Methods: Following the PRISMA guidelines, we systematically reviewed available records across the WHO, World Bank, and UNAIDS-defined MENA region describing the human, animal, and vector prevalence for six arboviruses which were selected based on their known endemicity in the region and broader global importance: chikungunya virus (CHIKV), crimean-congo hemorrhagic fever virus (CCHFV), dengue virus (DENV), rift valley fever virus (RVFV), west nile virus (WNV), and yellow fever (YFV). Geospatial prevalence maps were generated using ArcGIS software.
Results: We screened 2,090 reports and identified 586 prevalence measures for the arboviruses of interest in humans (40%) and animals (60%) in MENA. Countries with no published prevalence data were Algeria, Bahrain, Palestine, Qatar, and Syria, although vector studies confirmed the presence of CCHFV and WNV in Syria and Algeria, respectively. A wide variety of diagnostic methods and study designs were used, limiting extrapolation of results to the general population and region. Nevertheless, the review showed the presence of all of the target viruses with indications of regional differences. For example, spatial mapping revealed a high prevalence (20-40%) of DENV in the Red Sea region and Pakistan, while YFV presence was only confirmed in Somalia and Sudan (prevalence range 6-14%). We also found great differences between countries in coverage of the published literature, with most CCHFV prevalence reports provided by authors from Turkey and Iran, and only a few studies available for CHIKV, whose prevalence was highest in Sudan (16%). Reports on RVFV seroprevalence were limited to countries with known outbreaks, including Egypt, Sudan, Saudi Arabia, and Yemen.
Conclusion: Arboviruses are endemic to the MENA region, though wide variations in study designs, test methods, and underreporting limit definitive conclusions about disease pressures in many countries. Geospatial prevalence maps suggest the Red Sea region is a particular focus of arbovirus activity, while Afghanistan and North Africa may harbor substantially underrecognized burdens of arboviral diseases.
C. Reusken, None
M. Glesby, None
M. Koopmans, None
L. Abu-Raddad, None