Coxiella burnetii in the Arabian Peninsula: A One Health Perspective Through Systematic Review and Meta-Analysis

Coxiella burnetii is a zoonotic, obligate intracellular Gram-negative bacterium that poses significant public and veterinary health challenges. This review aimed to assess the One Health burden of C. burnetii in the Arabian Peninsula by estimating the pooled prevalence and associated risk factors of the disease to guide control at the human-animal-environment interface. Following PRISMA guidelines and registration in OSF, a comprehensive literature search was conducted in the Arabic Collection Site, EBSCOhost, Embase, PubMed, Scopus, and Web of Science. A total of 320 articles were gathered, from where 64 articles were selected for the review. C. burnetii was reported in humans (28 studies), livestock (51), dogs (2), wildlife (3), and other samples (6). Human seroprevalence was estimated at 20.3%, with most cases attributed to exposure to ruminants. Among domestic ruminants, the pooled seroprevalence was 40.7%, highest in the Kingdom of Saudi Arabia (KSA; 72.2%), followed by the United Arab Emirates (UAE; 31.1%), and Iraq (19.5%). Large ruminants infested with ticks had a significantly higher seroprevalence (74.0%) compared to those without infestation (25.1%). Overall, 17.9% of samples tested from ruminants were positive by PCR. The highest detection rate was observed in reproductive samples (73.5%), followed by feces (61.2%) and milk (32.3%). Meta-regression revealed significant associations between prevalence and specific factors, including country, tick infestation, and sample type. The review also suggests that additional, unmeasured, or context-specific factors may influence disease dynamics. The study highlights substantial knowledge gaps despite the zoonotic and economic importance of C. burnetii in the region. A coordinated One Health surveillance framework is urgently needed to better understand its distribution, transmission dynamics, and impact on human and animal health and productivity in the Arabian Peninsula.