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All issues Volume 32 (2025) Parasite, 32 (2025) 68 Full HTML
Open Access
Issue
Parasite
Volume 32, 2025
Article Number 68
Number of page(s) 10
DOI https://doi.org/10.1051/parasite/2025061
Published online 22 October 2025

© X. Wang et al., published by EDP Sciences, 2025

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background

Toxoplasmosis, one of the most common parasitic infections, is caused by the obligate intracellular protozoan Toxoplasma gondii. Although the only definitive hosts of T. gondii are felids, there is a wide variety of intermediate host species, especially mammals, birds, livestock, and humans [11]. Humans are mainly infected by ingesting raw or undercooked meat, water, vegetables, and fruits contaminated with sporulated oocysts [14]. The severity of toxoplasmosis in humans varies, ranging from asymptomatic infections to severe ocular and neurological lesions. While primary infections in adults are mostly asymptomatic, infections in immunodeficient or immunocompetent patients may cause fatal toxoplasmic encephalitis, myocarditis, and pneumonitis [23]. Additionally, infections during pregnancy pose a risk of mother-to-child transmission or serious damage to the developing fetus, including long-term disabilities, stillbirth, or fetal death [39].

Globally, over one billion people are estimated to be infected with T. gondii [17]. However, significant spatial heterogeneity has been reported across various countries and regions. Infection prevalence ranges from 30% to 90% in Central America, South America, and continental Europe [30, 42], compared to 8% to 22% in the United States [2, 12]. The epidemiology of T. gondii infection is influenced by factors such as climate [29, 43], cultural practices [38], and food habits [44]. High seroprevalence rates have been reported in regions where consumption of raw or undercooked meat is common, and where contact with contaminated soil or water is prevalent [15, 37]. Additionally, socioeconomic factors [5], such as income per capita and human development index, can influence the prevalence of T. gondii infections within populations [5, 34].

Diagnostic methods available for detecting T. gondii infection in humans primarily involve histopathology, immunohistochemistry, molecular methods, and indirect (serological) tests [23, 27]. Molecular methods, including polymerase chain reaction (PCR), offer a more specific approach by identifying T. gondii DNA in blood, tissue, or other bodily fluids, which is particularly useful for detecting active infections or in immunocompromised patients [19, 27]. Serological tests such as enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay (IFA), which detect antibodies against the parasite, are generally highly sensitive and are widely used because of their accessibility and simplicity [21, 25].

Understanding the prevalence or seroprevalence of T. gondii infection among different population groups is crucial for identifying high-risk populations and implementing targeted public health interventions. Despite numerous epidemiological studies in various countries or regions, updated serosurveys focusing on T. gondii in southeast China remain limited. This study aimed to investigate the seroprevalence of T. gondii infection in the general population, occupational groups with close contact with animals, and blood donors in Zhejiang Province, southeastern China. By employing serological methods, the study sought to elucidate epidemiological patterns and inform disease management policies.

Methods

Ethics approval

The study was approved by the ethics review board of the Zhejiang Provincial Center for Disease Control and Prevention (No. 2021-004-01, January 27th, 2021).

Study sites

This study was conducted between 2019 and 2023 and included five counties in Zhejiang Province: Deqing, Dongyang, Yiwu, Ninghai, and Pujiang. Dongyang, Yiwu, and Pujiang are located in central Zhejiang, while Deqing and Ninghai are in the northern and eastern parts of the province, respectively.

Participants

Three groups of participants were recruited: the general population, animal contact workers, and blood donors. Each year, 100–200 participants undergoing routine physical examinations at town-level hospitals in Dongyang, Yiwu, Ninghai, and Pujiang were included in the general population. Animal contacts – workers occupationally exposed to animals, animal breeders, meat processing and sales personnel, and veterinarians – were surveyed in Deqing, Dongyang, Ninghai, and Pujiang. Specific details regarding the type of animal contact were collected from each participant. Blood donors were recruited from county-level blood centers in Dongyang, Yiwu, Ninghai, and Pujiang. Data on age, sex, and risk factors associated with T. gondii infection of animal contact workers, such as exposure type and animals involved, were collected from participants.

Sample collection

Approximately 2 mL of venous blood was collected from each participant. Specimens were stored at 4 °C and transported to a local center for disease control and prevention within 24 h. Additionally, all blood samples were separated into sera, red blood cells, and white blood cells within 24 h of blood collection and stored at −20 °C until analysis.

