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7.26 p.m.

Baroness Trumpington: My Lords, I am grateful to the noble Baroness, Lady Robson, for giving us the opportunity to explain the Government's policy on toxoplasmosis and our position on research, as well as for her forbearance in allowing me to take the place of

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my noble friend Lady Cumberlege. As the noble Baroness said, and as the noble Lord, Lord Rea, detailed, toxoplasmosis is a very unpleasant, albeit rare, disease in babies. As a government we must aim to prevent people, particularly pregnant women, from catching it.

The noble Baroness, Lady Robson, asks whether a large-scale study of toxoplasmosis in pregnancy should be established. It is our aim that centrally commissioned research should result in real improvements in services, and in improvements in the health of the population. For that reason, priorities for the whole of our research programme are reviewed regularly according to criteria, which include the extent and seriousness of the condition and the contribution which research can make into developing health policy.

We recognise that the birth of a child affected seriously by congenital toxoplasmosis is a tragedy for the child and for the family involved; but looking at it in terms of the epidemiological data, congenital toxoplasmosis is not a frequent problem. I should like to add to the knowledge of the noble Lord, Lord Rea: the number of babies born each year who are damaged by the disease probably lies between 15 and 50. A research study is currently under way based at the Institute of Child Health, and covering a number of regions. It is investigating the extent of long-term eye damage associated with congenital toxoplasmosis.

In 1992, a Royal College of Obstetricians and Gynaecologists multidisciplinary working group reviewed the case for prenatal screening for toxoplasmosis infection at our request. The group concluded that a national screening programme would not be appropriate because of the possibility that it might cause more harm than benefit.

The main reasons for its advice are, first, that there is uncertainty about the effectiveness of the treatment; secondly, that the currently available tests are not sufficiently sensitive and specific; thirdly, that, in order to detect infections occurring during pregnancy, testing would need to be repeated at regular intervals because women may become infected without having any symptoms; and, fourthly, but perhaps most worryingly, that there is a risk of unnecessary terminations.

The key issues are, therefore, reliability of testing and safety and effectiveness of treatment. A study of the epidemiology of toxoplasmosis in pregnancy may allow us to make more precise estimates of prevalence. However, it would not necessarily alter current conclusions on the balance of risk and benefit of a national screening programme or on the appropriate management of toxoplasmosis in pregnancy.

The report of the RCOG working party, which was published in 1992, included up-to-date information on management. The department funded distribution of the document, which was sent to all obstetricians. Recently, there have also been helpful review articles in journals such as the British Medical Journal. These will help doctors to keep up to date.

The noble Baroness, Lady Robson, asked for standard guidelines to be instigated by the Department of Health. It is not for the department to produce medical guidelines; that is the role of the relevant professional

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bodies, including the Royal Colleges. The department will consider commending to the health authorities clinical guidelines from professional bodies.

The main agency through which the Government support bio-medical and clinical research is the Medical Research Council. The noble Baroness will be well aware that the MRC receives its grant-in-aid from the Office of Public Service and Science under the Chancellor of the Duchy of Lancaster. It is an independent body which decides what research to support.

As regards toxoplasmosis, the MRC is currently funding two major studies. One is aimed at improving diagnosis in adults and the other at development of a vaccine. In addition to this MRC-funded work, universities and medical schools which are supported by public funding may also be funding research into toxoplasmosis. The MRC is always willing to consider scientifically sound proposals for research in competition with other proposals.

The Department of Health is not currently funding any research into toxoplasmosis. The department funds research through its centrally commissioned programme. As I explained earlier, research is funded according to agreed priorities, to inform policy and healthcare decisions. In addition, the NHS has a needs-led research and development programme, which identifies R&D needs in particular areas. The advisory group in mother and child health consulted a wide range of interested organisations, including the Toxoplasmosis Trust, to identify broad areas where research is needed. Priorities for R&D relating to mother and child health will be announced and the report will be widely disseminated in the New Year.

Baroness Robson of Kiddington: My Lords, I was not asking for research into how to treat toxoplasmosis; I was asking for a study of the incidence all over the country. That is quite different.

Baroness Trumpington: My Lords, I am aware of what was asked for; I am merely putting forward a different aspect. I answered the noble Baroness's point by saying that it is not the role of the Department of Health to produce such guidelines; it is for the professional bodies. Perhaps I may continue because I have more encouraging news.

The most important challenge is to prevent toxoplasmosis infection, in particular in pregnant women. Although research is in hand, there is no short-term prospect of a vaccine and so our priority is to inform women of the simple measures that they can take when they are pregnant in order to protect themselves from toxoplasmosis. I am pleased to see the noble Baroness nodding in agreement.

Toxoplasmosis is preventable and there can be no substitute for hammering home the basic message of good old-fashioned hygiene. Handwashing is vital before and after food preparation and handling raw meat. Everyone, in particular pregnant women or those trying to conceive, should be aware that meat must be thoroughly cooked before consumption and that fruit

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and vegetables should be thoroughly washed. This applies especially to home grown vegetables if cats live in the neighbourhood.

Attempts to reduce the incidence of toxoplasmosis have concentrated on health education measures, in particular among pregnant women, and the Government have taken positive steps in this area. The department produces a leaflet called, While you are Pregnant—safe eating and how to avoid infection from food and animals, which contains information on avoiding toxoplasmosis. The Health Education Authority produces its pregnancy book, which also contains information on toxoplasmosis and which is provided to

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women when they first attend antenatal clinics. The Institute of Child Health is co-ordinating a multicentre European study on infection risk factors, which will further inform the advice given to pregnant women. We also greatly appreciate the achievements of the Toxoplasmosis Trust in educating the public in prevention; and the department provides core funding to assist the Toxoplasmosis Trust in its work. This amounted to £15,000 in 1994-95.

I hope that the noble Baroness and the noble Lord will understand from what I have said that the Government not only take the condition seriously but are actively supporting measures to fight it.

        House adjourned twenty-two minutes before eight o'clock.

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