BEYOND CASE COUNTS: SOCIODEMOGRAPHIC VULNERABILITIES AND SURVEILLANCE GAPS IN GESTATIONAL TOXOPLASMOSIS IN BRAZIL AND MARANHÃO

Abstract

Gestational toxoplasmosis is simultaneously a clinical, environmental, and social event, and its epidemiological interpretation should not be restricted to annual changes in notification counts. This study interpreted sociodemographic, territorial, and case-closure patterns in gestational toxoplasmosis notifications in Brazil, focusing on Maranhão, from 2021 to 2025. A descriptive, ecological, retrospective epidemiological study was conducted using publicly available aggregated tabulations from the Brazilian Notifiable Diseases Information System. Data for 2026 were excluded because they were partial. Because queries were generated independently, variable-specific denominators were retained: 66,376 valid records for age/race, 69,076 for region, and 68,773 for outcome. Among sociodemographic records, 78.0% involved women aged 20-39 years and 19.1% involved adolescents aged 10-19 years; 63.7% were classified as brown or Black. The Northeast and Southeast accounted for 61.7% of notifications. Maranhão recorded 2,118 cases, corresponding to 3.1% of the regionally tabulated national total and 9.6% of notifications in the Northeast. For case outcome, 31,022 notifications (45.1%) were unknown or blank, whereas 37,700 (54.8%) were classified as cure. These findings do not estimate individual risk or incidence; rather, they reveal an overlap between reproductive, racial, and territorial vulnerability markers and a surveillance system that detects cases but often fails to document their closure. Gestational toxoplasmosis control requires socially situated prevention, territorially organized diagnosis, and integration across prenatal care, laboratories, maternity services, child follow-up, and surveillance.