Serologic tests

Anti-T. gondii IgG and IgM were detected in serum samples using commercial ELISA kits (NovaTec Immunodiagnostica GmbH, Dietzenbach, German), following the manufacturer’s instructions. Positive, negative, and blank controls were included in each test batch.

Data analysis

Data were organized using Microsoft Office Excel 2021 (Microsoft Corporation, Redmond, WA, USA). All statistical analyses were performed using R Project, version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria). A map of the study site location and prevalence of antibodies at each site was generated using ArcGIS, version 10.1 (Esri, Redlands, CA, USA). Categorical variables were analyzed using the chi-squared test, with Fisher’s exact test applied when appropriate. Logistic regression was used to analyze the risk factors for T. gondii infection. Statistical significance was set at a p-value of < 0.05.

Results

General information

A total of 2,943 participants were enrolled from five study sites between 2019 and 2023, including 519 animal contact workers, 1,722 people from the general population, and 702 blood donors (Fig. 1; see Supplementary Table 1). The median age of the study population was 44 years (range, 1–88). Of the total participants, 1,513 were male and 1,430 were female, with similar median ages (women, 44 years; men, 42 years).

thumbnail Figure 1

Location of study sites, produced based on the standard map service website of the Ministry of Natural Resources of China GS (2022) 4314, with no modification of the base map boundary.

Overall prevalence of T. gondii infections

Considerable spatial diversity was observed in the seroprevalence of T. gondii. The highest IgG seroprevalence was found in Ninghai (6.00%, 50/833) and Deqing (4.40%, 4/91), followed by Dongyang (4.53%, 52/1,148). Pujiang had the lowest positivity (1.34%, 9/671) (see Supplementary Table 2). Anti‐T. gondii IgG and IgM antibodies were detected in 120 and 12 participants, respectively, yielding an apparent IgG seroprevalence of 4.08% (120/2,943) and a small IgM seroprevalence of 0.41% (12/2,943). Notably, four samples tested positive for both IgG and IgM (Table 1). The prevalence for middle age (30–50] was 4.76% for IgG and 0.40% for IgM.

Table 1

Overall seroprevalence of T. gondii in Zhejiang Province, 2019 to 2023.

An increasing trend was observed in participants aged ≤ 60 years, while a decline was observed in those aged > 60 years (Table 2). IgG positivity rate by age showed a similar pattern, with overall seroprevalence of T. gondii highest in the (50, 60] age group (5.47%, 29/530). The highest prevalence of positive IgM was found in the (60, 70] age group (1.21%, 3/247), while the prevalence in other groups was below 1% (see Supplementary Figure 1).

Table 2

Overall seroprevalence of T. gondii by age group.

Differing patterns were observed between men and women. Men exhibited higher IgG positivity rates (4.56%, 69/1,513) compared to women (3.57%, 51/1,430) (χ2 = 1.857, p = 0.173). Furthermore, the positivity rate in men was highest in the (60, 70] age group, whereas it was highest in the (50, 60] age group for women (see Supplementary Figure 1).

Seroprevalence of T. gondii in the general population

The general population consisted of 803 women and 919 men with a median age of 43 years (range, 1–88). The overall IgG prevalence in the general population was 1.68% (29/1,722), with higher positivity rates (> 2.00%) observed among farmers, freelancers, healthcare workers, and individuals in privately owned businesses (Table 3). While men had higher IgG prevalence rates (1.74%, 14/803) than women (1.63%, 15/919), the difference was not statistically significant (χ2 = 0.031, p = 0.860). The IgG seroprevalence increased with age and was highest in the (50, 60] age group (2.32%, 7/302) before declining to 1.67% (3/180) in the (60, 70] age group and 1.49% (2/134) in the > 70 age group. In contrast, IgM positivity remained low (< 1.0%) across all age groups (Table 4, Fig. 2).

thumbnail Figure 2

Seroprevalence of Toxoplasma gondii (IgG) by gender and age in the general population, animal contact workers, and blood donors: (a and b, general population; c and d, animal contact workers; e and f, blood donors).

Table 3

T. gondii seroprevalence by participants types.

Table 4

IgG prevalence of T. gondii in the general population, animal contact workers, and blood donors by age.

