Seroprevalence of tick-borne diseases in Europe in occupational settings: A systematic review and metanalysis

Objectives: Tick-borne diseases (TBDs) pose a growing occupational risk due to the expanding geographical range of tick species and their associated pathogens. This study aims to assess TBD seroprevalence among different occupational groups in Europe, identifying high-risk professions and guiding targeted prevention efforts. Study design: A systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate TBD seroprevalence in occupational settings across Europe from January 2013 to June 2024. Methods: A comprehensive search of PubMed, Web of Science, and Scopus identified 36 relevant studies. Heterogeneity among studies was assessed using Cochran's Q test and the inconsistency index (I2), with sensitivity and outlier analyses applied to evaluate their impact. Publication bias was examined through funnel plot analysis, Egger's test, and Duval & Tweedie's trim-and-fill method. Results: Seroprevalence varied significantly across occupations. The highest rates were found for Coxiella burnetii among livestock and dairy producers (up to 73.7 % in Italy) and Borrelia burgdorferi among forestry workers, particularly in Poland. A meta-analysis of 33 studies revealed seroprevalence rates of 8.2 % in military workers (no publication bias), 26.0 % in forestry workers, 8.0 % in veterinarians, and 18.0 % in farmers, with high overall heterogeneity. Conclusions: TBD risk is influenced by occupational exposure, environmental factors, and regional differences. Given the substantial variation across worker categories, targeted preventive measures, increased awareness, and enhanced surveillance efforts are necessary to mitigate risks in high-exposure professions.