Anti- Toxoplasma gondii Antibodies in European Residents: A Systematic Review and Meta-Analysis of Studies Published between 2000 and 2020.

Toxoplasmosis has a major impact on animal and public health. Information regarding the seroprevalence of human Toxoplasma gondii infections from a European perspective has not yet been compiled to date. Thus, the present review summarized available resident data from the period 2000-2020. The overall seroprevalence of anti- T. gondii IgG was 32.1%, with great variability between countries ( n = 30). The subgroup analysis identified different pooled prevalence data depending on the geographic area ( p < 0.0001), target population ( p = 0.0147), and serological diagnosis assays used ( p = 0.0059). A high heterogeneity (I 2 = 100%, p < 0.001; Q = 3.5e+05, d.f. = 135, p < 0.001) and degree of publication bias (Egger's test = 6.14, p < 0.001) were observed among the 134 studies considered. The occurrence of anti- T. gondii IgM, which was reported in 64.7% of studies, reached a pooled seroprevalence of 0.6%. In addition, among the eight main risk factors identified, "contact with soil", "consumption of undercooked beef", and "intake of unwashed vegetables" were the most significantly associated with infections. The fact that one-third of the European population has been exposed to T. gondii justifies extra efforts to harmonize surveillance systems and develop additional risk-factor analyses based on detailed source attribution assessment.