Prevalence of enteric non‐typhoidal Salmonella in humans in the Middle East and North Africa: A systematic review and meta‐analysis

Abstract

To enhance efforts related to controlling foodborne pathogens in the Middle East and North Africa (MENA), information on epidemiology of non‐typhoidal Salmonella enterica (hereafter termed “Salmonella”) is limited. We quantified the overall regional and country‐specific Salmonella prevalence in different human populations and identified the most common serotypes. Published literature of Salmonella prevalence was systematically reviewed and reported following the Preferred Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Pooled Salmonella prevalence measures were estimated using a random‐effects model. We identified 46 research reports that reported 84 Salmonella prevalence measures in 15 out of 24 countries in MENA. There were 252,831 tested humans with 6,356 Salmonella‐positive cases. The pooled Salmonella prevalence in MENA was estimated at 6.6% (95% confidence interval (CI): 5.4%–7.9%). The highest pooled Salmonella prevalence measures were in Morocco (17.9%, 95% CI: 5.7%–34.8%, 1997–2012), Tunisia (10.2%, 95% CI: 4.3%–18.0%, 1988–2009) and Sudan (9.2%, 95% CI: 6.5%–12.2%, 2006–2008), while the lowest were in Jordan (1.1%, 95% CI: 0.1%–3.0%, 1993–2010), Oman (1.2%, 95% CI: 1.2%–1.3%, 1998–2002) and Palestine (1.2%, 95% CI: 0.4%–2.1%, 1999–2011). In MENA, Salmonella pooled prevalence in gastrointestinal symptomatic, gastrointestinal asymptomatic and food handlers population groups was 13.0% (95% CI: 7.6%–19.6%), 11.4% (95% CI: 2.2%–25.7%) and 3.8% (95% CI: 1.0%–8.0%), respectively. Salmonella prevalence was 14.5% (95% CI: 8.7%–26.1%) in studies tested <100 subjects, whereas 4.6% (95% CI: 3.6%–5.8%) in studies tested ≥100 subjects. Salmonella Enteritidis (29.8%) and Typhimurium (23.6%) were the most common serotypes. Salmonella was a common foodborne pathogen in MENA countries, particularly in North African countries. Findings inform the scientific community, the public and the decision‐makers with Salmonella prevalence and gaps in evidence in MENA to support control and prevention strategies and could leverage more research studies.

Current State of Salmonella, Campylobacter and Listeria in the Food Chain across the Arab Countries: A Descriptive Review

“…The rate of salmonellosis incidence varies between countries across the Arab World and is influenced largely by the absence of systematic, harmonized national and regional surveillance and reporting systems. According to a recent systematic review and meta-analysis on prevalence of enteric NTS in humans in the Arab world, the highest pooled Salmonella prevalence measures were in Morocco (17.9%, 95% CI: 5.7-34.8%, 1997-2012), Tunisia (10.2%, 95% CI: 4.3-18.0%, 1988-2009) and Sudan (9.2%, 95% CI: 6.5-12.2%, 2006-2008), while the lowest were in Jordan (1.1%, 95% CI: 0.1-3.0%, 1993-2010), Oman (1.2%, 95% CI: 1.2%-1.3%, 1998-2002) and Palestine (1.2%, 95% CI: 0.4-2.1%, 1999-2011) [15]. Several published studies indicate that the most widely reported serovars associated with acute diarrheal disease across the Middle East are the Salmonella serovars typhimurium and enteritidis [71][72][73].…”

“…Measuring the prevalence of NTS in food products is important to quantify the risk of foodborne Salmonella infections in humans in the Arab World. According to a recent metaanalysis study by Rifai et al [15], the pooled prevalence of NTS in the human population in the Arab countries was estimated at 6.6% (95% confidence interval (CI): 5.4-7.9%). In 2019 [15], Rifai et al conducted a systematic review and meta-analysis to summarize current data on national and regional specific NTS prevalence in foods in the MENA region.…”

“…According to a recent metaanalysis study by Rifai et al [15], the pooled prevalence of NTS in the human population in the Arab countries was estimated at 6.6% (95% confidence interval (CI): 5.4-7.9%). In 2019 [15], Rifai et al conducted a systematic review and meta-analysis to summarize current data on national and regional specific NTS prevalence in foods in the MENA region. The pooled prevalence of NTS was 8.8% (95% CI: 7.0-10.8%).…”

Climate change impacts on infectious diseases in the Eastern Mediterranean and the Middle East (EMME)—risks and recommendations

“…For example, the survival and multiplication of salmonellosis in the environment and in food is influenced by temperature (Milazzo et al 2016 ). In the EMME region, non-typhoidal Salmonella cases were reported in Lebanon, Saudi Arabia, Bahrain, Iraq, and Kuwait (Al-Rifai et al 2019 ). Although the knowledge on campylobacteriosis in the Middle East is limited, Campylobacter species are a major and increasing cause of gastroenteritis in this region (Kaakoush et al 2015 ).…”

One Health Perspective of Salmonella Serovars in South Africa Using Pooled Prevalence: Systematic Review and Meta-Analysis

“…Humans, on the other hand, can become infected by coming into contact with live animals or being in an environment contaminated with animal feces and then accidently ingesting pathogens [ 8 , 19 ]. The systematic reviews and meta-analyses: a step-by-step guide will be used to quantify and summarize the findings of these studies [ 20 ]. Few systematic reviews and meta-analyses studies have been performed in sub-Saharan Africa and Africa in the last ten years on invasive nontyphoidal Salmonella (iNTS) disease and the prevalence of Salmonella [ 8 , 21 – 23 ].…”