Human ascarid infections in a one health framework and their epidemiology hidden burden and public health challenges

Human ascarid infections remain among the most widespread parasitic diseases worldwide, affecting more than one billion people and disproportionately burdening populations living in conditions of inadequate sanitation, close contact with animals, and persistent environmental contamination. Ascariasis caused by Ascaris lumbricoides, zoonotic exposure to Ascaris suum, and toxocariasis caused by Toxocara canis and Toxocara cati together represent major yet frequently underrecognized public health challenges, particularly in low- and middle-income settings. This review synthesizes current evidence on the transmission dynamics, diagnostic limitations, and control challenges of human-relevant ascarid infections within a One Health framework that integrates human, animal, and environmental dimensions. We examine how persistent environmental contamination, animal reservoirs, and socioeconomic vulnerabilities jointly shape infection risk and sustain transmission across diverse epidemiological contexts. Particular emphasis is placed on the hidden burden generated by subclinical and covert infections, as well as by the limited sensitivity of commonly used diagnostic tools, which together contribute to substantial underestimation of prevalence and morbidity. The review further discusses emerging concerns related to sustained anthelmintic exposure across human and veterinary sectors, highlighting potential implications for long-term control and the importance of strengthening surveillance of drug efficacy within public health programs. By integrating epidemiological, environmental, and health system perspectives, we identify key gaps that constrain current control strategies and outline priorities for more effective and sustainable interventions. Overall, this review underscores the necessity of coordinated One Health approaches that extend beyond preventive chemotherapy to include improved diagnostics, environmental management, veterinary interventions, and community engagement, aiming to reduce the persistent public health burden associated with human ascarid infections.