Surveillance of Zoonotic Tuberculosis in Low-Income, Middle-Income and High-Income Countries: A Systematic Review

Background: Little is known about Zoonotic tuberculosis (zTB) burden across the globe. We aimed to describe zTB surveillance programs in WHO signatory countries, evaluating its intersection with income levels and Mycobacterium bovis risk of transmission. Methods: For this systematic review, we searched the main articles databases and also gray literature for guides documents published between 1980 and 2019. For inclusion, the articles and guides documents had to be in English, French, Portuguese, Spanish or Italian. Only original articles, narrative and systematic reviews have been accepted and the guides documents should be available at official websites. We excluded articles not focusing on epidemiology, control and surveillance. We used bovine TB cases in livestock and wildlife populations as a proxy for the country’s risk of zTB using data from the World Organization for Animal Health (OIE), from 2015 to 2018. Countries were classified according to the level of income (World Bank's classification) and strength of zTB surveillance. The study is registered with PROSPERO number CRD42018090603. Findings: We selected 13 articles and 208 guides documents including data from 119/194 countries (61·3%). We found that there is a lack of surveillance data of zTB in over half of the 194 WHO signatory countries, and where it exists, is concentrated in countries where the risk of zTB is lower. Majority of surveillance systems perform passive surveillance and are not integrated into the One Health perspective, which was evidenced in 4/119 (3·4%) countries, all high-income. Interpretation: Our findings highlights weaknesses in ZTB surveillance worldwide which reflects lack of information that could support an adequate understanding of its burden, especially in countries with major risk for Mycobacterium bovis transmission. To face this challenge, efforts will be needed to promote intersectoral policies, implementing the One Health strategy. Funding Statement: This study was supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) and Sara Borrell grant from the Instituto de Salud Carlos III (CD19/00110). Declaration of Interests: The authors declare that they have no competing interests.