The prevalence of Q fever in the Eastern Mediterranean region: a systematic review and meta-analysis

Epidemiol Health. 2022:44:e2022097. doi: 10.4178/epih.e2022097. Epub 2022 Oct 28.


Objectives: Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.

Methods: Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).

Results: In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).

Conclusions: Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.

Keywords: Coxiella burnetii; Mediterranean region; Meta-analysis; Prevalence; Q fever.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Animals
  • Camelus / microbiology
  • Cattle
  • Coxiella burnetii*
  • Dogs
  • Goats
  • Horses
  • Humans
  • Iran / epidemiology
  • Prevalence
  • Q Fever* / epidemiology
  • Q Fever* / microbiology
  • Q Fever* / veterinary
  • Seroepidemiologic Studies
  • Sheep