| Cystic echinococcosis (CE) represents an increasing public health concern in many parts of the world, including
the Middle East. The present study is the first systematic review and meta-analysis to assess the seroprevalence
rate and population genetic structure of human CE in the eastern Mediterranean region. To estimate the population
genetic structure, Echinococcus sequences of the cytochrome oxidase subunit 1 (cox1) gene isolated from
countries from this geographical area were retrieved from the GenBank database. An electronic search for articles
from 1990 until 2015 was performed using databases PubMed, ScienceDirect, and Scopus. A total of 53
articles reporting on CE seroprevalence and genotyping data met our eligibility criteria and were included in a
meta-analysis. The overall CE seroprevalence rates in the general population and in individuals at high risk of
infection were estimated using the random-effect model at 7.4% (95% CI=4.8–10.6) and 10.7% (95%
CI=7.6–14.3), respectively. Risk factors including age group (P < 0.001), dog ownership (P=0.03), residence
area (P < 0.001), and educational level (P=0.04) showed a statistically significant association with CE
seroprevalence. A pairwise fixation index (Fst), used as an estimation of gene flow, suggested a moderate level of
genetic differentiation between members of the E. granulosus sensu stricto (G1-G3) complex from Iranian and
Turkish metapopulations (Fst=0.171). The finding of common haplotypes may represent an ancestral transfer
of alleles among populations probably during the early stages of animal domestication. The high CE seroprevalence
rates found highlight the necessity of implementing appropriate public education for preventive and
control strategies, particularly in individuals at high risk of infection; furthermore, our genetic findings reveal
novel molecular data concerning microevolutionary events of Echinococcus isolates among Middle East countries. |