Seroprevalence of T. gondii in animal contact workers

The median age of the animal contact workers was 49 years (range, 18–83) and included 341 men and 178 women. A high seroprevalence was observed among animal contact workers, with the majority being IgG positive (10.40%, 54/519), while IgM prevalence remained low at 0.77% (4/519) (Table 3). Two participants tested positive for both IgG and IgM. The overall positivity rate was similar between males (10.26%, 35/341) and females (10.67%, 19/178). The positivity frequency increased with age, and was also consistently higher than the general population and blood donors, with the highest IgG prevalence found in the (70, 90] age group at 14.29% (2/14) (Table 4, Fig. 2). Multivariate analysis showed that the infection risk of animal contact workers is statistically higher than that of the general population (OR = 6.202, 95% CI: 3.793–10.140) (Table 5).

Table 5

Risk factors for T. gondii infection among participants.

Regarding specific types of animal exposure, workers with two types of animal exposure showed a higher IgG positivity rate (13.16%) compared to those with a single type (8.50%), although this difference was not statistically significant (χ2 = 2.911, p = 0.088). The IgG positivity proportions for slaughterers, breeders, and cleaners were 9.09% (15/165), 9.26% (10/108), and 9.09 % (1/11), respectively. Workers with two exposure types exhibited higher seroprevalence: breeders + slaughterers (20.00%), sales + processing (13.07%), and sales + slaughterers (12.73%). No positive IgG or IgM was detected in milkers, veterinarians, or managers (Table 6).

Table 6

T. gondii seroprevalence by exposure types of animal contacts.

The highest IgG frequency was found among workers occupationally exposed to cattle (12.69%), followed by those exposed to sheep (9.69%) and pigs (8.85%) (Table 7) (χ2 = 1.4322, p = 0.489). Further analysis of interactive effects between exposure types and exposed animals revealed that among cattle contact workers, “sales + processing” had the highest seroprevalence at 37.5%, followed by “sales + slaughterer” (18.18%) (p = 0.048). For sheep contacts, “breeder + slaughterer” (25.00%) and “sales + processing” (10.69%) had higher seroprevalence (p = 0.547). Among pig contact workers, slaughterers showed a higher positivity rate than breeders (χ2 = 1.261, p = 0.261) (Fig. 3).

thumbnail Figure 3

Interactive effect between exposure types and exposed animals in animal contact workers.

Table 7

T. gondii seroprevalence by exposed animals of animal contact persons.

Seroprevalence of T. gondii in blood donors

The 702 blood donors enrolled in the study were aged 18–59 years (median, 39 years), with 369 (52.56%) being male. Nearly 6% of blood donors were found to be T. gondii seropositive (5.56%, 39/702), most of whom were IgG positive (5.27%, 37/702) (Table 3). Three participants were IgM positive (0.43%, 3/702). A similar IgG positivity rate was observed between males (5.42%, 20/369) and females (5.11%, 17/333). IgG positivity was not observed in the (10, 20] age group but increased to 5.15% in the (20, 30] age group and plateaued at 5%–6% in the 20–60 age group.

Of note, the IgG level was higher in blood donors than in the general population in each age group (20, 30], (30, 40], (40, 50], and (50, 60], with statistically significance, despite younger age distribution. The odds ratio for T. gondii infection between blood donors and general population was statistically significant (OR = 3.147, 95% CI: 1.852–5.349) (Table 5). There was a statistically significant difference among study sites (p = 0.043), with the lowest rate reported in Pujiang (0.80%, 1/125) and rates ≥ 5.0% in Yiwu (5.0%, 2/40), Ninghai (6.46%, 32/495), and Dongyang (4.76%, 2/42) (Fig. 4).

thumbnail Figure 4

Seroprevalence of Toxoplasma gondii (IgG) by participants types in study sites.

