Suijkerbuijk A W M, van Gils P F, Bonačić Marinović A A, Feenstra T L, Kortbeek L M, Mangen M-J J, Opsteegh M, de Wit G A, van der Giessen J W B
Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Zoonoses Public Health. 2018 Feb;65(1):185-194. doi: 10.1111/zph.12417. Epub 2017 Nov 12.
Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate serological monitoring of pigs at slaughter followed by an audit and tailor made advice for farmers in case positive results were found. The benefits will be modelled stochastically as reduction in DALYs and monetized in Euro's following reference prices for DALYs. If the balance of total costs and benefits is positive, this will lend support to implementation of these preventive interventions at the societal level. Ultimately, the SCBA will provide guidance to policy makers on the most optimal intervention measures to reduce the disease burden of T. gondii in the Netherlands.
弓形虫感染在荷兰造成了巨大的疾病负担，估计健康损失为1900个伤残调整生命年，每年的疾病成本估计为4400万欧元。人类感染是通过接触环境中的卵囊以及食用含有组织包囊的未煮熟肉类而发生的，这会导致无症状或轻微症状，但也可能导致眼部弓形虫病的发展。孕妇感染可导致死产和新生儿疾病。目前，预防措施仅针对孕妇。给猫接种疫苗、冷冻用于未煮熟食用的肉类以及加强养猪场的生物安全是预防弓形虫病的可能干预措施。由于这些干预措施给社会各部门带来成本，而受益部门与之不同，因此我们进行了社会成本效益分析（SCBA）。在社会成本效益分析中，确定受干预措施影响的社会领域的成本和效益，明确指出哪些利益相关者支付费用以及谁从中受益。我们使用流行病学模型来考虑对所有家养猫或畜牧场的猫进行疫苗接种后弓形虫的传播情况。为了确定将被未煮熟食用的相关高风险肉类产品，将使用一个定量微生物风险评估模型，该模型用于将预测的弓形虫感染归因于特定肉类产品。此外，我们评估在屠宰时对猪进行血清学监测，随后进行审计，并在发现阳性结果时为农民提供量身定制的建议。效益将以随机方式建模为伤残调整生命年的减少，并按照伤残调整生命年的参考价格以欧元进行货币化。如果总成本和效益的平衡为正，这将为在社会层面实施这些预防干预措施提供支持。最终，社会成本效益分析将为政策制定者提供指导，以确定最优化的干预措施，减轻荷兰弓形虫的疾病负担。
