Meta-analysis of the prevalence of the main human pathogens in vegetables, with emphasis on lettuce

This meta-analysis aims to summarize the available information on the prevalence of the main human pathogenic microorganisms in vegetables, with emphasis on lettuce (Lactuca sativa). The database searches included scientific papers from 1980 to 2019, without language restrictions. Inclusion criteria were prevalence or incidence studies published in peer-reviewed journals reporting the total number of vegetable samples studied and the number of samples positive for the presence of the studied pathogens. The target pathogens were grouped into the following categories: bacteria, parasites and viruses. Results of different vegetable types, years of sampling, analyzed regions or species of microorganisms reported in the same article were considered as different studies. Therefore, each scientific article may contain several studies. Multilevel random-effect meta-analysis models were fitted to estimate the mean occurrence rate of pathogenic microorganisms and to compare them with different factors potentially associated with the outcome. Overall, the prevalence of bacterial, parasitic and viral pathogens in vegetables was relatively low. The mean prevalence of bacterial hazards was < 0.023, with the exception of S. aureus, whose prevalence was estimated at 0.096. The mean occurrence rates of parasites and viruses were 0.067 (95 % CI: 0.056-0.080) and 0.079 (95 % CI: 0.054-0.113), respectively. The prevalence of pathogenic E. coli and parasites increased as the year of publication of the scientific articles progressed, whereas the prevalence of the other bacterial pathogens and enteric viruses was steady. The types of vegetables evaluated did not affect pathogen prevalence. The prevalence of pathogenic microorganisms differed according to the continent of origin, except for E. coli O157:H7 and parasites. The prevalence of pathogens in vegetables is of public health importance, especially in vegetable types that are eaten raw, without thermal treatment to inactivate pathogens. This meta-analysis results show the need to apply proper sanitation methods to treat raw vegetables in order to avoid foodborne infections.