Global meta-analysis on <i>Babesia</i> infections in human population: prevalence, distribution and species diversity

Human babesiosis is an emerging tick-borne protozoan zoonosis caused by parasites of the genus <i>Babesia</i> and transmitted by ixodid ticks. It was thought to be a public health problem mainly for the immunocompromised, however the increasing numbers of documented cases among immunocompetent individuals is a call for concern. In this systematic review and meta-analysis, we reported from 22 countries and 69 studies, an overall pooled estimate (PE) of 2.23% (95% CI: 1.46–3.39) for <i>Babesia</i> infections in humans. PEs for all sub-groups varied significantly (p Babesia species and targeted population ranged between 0.43% (95% CI: 0.41–0.44) and 7.41% (95% CI: 0.53–54.48). <i>Babesia microti</i> recorded the widest geographic distribution and was the predominant specie reported in North America while <i>B. divergens</i> was predominantly reported in Europe. Eight <i>Babesia</i> species; <i>B. bigemina, B. bovis, B. crassa</i>-like, <i>B. divergens, B. duncani, B. microti, B. odocoilei</i> and <i>B. venatorum</i> were reported in humans from different parts of the world with the highest prevalence in Europe, lower middle income countries and among individuals with history of tick bite and other tick-borne diseases. To control the increasing trend of this emerging public health threat, tick control in human settlements, the use of protective clothing by occupationally exposed people and the screening of transfusion blood in endemic countries are recommended. <b>Abbreviations</b> AJOL: African Journals OnLine, CI: Confidence interval, CIL: Country income level, df: Degree of freedom, HIC: Higher-income countries, HQ: High quality, <i>I</i>²: Inverse variance index, IFAT: Indirect fluorescent antibody test, ITBTBD: Individuals with tick-bite and tick-borne diseases, JBI: Joanna Briggs Institute, LIC: Lower-income countries, LMIC: Lower middle-income countries, MQ: Medium quality, NA: Not applicable, N/America: North America, OEI: Occupational exposed individuals, OR: Odds ratio, PE: Pooled estimates, PCR: Polymerase chain reaction, Prev: Prevalence, PRISMA: Preferred Reporting System for Systematic Reviews and Meta-Analyses, Q: Cochran’s heterogeneity statistic, QA: Quality assessment, Q-p: Cochran’s p-value, qPCR: Quantitative polymerase chain reaction, S/America: South America, Seq: Sequencing, UMIC: Upper middle-income countries, USA: United States of America