Prevalence estimates of Opisthorchis viverrini and Clonorchis sinensis infection in the Greater Mekong subregion:a systematic review and meta-analysis

Background Opisthorchiasis and clonorchiasis,caused by Opisthorchis viverrini and Clonorchis sinensis,respectively,are significant yet neglected foodborne trematodiases in the Great Mekong Subregion(GMS).Despite the reporting of the prevalence of these human liver flukes in the region over the past decades,there has been a lack of a comprehensive and systematic consolidation of this data.Therefore,we aimed to conduct a thorough systematic review and meta-analysis to synthesize and analyze time-trend prevalence estimates of both O.viverrini and C.sinensis across the GMS for the past 30 years.Methods This study undertakes a systematic review using a comprehensive search for published articles in PubMed,EMBASE,Scopus,Cochrane and Thai Journal Online databases until early 2023.The pooled prevalence of O.viverrini and C.sinensis infection was analyzed through a random-effects meta-analysis,with meta-regression analysis used to quantify associations with study characteristics.Sub-group analysis was conducted,whenever comparison data were available,to assess the risk of O.viverrini and C.sinensis infection in each GMS country.Heterogeneity among studies was assessed using the Q statistic and quantified by using the I^(2)Index.Results From a total of 2997 articles,155 articles comprising 218 datasets and 751,108 participants were included for review.The GMS prevalence of O.viverrini was 21.11%[45,083/260,237;95%confidence interval(CI):17.74-24.47%].Pooled prevalence estimates were highly observed in Laos(34.06%,95%CI:26.85-41.26%),followed by Thailand(18.19%,95%CI:13.86-22.51%),and Cambodia(10.48%,95%CI:5.52-15.45%).Myanmar and Vietnam had limited data sources for calculation.Clonorchis sinensis infection in GMS was 25.33%(95%CI:18.32-32.34%),with Guangxi,China,exhibiting the highest prevalence rates at 26.89%(95%CI:18.34-35.43%),while Vietnam had a prevalence rate of 20.30%(95%CI:9.13-31.47%).O.viverrini prevalence decreased significantly over time,whereas C.sinensis infection appeared to be stable consistently over time in both China and Vietnam.Conclusions This comprehensive study,drawing from the largest datasets to date,offers an in-depth systematic prevalence review of human liver flukes in the Greater Mekong Subregion.It underscores the imperative for systematic surveillance,data collection,and the implementation of intervention and control measures for these infectious diseases of poverty.