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However, the national distribution of <jats:italic>Paragonimus<\/jats:italic> spp. infection and its associated environmental determinants remain poorly understood. In this paper, we summarize the infection of <jats:italic>P<\/jats:italic>. <jats:italic>westermani<\/jats:italic> and <jats:italic>P<\/jats:italic>. <jats:italic>skrjabini<\/jats:italic> and describe key biogeographical characteristics of the endemic areas in China.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data on <jats:italic>Paragonimus<\/jats:italic> infection in humans and animal hosts were extracted from eight electronic databases, including CNKI, CWFD, Chongqing VIP, SinoMed, Medline, Embase, PubMed, and Web of Science. A random-effects meta-analysis model was used to estimate the pooled prevalence. All survey locations were georeferenced and plotted on China map, and scatter plots were used to illustrate the biogeographical characteristics of regions reporting <jats:italic>Paragonimus<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 28,948 cases of human paragonimiasis have been documented, with 2,401 cases reported after 2010. Among the 11,443 cases with reported ages, 88.05% were children or adolescents. The pooled prevalence of <jats:italic>P<\/jats:italic>. <jats:italic>skrjabini<\/jats:italic> is 0.45% (95% <jats:italic>CI<\/jats:italic>: 0.27\u20130.66%) in snails, 31.10% (95% <jats:italic>CI<\/jats:italic>: 24.77\u201337.80%) in the second intermediate host, and 20.31% (95% <jats:italic>CI<\/jats:italic>: 9.69\u201333.38%) in animal reservoirs. For <jats:italic>P<\/jats:italic>. <jats:italic>westermani<\/jats:italic>, the pooled prevalence is 0.06% (95% <jats:italic>CI<\/jats:italic>: 0.01\u20130.13%) in snails, 52.07% (95% <jats:italic>CI<\/jats:italic>: 43.56\u201360.52%) in the second intermediate host, and 21.40% (95% <jats:italic>CI<\/jats:italic>: 7.82\u201338.99%) in animal reservoirs. <jats:italic>Paragonimus<\/jats:italic> are primarily distributed in regions with low altitude, high temperature, and high precipitation. In northeastern China, only <jats:italic>P<\/jats:italic>. <jats:italic>westermani<\/jats:italic> infections have been documented, while in more southern areas, infections of both <jats:italic>P<\/jats:italic>. <jats:italic>westermani<\/jats:italic> and <jats:italic>P<\/jats:italic>. <jats:italic>skrjabini<\/jats:italic> have been reported.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Paragonimiasis remains prevalent in China, particularly among children and adolescents. Variations exist in the intermediate hosts and geographical distribution of <jats:italic>P<\/jats:italic>. <jats:italic>westermani<\/jats:italic> and <jats:italic>P<\/jats:italic>. <jats:italic>skrjabini<\/jats:italic>. Additionally, altitude, temperature, and precipitation may influence the distribution of <jats:italic>Paragonimus<\/jats:italic>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012366","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T17:53:24Z","timestamp":1722880404000},"page":"e0012366","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Infection and biogeographical characteristics of Paragonimus westermani and P. skrjabini in humans and animal hosts in China: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"18","author":[{"given":"Kai","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Chao","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-Tai","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ao-Long","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Xin","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Yan","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3156-5234","authenticated-orcid":true,"given":"Lan-Hua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"issue":"2","key":"pntd.0012366.ref001","first-page":"192","article-title":"Paragonimus & paragonimiasis in India","volume":"136","author":"TS Singh","year":"2012","journal-title":"Indian J Med Res"},{"key":"pntd.0012366.ref002","doi-asserted-by":"crossref","first-page":"105074","DOI":"10.1016\/j.actatropica.2019.105074","article-title":"Paragonimus and paragonimiasis in Asia: An update","volume":"199","author":"A Yoshida","year":"2019","journal-title":"Acta Trop"},{"key":"pntd.0012366.ref003","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/B978-0-12-378612-8.00159-1","volume-title":"Encyclopedia of Food Safety","author":"Y Nawa","year":"2014"},{"issue":"12","key":"pntd.0012366.ref004","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1517\/13543784.14.12.1513","article-title":"Triclabendazole for the treatment of fascioliasis and paragonimiasis","volume":"14","author":"J Keiser","year":"2005","journal-title":"Expert Opin Investig Drugs"},{"issue":"2","key":"pntd.0012366.ref005","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4103\/0255-0857.49424","article-title":"Paragonimus heterotremus infection in Nagaland: A new focus of Paragonimiasis in India","volume":"27","author":"TS Singh","year":"2009","journal-title":"Indian J Med Microbiol"},{"issue":"18","key":"pntd.0012366.ref006","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1056\/NEJMcps053177","article-title":"Clinical problem-solving. 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