**4. Economic impact of toxoplasmosis**

The real economic impact of toxoplasmosis is difficult to estimate, because in most immuno‐ competent individuals, the infection goes unnoticed or has claimed clinical presentation to other diseases [22,29]. However, it is estimated that the economic impact should be very high due to the loss of one or more days of work in mild cases, treatment and care needs, sick children, especially those with mental retardation and blindness, loss of quality lifestyle and the costs of hospitalization in severe cases and the cost of monitoring pregnant women and treatment during pregnancy who are *T. gondii* positive [26,36,37].

In United States,, despite the low incidence, the economic impact of CT is high due to the severity of the infection, associated complications, treatment and social costs. CT costs have been estimated as \$ 1.26 million per case and were mainly attributed to drug costs, annual losses of productivity, special education and health care costs [38]. On the other hand, in the United States, some 3,000 babies are born every year with CT and the annual cost of treating this disease is between US\$ 31 and US\$ 40 million [39]. The total economic impact of CT just in the United States has been estimated as over \$ 7.7 billion per year, which makes it the second most important infection to humans after foodborne salmonellosis [40]. In the United King‐ dom, the annual economic impact is estimated \$ 12 million [26].

In most productive animals, toxoplasmosis occurs asymptomatically; however, in animal production, toxoplasmosis is considered as an economically important disease of livestock, especially sheep and goats, where it can cause early embryonic death and resorption, fetal death and mummification, abortion, stillbirth and neonatal death [41].

Regarding economic impact of infection with *T. gondii* in productive species, just in the United Kingdom, economic losses were estimated to be between 15 and 20%, from scanning to sale, but on some farms losses can reach over 30% [42]. This is often a result of a disease outbreak of *T. gondii* abortion. Other authors had mentioned that cost of *Toxoplasma* in the UK flock was estimated to be £12 million [43]. These estimates included loss of production, cost of treatment, control and monitoring but did not include the costs associated with human health. As a matter of fact, the economic losses caused by *T. gondii* infection in sheep are difficult to estimate because the disease occurs sporadically. Moreover, only a small number of the lambs aborted are subjected to diagnosis [43]. In addition, the material sent for diagnosis, besides being potentially inadequate, might also be examined erroneously and, finally, serological testing lacks specificity [45].

In pigs, the infection with *T. gondii* also use to be asymptomatic, but in some cases, the active infection or parasitemia reactivation could impact over reproductive parameters (abortions or weak stillborns), mainly when is present in concomitance with other viral agents such as parvovirus [46] or circovirus.
