Update on the Seroepidemiology of Human Cystic Echinococcosis and Associated Risk Factors in Iran: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS

Cystic echinococcosis (CE) poses a significant public health challenge in developing countries, including Iran. This systematic review and meta-analysis aim to enhance our understanding of CE prevalence by providing an updated assessment of the general prevalence of human CE in Iran through a comprehensive review of the literature.

METHODS

PubMed, Scopus, Web of Science, Google Scholar, Magiran, and Scientific Information Database (SID) databases were searched for relevant literature published between January 1990 and December 2023. All peer-reviewed original papers evaluating the seroprevalence of human CE were included. Meta-analysis was performed using a random-effects model with 95% confidence intervals (CIs). Heterogeneity among the included studies was assessed using Cochran's and tests. The funnel plot and Egger's test were used to evaluate potential publication bias.

RESULTS

Sixty-eight studies met the inclusion criteria. The overall seroprevalence of human CE in Iran's general population was 4% (95% CI 3%-6%). Significant differences in seropositivity to human CE were observed among age groups, urban versus rural residence, diagnostic methods, and in relation to the presence of dogs at home or on farm. Substantial heterogeneity was observed across the included studies (  = 99.47%;  < 0.001). The funnel plot and Egger's test revealed considerable publication bias (Egger's test;  < 0.001).

CONCLUSION

Our findings demonstrate that CE remains prevalent in Iran, necessitating intensified health interventions and the development of targeted strategies for prevention and control. Recommendations include deworming dogs with praziquantel and vaccination of sheep with recombinant EG95 protein, removing raw offal or carcasses from the diet of dogs, hand washing, fencing of slaughterhouses with offal disposal systems, community participation for the control program and screening strategies for the diagnosis of asymptomatic cases and their timely treatment.