{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T02:03:10Z","timestamp":1791511390776,"version":"4.3.4"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p><jats:italic>Francisella tularensis<\/jats:italic>, the bacterium that causes tularemia, has been a persistent and widespread pathogen in various regions of the world for centuries. <jats:italic>Francisella tularensis<\/jats:italic> 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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 <jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic>. The weighted pooled prevalence was calculated using a random-effects model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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-<jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic> antibodies were found in 6.92% and 5.5% of the high-risk individuals and Iran, respectively. The pooled prevalence of <jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic> 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 <jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic>. The pooled prevalence of <jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic> 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 <jats:italic>F<\/jats:italic>. <jats:italic>tularensis<\/jats:italic> in WHO-EMRO countries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012141","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T17:43:24Z","timestamp":1715363004000},"page":"e0012141","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Epidemiology of tularemia in the countries of the WHO Eastern Mediterranean Region (EMRO): A systematic review and meta-analysis"],"prefix":"10.1371","volume":"18","author":[{"given":"Mohammad","family":"Sholeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9934-4262","authenticated-orcid":true,"given":"Safoura","family":"Moradkasani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1920-1737","authenticated-orcid":true,"given":"Saber","family":"Esmaeili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"pntd.0012141.ref001","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/B978-0-12-382006-8.00016-5","volume-title":"Microbial Forensics","author":"RT Okinaka","year":"2011"},{"issue":"1","key":"pntd.0012141.ref002","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S1473-3099(15)00355-2","article-title":"Tularaemia: clinical aspects in Europe.","volume":"16","author":"M Maurin","year":"2016","journal-title":"The Lancet Infectious Diseases"},{"issue":"1","key":"pntd.0012141.ref003","doi-asserted-by":"crossref","first-page":"12","DOI":"10.26444\/aaem\/139242","article-title":"Tularaemia\u2014a diagnostic challenge","volume":"29","author":"M Wawszczak","year":"2022","journal-title":"Ann Agric Environ Med"},{"key":"pntd.0012141.ref004","article-title":"Unusual case of prosthetic joint infection caused by Francisella tularensis.","author":"H Rawal","year":"2017","journal-title":"Case Reports."},{"issue":"4","key":"pntd.0012141.ref005","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/00005792-198507000-00006","article-title":"Tularemia: a 30-year experience with 88 cases.","volume":"64","author":"ME Evans","year":"1985","journal-title":"Medicine."},{"key":"pntd.0012141.ref006","first-page":"141","volume-title":"Francisella tularensis as a potential agent of bioterrorism?:","author":"M. 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