Prevalence and risk factors of coxiellosis at the human–animal–environment interface in the South Asian countries: A systematic review and meta-analysis

Coxiellosis, a zoonotic bacterial infection caused by Coxiella burnetii, affects diverse mammalian hosts and is prevalent worldwide, including in South Asia. This study aimed to investigate the epidemiology of Coxiellosis in South Asia, focusing on distribution, host diversity, prevalence, and associated risk factors at the human–animal–environment interface. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and a registered protocol, online searches were conducted in Embase, PubMed, Scopus, and Web of Science on August 6, 2023, to retrieve articles from the South Asian countries without restrictions on hosts or timeframe. Two authors independently reviewed, extracted data, and assessed quality based on predefined criteria, which were then evaluated and compiled into a single document and analyzed. The review identified 112 articles published between 1954 and 2023. Among humans, the estimated pooled seroprevalence (EPSP) was 9.2%, and the estimated pooled carrier prevalence (EPCP) was 6.2%. Ruminant herd-level EPSP and EPCP were 77.3% and 74.6%, and at the individual level, were 11.9% and 5.3%, respectively. Seroprevalence was significantly influenced by country, tick infestation, reproductive disorders, age, and body condition of ruminants. Nonruminant mammals, such as dogs (16.8%), horses (6.0%), pigs (3.9%), and rodents (14.8%), were also seropositive. Several avian and reptile species showed EPSP rates of 14.5% and 29.2%, respectively. Bacterial DNA was detected in ticks and soil samples, with EPCP of 1.0% and 3.3%, respectively. We recommend prioritizing One Health surveillance and intervention to prevent infections among humans, livestock, poultry, pets, and wildlife. Special emphasis should be placed on aged and emaciated animals, tick infestations, and animals with reproductive disorders.