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Meta-Analysis
. 2020 Apr 30;10(1):7337.
doi: 10.1038/s41598-020-63740-y.

Review Global seroprevalence of legionellosis - a systematic review and meta-analysis

Frances F Graham  1 , Simon Hales  2 , Paul S White  3 , Michael G Baker  2
Affiliations
Meta-Analysis

Review Global seroprevalence of legionellosis - a systematic review and meta-analysis

Frances F Graham et al. Sci Rep. .

Abstract

Legionella is a ubiquitous pathogen yet the global occurrence of legionellosis is poorly understood. To address this deficit, this paper summarises the available evidence on the seroprevalence of Legionella antibodies and explores factors that may influence seroprevalence estimates. Through a systematic review, a total of 3979 studies were identified with seroprevalence results published after 1 January 1990. We tabulated findings by World Health Organization (WHO) region, location, study period and design, composition of study population(s) for all ages in terms of exposure, sex, detection methods, IFA titre, Legionella species measured, and present seroprevalence point estimates and 95% confidence intervals. Sampled populations were classified according to income, WHO region, gender, age, occupation and publication date. We conducted a meta-analysis on these subgroups using Comprehensive Meta-Analysis 3.0 software. Heterogeneity across studies was evaluated by the Q test in conjunction with I2 statistics. Publication bias was evaluated via funnel plot and Egger's test. Fifty-seven studies met our inclusion criteria, giving an overall estimate of seroprevalence for Legionella of 13.7% (95% CI 11.3-16.5), but with substantial heterogeneity across studies.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Results of the database searches and selection of eligible studies of Legionella seroprevalence.
Figure 2
Figure 2
Map showing global distribution of the 57 included seroprevalence studies.
Figure 3
Figure 3
Forest plot of pooled seroprevalence of antibodies to Legionella (event rate) according to country status (high income verses low and middle income). Horizontal lines represent 95% confidence intervals (CIs). Each box represents the seroprevalence rate point estimate and its area is proportional to the weight of the study determined by inverse variance weighting. The diamond represents the overall summary estimate using the random effects model, with the 95% CI given by its width.
Figure 4
Figure 4
Funnel plot of standard error by logit effect size (event rate) for all studies (n = 57).
See this image and copyright information in PMC

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