Objective To determine the odds ratio and population attributable fraction associated with food and environmental risk factors for acute toxoplasmosis in pregnancy. Design Case-control study. Setting Six large European cities. Participants Pregnant women with acute infection (cases) detected by seroconversion or positive for anti-Toxoplasma gondii IgM were compared with pregnant women seronegative for toxoplasma (controls). Main outcome measures Odds ratios for acute infection adjusted for confounding variables; the population attributable fraction for risk factors. Results Risk factors most strongly predictive of acute infection in pregnant women were eating undercooked lamb, beef, or game, contact with soil, and travel outside Europe and the United States and Canada. Contact with cats was not a risk factor. Between 30% and 63% of infections in different centres were attributed to consumption of undercooked or cured meat products and 6% to 17% to soil contact. Conclusions Inadequately cooked or cured meat is the main risk factor for infection with toxoplasma in all centres. Preventive strategies should aim to reduce prevalence of infection in meat, improve labelling of meat according to farming and processing methods, and improve the quality and consistency of health information given to pregnant women. IntroductionIn Europe, congenital toxoplasmosis affects between 1 and 10 in 10 000 newborn babies, 1 of whom 1% to 2% develop learning difficulties or die and 4% to 27% develop retinochoroidal lesions leading to permanent unilateral impairment of vision.2-6 Effective prevention of congenital toxoplasmosis depends on avoidance of infection during pregnancy. Infection is acquired by ingestion of viable tissue cysts in meat or oocysts excreted by cats that contaminate the environment. Uncertainty about how most women acquire infection results in advice to avoid numerous risk factors, making compliance difficult.8 9 Development of more focused strategies requires up to date and regionally relevant information on the principal sources of infection during pregnancy.The prevalence of previous toxoplasma infection in pregnant women ranges from 10% in the United Kingdom 10 and Norway 11 to around 55% in France 12 and Greece 13; in many countries it has declined sharply over the past three decades.14-16 Regional variation has been attributed to climate, 11 cultural differences in the amount and type of raw meat consumed, 7 17 and the increased consumption of meat from animals farmed indoors and frozen meat. 7 18 The decline in prevalence of infection, however, does not necessarily reflect a fall in the incidence of toxoplasmosis acquired during pregnancy. Instead, the decline in prevalence in pregnant women probably reflects a decline in incidence during childhood. 15More women are susceptible to infection now, and the frequency of exposure to risk factors for infection may have increased. Recent changes include a shift from consumption of beef to pork and poultry and increased consumption of organic meat and "val...

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Bovine Tuberculosis (bTB) in cattle is a global health problem and eradication of the disease requires accurate estimates of diagnostic test performance to optimize their efficiency. The objective of this study was, through statistical meta-analyses, to obtain estimates of sensitivity (Se) and specificity (Sp), for 14 different ante-mortem and post-mortem diagnostic tests for bTB in cattle. Using data from a systematic review of the scientific literature (published 1934-2009) diagnostic Se and Sp were estimated using Bayesian logistic regression models adjusting for confounding factors. Random effect terms were used to account for unexplained heterogeneity. Parameters in the models were implemented using Markov Chain Monte Carlo (MCMC), and posterior distributions for the diagnostic parameters with adjustment for covariates (confounding factors) were obtained using the inverse logit function. Estimates for Se and/or Sp of the tuberculin skin tests and the IFN-γ blood test were compared with estimates published 2010-2015. Median Se for the single intradermal comparative cervical tuberculin skin (SICCT) test (standard interpretation) was 0.50 and Bayesian credible intervals (CrI) were wide (95% CrI 0.26, 0.78). Median Sp for the SICCT test was 1.00 (95% CrI 0.99, 1.00). Estimates for the IFN-γ blood test Bovine Purified Protein Derivative (PPD)-Avian PPD and Early Secreted Antigen target 6 and Culture Filtrate Protein 10 (ESAT-6/CFP10) ESAT6/CFP10 were 0.67 (95% CrI 0.49, 0.82) and 0.78 (95% CrI 0.60, 0.90) respectively for Se, and 0.98 (95% CrI 0.96, 0.99) and 0.99 (95% CrI 0.99, 1.00) for Sp. The study provides an overview of the accuracy of a range of contemporary diagnostic tests for bTB in cattle. Better understanding of diagnostic test performance is essential for the design of effective control strategies and their evaluation.