Worldwide meta-analysis on Anaplasma phagocytophilum infections in animal reservoirs: Prevalence, distribution and reservoir diversity

A wide range of vertebrate species are competent reservoirs of Anaplasma phagocytophilum, where the pathogen is maintained in the enzootic cycle and transmitted to humans through activities of tick vectors. An insight into the role and diversity of these reservoirs is vital in understanding the epidemiology of this pathogen. Here, we determined the prevalence, distribution and reservoir diversity of A. phagocytophilum using a systematic review and meta-analysis. Data pooling was performed by the random-effects model, heterogeneity was assessed by the Cochran's Q-test and publication bias by Egger's regression test. Eighty-nine studies from 33 countries across 5 continents revealed A. phagocytophilum pooled prevalence of 15.18% (95% CI: 11.64, 19.57). Continental estimates varied significantly (p < 0.0001), with a range of 2.88% (95% CI: 0.25, 26.20) in South America to 19.91% (95% CI: 13.57, 28.24) in Europe. Country-based estimates ranged between 2.93% (95% CI: 1.17, 7.16) in Slovakia and 71.58% (95% CI: 25.91, 94.77) in Norway. Studies on A. phagocytophilum were concentrated in Europe (51.69%; 46/89) by continent and the USA (22.47%; 20/89) by country. Prevalence in wildlife (17.64%; 95% CI: 12.21-28.59) was significantly higher (p < 0.001) than that among domestic animals (10.68%; 95% CI: 6.61-16.83). Diverse species of wildlife, domestic animals and birds were infected by A. phagocytophilum. To curtail the public health, veterinary and economic consequences of A. phagocytophilum infections, we recommend an all-inclusive epidemiological approach that targets the human, animal and environmental components of the disease.