Discussion

Measurement of IgM and IgG seroprevalence offers an efficient way to assess the incidence of T. gondii infections in populations. Our serosurvey revealed a low seropositivity rate (IgG, 4.08%; IgM, 0.41%) for toxoplasmosis in the general population in Zhejiang province, southeastern China. This rate is considerably lower than those reported in other countries, such as Germany (IgG, 49.08%) [42], Italy (IgG, 28.2%; IgM, 1.3%) [32], France (IgG, 55.38%) [7], the United Kingdom (IgG, 16.07%) [28], and the United States (IgG, 10.8%–31%) [12, 20]. Several factors likely contribute to the low prevalence in our study. First, there has been a low prevalence of T. gondii among food animals (pooled seroprevalence, 15.3%) in China in recent years [44]. Second, raw or undercooked meat is seldom consumed in Zhejiang province. Third, economic and social development in recent years has greatly improved individual hygiene habits, thereby reducing exposure to the parasite. Similar to findings for Europe [8], seroprevalence increased with age, with a maximum in the (50, 60] age group (5.47%), likely due to lifelong exposure. Men showed marginally higher IgG rates than women (4.56% vs. 3.57%), although the difference was not statistically significant (p = 0.173), contrasting with European data showing no consistent gender difference. Furthermore, the pattern of T. gondii IgG antibody prevalence in our serological survey differed among the general population, animal contact workers, and blood donors. Specifically, the positivity rate was highest in the (50, 60] and (30, 40] age groups in the general population and blood donors, respectively, before declining in older age groups. In contrast, a cumulative effect with age was observed among animal contact workers. The observed association between IgG prevalence and age in the general population contrasts with previous studies, which commonly report higher seroprevalence in older age groups [7, 32]. This discrepancy may reflect geographical heterogeneity between countries or regions. Other possible explanations include survivor bias in older individuals, which is common in cross-sectional studies, as well as antibody attenuation of T. gondii in older individuals. While IgM has a short duration (median 12.8 months) with high variability [13], IgG is reported to persist for years or indefinitely [13]. Cohort studies are needed to determine the decline pattern of IgG in the general population.

It is reported that animal contact workers have a higher prevalence of T. gondii infection owing to their higher exposure opportunities, especially in Africa (84.0%) [9], followed by Europe (72.8%) [3], the Middle East (46.1%) [16], and the Americas (44.4%) [1]. The overall positivity rate of T. gondii infection in the occupationally exposed population in China is relatively lower (5.0%–18.0%). However, conflicting data exist regarding the association between animal contact and T. gondii infection risk [9, 35, 40]. A study from Canada found no increased risk in individuals exposed to animals [35]. Another study from India reported a low seroprevalence of toxoplasmosis among veterinary personnel [40]. These conflicting findings may be related to various factors, such as different regions, social environments, survey time, and study design. Furthermore, discrepancies in seroprevalence rates between studies may also stem from variations among ELISA kits, which lack standardized antigens, protocols, and cutoff thresholds, making direct comparisons challenging. Our study confirmed that animal contact workers were more likely to have IgG seropositivity than the general population (10.40% vs. 1.68%), demonstrating an association between animal exposure and T. gondii infection. This association is further supported by higher seropositivity rates observed among individuals with exposure to two or more types of animals, emphasizing the role of occupational exposure. Additionally, seroprevalence in animal contact workers increased with advancing age, consistent with studies from Finland [36] and India [10], highlighting the cumulative risk of animal exposure. Based on these findings, routine surveillance and countermeasures are suggested for high-risk groups to prevent and minimize the incidence of toxoplasmosis, such as using personal protective equipment and promoting hand hygiene practices.

While sheep/goats are classical intermediate hosts, our data suggest that cattle-associated work deserves greater scrutiny [38]. Potential mechanisms include environmental contamination from cattle farm/factory facilitating oocyst transmission, or cattle handlers in our study area may have prolonged exposure to contaminated soil/water, a known reservoir for oocysts. In addition, cattle workers’ heightened exposure may also stem from combined occupational and behavioral factors, such as inadequate hygiene. Our results reinforce the need for species-specific protective measures alongside dietary education.

Screening for T. gondii in blood banks is not mandatory globally [6]. However, T. gondii transmission from blood donors to recipients has raised concerns because of the parasite’s ability to remain viable in blood for nearly 2 months, which increases the possibility of transmission by blood or component transfusions [41]. Blood recipients, who are often immunocompromised or immunosuppressed, are particularly vulnerable to serious clinical consequences from T. gondii infection. Seropositivity rates among blood donors vary widely across different regions (10–80%) or even within a country [4, 10, 18]. A geographical disparity in T. gondii antibody prevalence has been reported in Mexico [4]. Furthermore, a meta-analysis in Iran, with a sample size of 4,538, reported seroprevalence of 18.3%–56.4% among blood donors [26]. Lupu et al. also found that nearly half of blood donors were T. gondii antibody-positive in Romania [24]. Additionally, high seroprevalence rates were found in blood donors from Brazil [31], Portugal [33], and Tunisia [22]. In contrast, our study found a low IgG positivity rate of 5.27%, which was much lower than those reported in other countries, but comparable with the 6.26% prevalence shown by a systematic review from 1986 to 2017 in China. The relatively low overall positivity of T. gondii antibodies in our study is likely because the majority of the population in Zhejiang province consumes well-cooked food. However, the IgG prevalence in blood donors in our study was significantly higher than that in the general population (5.27% vs. 1.68%) (χ2 = 80.897, p < 0.001), indicating that T. gondii infections are more common among blood donors in Zhejiang province. This is inconsistent with European trends [8], where blood donors typically reflect lower-risk groups. IgG positivity rates of blood donors by occupation were all higher than those of the general population (farmers: 3.47% vs. 1.82%; freelancers: 7.06% vs. 2.47%; healthcare workers: 7.04% vs. 3.70%; workers: 5.00% vs. 1.92%; white-collar: 6.63% vs. 0%), although patterns between them were comparable. These findings underscore potential donor-specific risk factors (e.g., lifestyle, regional exposures) and highlight the public health imperative for enhanced T. gondii screening in blood donors.

