOPLASMOSIS IN THE PHILIPPINES Denise Barlis D. Sc., Jayvee Rhoan Descalsota Ph. D., and Kirk Llew Quijote M.D.

INTRODUCTION Toxoplasmosis is a zoonotic disease of humans and other vertebrates caused by the Apicomplexan parasite Toxoplasma gondii. Cats and felines in general are the reservoir and definitive hosts of the parasite while a variety of vertebrates act as intermediate hosts. Humans get infected by several mechanisms including transplacental transmission of parasite to the fetus from an infected mother, leading to congenital toxoplasmosis and miscarriage. The more common transmission route is the ingestion of undercooked meat with Toxoplasma zoitocysts, whose enclosed bradyzoites divide intracellularly as tachyzoites in the intestinal mucosa and enter the circulatory vessels to invade the brain and other tissues, later forming obstructive zoitocysts which if disintegrated, elicits strong inflammatory response. Serologic prevalence data indicate that toxoplasmosis is one of the most common of human infections throughout the world. In a serologic test for Toxoplasma antibody by ELISA, the overall seropositivity was 11.1% in Metro Manila, 61.2% in Mindoro, and 30.1% in Leyte, indicating significantly higher seropositivities in rural than urban settings (Kawashima et al, 2000). OBJECTIVES To propose control and preventive measures that would reduce the incidence and prevalence of toxoplasmosis in the Philippines RATIONALE Proper control and preventive measures which takes advantage of the transmission routes of T. gondii are essential to stop the spread of toxoplasmosis. These measures must include dissemination of relevant information to the public, actual short-term control and prevention plans, and sustainable longterm plans. CONTROL AND PREVENTIVE MEASURES Humans get toxoplasmosis from four major transmission routes: 1. Eating undercooked meat of animals harboring tissue cysts 2. Ingestion of food, water or other environmental samples contaminated with cat feces that contains oocysts or by inadvertent entry of oocysts into the mouth 3. Blood transfusion or organ transplantation 4. Transplacentally from mother to fetus

TRANSMISSION ROUTES 1. Eating of undercooked meat of animals harboring tissue cysts The tissue cyst contains the infective form bradyzoites. This route can be extended to include the issue of origin of cysts in the meat.

2. Ingestion of food, water or other environmental samples contaminated with cat feces that contains oocyst or by inadvertent entry of such samples into the mouth. The oocyst contains the infective form sporozoites. This route can be extended to include the issue of origin of Toxoplasma infection in cats.

CONTROL AND PREVENTIVE MEASURES 1. Government health agencies should raise the peoples awareness on the importance of the proper cooking of meat to destroy inherent pathogens through television and radio ads, internet websites, and print media. 2. Government should advocate irradiation of meat as tissue cysts are easily killed by exposure to 0.5 kilorads of gamma irradiation. 3. Households and restaurants should be taught that tissue cysts in meat are killed by heating the meat throughout to 67C or by cooling to -13C. Also, cooks should not taste or sample meat as it is being cooked. Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat and poultry. 4. Government should conduct regular meat sampling and inspection for cysts in wet markets or even in supermarkets by the proper government authorities. 5. Double-dead meat should be properly disposed of. 6. Animal farms should be regularly inspected and fines should be imposed on unsanitary ones especially those with cats freely roaming around. 7. Animal farms with persistent cases of Toxoplasma cysts in their meat products should be closed down. 1. Government health agencies should educate the public about the role of cats and other intermediate hosts in the transmission of Toxoplasma gondii in all its stages. 2. People should be taught measures to prevent contamination of their food with oocyst or inadvertent ingestion of oocyst: Never leave food or beverage uncovered as flies can act as mechanical vectors to the oocyst. When travelling to unfamiliar places, drink only bottled water. Wash hands thoroughly before eating especially after touching cats or clearing their litters. Gloves should be used while working in the garden. Childrens sandboxes should be covered when not in use. 3. Cat owners should be educated through various media on the hygienic and proper raising of cats, like the following: Feed cats with enough food, ideally only those canned animal food, so that they will not resort to hunting small vertebrates that may be infected with cysts. Raw meat should never be fed to cats. Cat litter trays should be emptied daily and regularly disinfected with boiling water to dispose of the oocysts before they become infective. Train cats to defecate only in the litter box. Cats should be bathed regularly. 4. Stray cats should be euthanized by the animal agencies.

5. Rodent, fly and other insect vector populations should be controlled by clearing the canals, proper garbage disposal and segregation, proper sewage treatment, maintaining clean households and buildings, and applying biocides to severe infestations. 6. Government should invest in filtration of water sources especially in areas with high toxoplasmosis incidence. 7. Feral cats should be kept away from human settlements by the proper animal agencies. 3. Blood transfusion or organ 1. Government health agencies should educate the public about the transplantation signs and symptoms and management of Toxoplasmosis and to discourage those suspected with disease from tissue and organ Blood may contain the infective form tachyzoites donation. while organs may contain 2. Proper screening of blood donors and organ donors should be implemented by the blood banks and organ banks. tachyzoites and cysts 3. Uncertified blood and organ collecting institutions should be with bradyzoites. criminally implicated. This route is the 4. Tattoo shops, barber shops, spas, and facial centers should be horizontal (person-toperson) transmission of T. monitored for hygienic practices. 5. Government should fund researches for the development of gondii hence can be more efficient blood and organ screening procedures and diagnostic extended to the treatment of people with procedures for Toxoplasmosis. Toxoplasmosis to prevent 6. Drugs against toxoplasmosis should be adequate from large hospitals to health centers. spread of disease to the 7. Government should fund researches for the development of population. cheap Toxoplasma vaccine. 8. Cases of toxoplasmosis should be recorded and monitored to recognize local outbreaks and prevent further spread. 4. Transplacentally from mother 1. Government health agencies should teach pregnant mothers to: to fetus Avoid playing with cats in the critical first trimester of Tachyzoites may be pregnancy. passed from the mother Avoid changing cat litter if possible. If no one else can to the fetus (vertical perform the task, wear disposable gloves and wash your transmission) hands with soap and warm water afterwards. Keep cats indoors. Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant. Be extra careful in the safety of foods eaten. 2. In areas of high toxoplasmosis incidence, the government should make it imperative to screen pregnant women for the said disease in order to have an early diagnosis and treatment. 3. In areas of high toxoplasmosis incidence, newborns should be screened for the said infection to achieve prompt treatment. 4. Women of reproductive age with toxoplasmosis should be treated completely to prevent congenital toxoplasmosis on their next pregnancy.