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Abstract：
BACKGROUND: Francisella tularensis, the bacterium that causes tularemia, has been a persistent and widespread pathogen in various regions of the world for centuries. Francisella tularensis can affect humans and various domestic and wild animals. The current study aimed to determine the epidemiological status of tularemia in countries of the WHO Eastern Mediterranean Region (EMRO) through a systematic review and meta-analysis.
METHODS: All included studies were identified through a systematic search of online databases, including Scopus, PubMed, Web of Science, and EMBASE, through July 26, 2022, using keywords and suitable combinations. We focused on cross-sectional studies investigating the prevalence of F. tularensis. The weighted pooled prevalence was calculated using a random-effects model.
RESULTS: A total of 206 studies were identified, of which 20 were finally included in the analysis. The human seroprevalence of tularemia in WHO-EMRO countries was 6.2% (95% CI, 4.2 9.2). In the subgroup analysis, anti-F. tularensis antibodies were found in 6.92% and 5.5% of the high-risk individuals and Iran, respectively. The pooled prevalence of F. tularensis in environmental samples (water and soil) from the WHO-EMRO countries was 5.8% (9.4% by PCR and 0.5% by culture). In addition, 2.5% (95% CI, 0.2 0.22.7) of ticks in WHO-EMRO countries were positive for F. tularensis. The pooled prevalence of F. tularensis in rodents is 2.0% (1.1% by PCR and 3.7% by serology). In addition, 0.6% of domestic ruminants (0.4% by PCR and 2.4% by serology) were positive for F. tularensis in WHO-EMRO countries.
CONCLUSIONS: According to the results of the present study, tularemia is an endemic but neglected disease in the WHO-EMRO region. However, most studies on tularemia are limited to a few countries in this region. Studies on tularemia in human populations, reservoirs, and vectors have been conducted in all countries in the WHO-EMRO region to obtain more detailed information about the epidemiology of tularemia in these regions.
METHODS: All included studies were identified through a systematic search of online databases, including Scopus, PubMed, Web of Science, and EMBASE, through July 26, 2022, using keywords and suitable combinations. We focused on cross-sectional studies investigating the prevalence of F. tularensis. The weighted pooled prevalence was calculated using a random-effects model.
RESULTS: A total of 206 studies were identified, of which 20 were finally included in the analysis. The human seroprevalence of tularemia in WHO-EMRO countries was 6.2% (95% CI, 4.2 9.2). In the subgroup analysis, anti-F. tularensis antibodies were found in 6.92% and 5.5% of the high-risk individuals and Iran, respectively. The pooled prevalence of F. tularensis in environmental samples (water and soil) from the WHO-EMRO countries was 5.8% (9.4% by PCR and 0.5% by culture). In addition, 2.5% (95% CI, 0.2 0.22.7) of ticks in WHO-EMRO countries were positive for F. tularensis. The pooled prevalence of F. tularensis in rodents is 2.0% (1.1% by PCR and 3.7% by serology). In addition, 0.6% of domestic ruminants (0.4% by PCR and 2.4% by serology) were positive for F. tularensis in WHO-EMRO countries.
CONCLUSIONS: According to the results of the present study, tularemia is an endemic but neglected disease in the WHO-EMRO region. However, most studies on tularemia are limited to a few countries in this region. Studies on tularemia in human populations, reservoirs, and vectors have been conducted in all countries in the WHO-EMRO region to obtain more detailed information about the epidemiology of tularemia in these regions.
摘要：
背景：图拉西斯，导致Tularemia的细菌，几个世纪以来，在世界各地一直是一种持续存在和广泛存在的病原体。杜拉弗朗西斯菌可以影响人类以及各种家养和野生动物。本研究旨在通过系统评价和荟萃分析来确定世卫组织东地中海区域（EMRO）国家的塔拉热病的流行病学状况。
方法：所有纳入的研究都是通过对在线数据库的系统搜索来确定的，包括Scopus,PubMed,WebofScience,和EMBASE,到2022年7月26日，使用关键词和合适的组合。我们专注于横断面研究，调查了土拉灵的患病率。使用随机效应模型计算加权合并患病率。
结果：共确定了206项研究，其中20人最终被纳入分析。在WHO-EMRO国家中，人的tularemia血清阳性率为6.2％（95％CI，4.29.2）。在亚组分析中，反F在6.92%和5.5%的高危人群和伊朗发现了tularensis抗体，分别。来自WHO-EMRO国家的环境样品（水和土壤）中的土拉特氏菌的合并患病率为5.8％（PCR为9.4％，培养为0.5％）。此外,在WHO-EMRO国家，2.5%(95%CI，0.20.22.7)的蜱体为土拉热杆菌阳性。在啮齿类动物中，土拉特氏菌的合并患病率为2.0％（PCR为1.1％，血清学为3.7％）。此外,在WHO-EMRO国家中，0.6％的国内反刍动物（PCR检测为0.4％，血清学检测为2.4％）为土拉特氏菌阳性。
结论：根据本研究的结果，在WHO-EMRO地区，Tularemia是一种地方性但被忽视的疾病。然而,大多数关于tularemia的研究仅限于该地区的少数国家。对人群中的塔拉热症的研究，水库,世卫组织-EMRO区域的所有国家都开展了病媒传播活动，以获得有关这些区域的兔热病流行病学的更详细信息。
方法：所有纳入的研究都是通过对在线数据库的系统搜索来确定的，包括Scopus,PubMed,WebofScience,和EMBASE,到2022年7月26日，使用关键词和合适的组合。我们专注于横断面研究，调查了土拉灵的患病率。使用随机效应模型计算加权合并患病率。
结果：共确定了206项研究，其中20人最终被纳入分析。在WHO-EMRO国家中，人的tularemia血清阳性率为6.2％（95％CI，4.29.2）。在亚组分析中，反F在6.92%和5.5%的高危人群和伊朗发现了tularensis抗体，分别。来自WHO-EMRO国家的环境样品（水和土壤）中的土拉特氏菌的合并患病率为5.8％（PCR为9.4％，培养为0.5％）。此外,在WHO-EMRO国家，2.5%(95%CI，0.20.22.7)的蜱体为土拉热杆菌阳性。在啮齿类动物中，土拉特氏菌的合并患病率为2.0％（PCR为1.1％，血清学为3.7％）。此外,在WHO-EMRO国家中，0.6％的国内反刍动物（PCR检测为0.4％，血清学检测为2.4％）为土拉特氏菌阳性。
结论：根据本研究的结果，在WHO-EMRO地区，Tularemia是一种地方性但被忽视的疾病。然而,大多数关于tularemia的研究仅限于该地区的少数国家。对人群中的塔拉热症的研究，水库,世卫组织-EMRO区域的所有国家都开展了病媒传播活动，以获得有关这些区域的兔热病流行病学的更详细信息。