This study has several limitations. First, specimens from the general population were collected from individuals attending routine physical examinations rather than a random sample, which may introduce selection bias. Second, IgG avidity was not tested to discriminate between acute and chronic toxoplasmosis. Third, information on risk factors was not collected to explore the possible reasons for high seroprevalence in animal contact workers and blood donors, which warrants further investigations.

Conclusions

This study demonstrated the epidemiological characteristics of T. gondii infection in the general population, animal contact workers, and blood donors in southeastern China. Variable patterns of T. gondii antibody distribution were revealed among the three participant types. Additionally, a cumulative risk was observed with age in animal contacts, and individuals with more animal exposure types exhibited higher seroprevalence. These findings highlight the importance of enhanced surveillance and targeted awareness programs for high-risk groups, particularly animal contact workers, to mitigate potential exposure.

Acknowledgments

We thank the epidemiologists of the Centers for Disease Control and Prevention of Deqing, Yiwu, Dongyang, Pujiang, and Ninghai districts for their invaluable assistance with sampling and data collection.

Funding

This work was funded by grants from the Basic public welfare research project of Zhejiang Province (Grant No. LGF22H260006) and Medical Research Program of Zhejiang Province (Grant No. 2022KY718).

Conflicts of interest

The authors declare that they have no competing interests.

Data availability statement

The dataset used and/or analyzed during the current study is available from the corresponding author on reasonable request.

Author contribution statement

Z.W and J.S conceived and designed the work. H.C, J.Z, K.Y, and Q.L performed the molecular studies. W.R, W.X, and X.Z analyzed the data. XW drafted the manuscript. All authors read and approved the final manuscript.

Supplementary material

Table S1. Sample numbers at different study sites. Access here

Table S2. Seroprevalence of T. gondii at different study sites. Access here

thumbnail Figure S1.

Seroprevalence of T. gondii by gender and age in all participants.

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Cite this article as: Wang X, Ruan W, Xu W, Chen H, Zhang J, Zhang X, Yu K, Lu Q, Wang Z & Sun J. 2025. Different patterns of Toxoplasma gondii infection epidemiology in the general population, animal contact workers, and blood donors in southeastern China between 2019 and 2023: a cross-sectional study. Parasite 32, 68. https://doi.org/10.1051/parasite/2025061.

All Tables

Table 1

Overall seroprevalence of T. gondii in Zhejiang Province, 2019 to 2023.

In the text
Table 2

Overall seroprevalence of T. gondii by age group.

In the text
Table 3

T. gondii seroprevalence by participants types.

In the text
Table 4

IgG prevalence of T. gondii in the general population, animal contact workers, and blood donors by age.

In the text
Table 5

Risk factors for T. gondii infection among participants.

In the text
Table 6

T. gondii seroprevalence by exposure types of animal contacts.

In the text
Table 7

T. gondii seroprevalence by exposed animals of animal contact persons.

In the text

All Figures

thumbnail Figure 1

Location of study sites, produced based on the standard map service website of the Ministry of Natural Resources of China GS (2022) 4314, with no modification of the base map boundary.
In the text
thumbnail Figure 2

Seroprevalence of Toxoplasma gondii (IgG) by gender and age in the general population, animal contact workers, and blood donors: (a and b, general population; c and d, animal contact workers; e and f, blood donors).
In the text
thumbnail Figure 3

Interactive effect between exposure types and exposed animals in animal contact workers.
In the text
thumbnail Figure 4

Seroprevalence of Toxoplasma gondii (IgG) by participants types in study sites.
In the text
thumbnail Figure S1.

Seroprevalence of T. gondii by gender and age in all participants.
In the text

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