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Market-source pathogens in traditional food markets, 2000-25: a systematic review and meta-analysis.

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Τίτλος: Market-source pathogens in traditional food markets, 2000-25: a systematic review and meta-analysis.
Συγγραφείς: Tong H; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Afzal S; Department of Medical Entomology and Parasitology, Institute of Public Health, Lahore, Pakistan., Mukhtar MU; Department of Medical Entomology and Parasitology, Institute of Public Health, Lahore, Pakistan., Sulaimon N; Institute of Veterinary Medicine of the Tajik Academy of Agricultural Sciences, Dushanbe, Tajikistan., E El Shanawany E; Department of Parasitology and Animal Diseases, National Research Centre, Cairo, Egypt., Bold B; National Center for Zoonotic Disease, Ulaanbaatar, Mongolia., Bayasgalan C; Department of Infectious Diseases and Microbiology, School of Veterinary Medicine, Mongolian University of Life Sciences, Ulaanbaatar, Mongolia., Zhang B; Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, China; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China., Liu L; Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, China; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China., Zheng J; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China., Guan S; Department of Epidemiology and Biostatistics, School of Public Health, Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, Hefei, China., Guo Z; Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK., Duan L; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China., Lv S; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China., Hu W; School of Life Sciences, Inner Mongolia University, Hohhot, China; Department of Infectious Diseases, Huashan Hospital, State Key Laboratory of Genetic Engineering, Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China., Zhou X; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China. Electronic address: zhouxn1@chinacdc.cn., Feng X; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: fengxy@shsmu.edu.cn.
Πηγή: The Lancet. Global health [Lancet Glob Health] 2026 Sep; Vol. 14 (9), pp. 104016. Date of Electronic Publication: 2026 Jul 30.
Τύπος έκδοσης: Systematic Review; Journal Article; Meta-Analysis
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101613665 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2214-109X (Electronic) Linking ISSN: 2214109X NLM ISO Abbreviation: Lancet Glob Health Subsets: MEDLINE
Imprint Name(s): Original Publication: [England] : Elsevier Ltd. 2013-
Ιατρικοί όροι (MeSH): Zoonoses*/epidemiology , Zoonoses*/microbiology , Foodborne Diseases*/epidemiology , Foodborne Diseases*/microbiology , Food Markets* , Food Microbiology*, Humans ; Animals
Περίληψη: Background: Traditional food markets, often referred to as wet markets, live poultry markets, or farmers' markets, remain a major source of animal-origin foods and fresh produce in many low-income and middle-income countries (LMICs). These markets bring humans, domestic animals, wildlife, and the environment into close contact and have been repeatedly implicated in the emergence of zoonotic and foodborne diseases. Yet, the overall global burden, pathogen spectrum, and risk gradients within these settings have not been comprehensively quantified.
Methods: We conducted a systematic review and meta-analysis of studies published between Jan 1, 2000, and Oct 31, 2025, following the PRISMA 2020 reporting guidelines. We searched major English and Chinese databases for cross-sectional or baseline studies reporting the detection of zoonotic or foodborne pathogens in traditional food markets or related retail settings. Studies were excluded if they were not conducted in traditional markets, had non-extractable data, had a sample size of fewer than 20, had intervention-related outcomes, had duplicate populations, or did not have prevalence or detection rate reporting. Data were extracted as detection records, defined as unique pathogen-sample type-market setting combinations. Study quality was assessed with the Joanna Briggs Institute tool for prevalence studies. We used random-effects meta-analysis of logit-transformed proportions to estimate pooled prevalence and 95% CIs overall and across major subgroups. Heterogeneity was assessed with I2 and τ2, and meta-regression was used to examine temporal trends and associations between study quality and prevalence. Robustness was assessed with leave-one-out analyses and small-study effects. This study is registered with PROSPERO, CRD420251267834.
Findings: We included 247 studies comprising 597 detection records from 41 countries across 16 regions. The global pooled prevalence of market-source pathogens in traditional markets was 15·32% (95% CI 13·96-16·80). By pathogen kingdom, pooled prevalence was 19·41% (16·21-23·08) for bacteria, 8·40% (7·15-9·83) for viruses, and 27·05% (21·91-32·89) for parasites. Regionally, prevalence was highest in southeast Asia (23·09% [18·43-28·52]), followed by south Asia (15·52% [10·06-23·20]) and east sub-Saharan Africa (14·54% [7·13-27·40]). By market type, fish and seafood markets showed the highest pooled prevalence (37·87% [26·05-51·33]), and by sample type, the highest estimates were observed in fish and seafood, raw meat, and environmental samples. Lower estimates were observed in cooked foods, fruit and vegetables, and worker samples, suggesting a gradient from animal and environmental reservoirs towards ready-to-eat foods and humans. Meta-regression showed no significant global linear temporal trend in prevalence, whereas higher methodological quality was associated with lower reported prevalence. Leave-one-out analyses suggested that no single study substantially altered the overall findings.
Interpretation: Traditional markets represent persistent global hotspots for zoonotic and foodborne pathogens, particularly in LMICs and high-risk food chains. The observed exposure gradient highlights crucial intervention points. These findings support a One Health-oriented framework for risk assessment and targeted surveillance, while emphasising the need for harmonised, prospective, multipathogen studies.
Funding: Foundation of Key Laboratory of Veterinary Biotechnology, National Key Research and Development Program of China, and the International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion.
(Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Competing Interests: Declaration of interests All authors declare no competing interests.
Entry Date(s): Date Created: 20260730 Date Completed: 20260903 Latest Revision: 20260911
Update Code: 20260912
DOI: 10.1016/j.langlo.2026.104016
PMID: 42532075
Βάση Δεδομένων: MEDLINE
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  Data: Market-source pathogens in traditional food markets, 2000-25: a systematic review and meta-analysis.
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  Data: <searchLink fieldCode="AU" term="%22Tong+H%22">Tong H</searchLink>; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.<br /><searchLink fieldCode="AU" term="%22Afzal+S%22">Afzal S</searchLink>; Department of Medical Entomology and Parasitology, Institute of Public Health, Lahore, Pakistan.<br /><searchLink fieldCode="AU" term="%22Mukhtar+MU%22">Mukhtar MU</searchLink>; Department of Medical Entomology and Parasitology, Institute of Public Health, Lahore, Pakistan.<br /><searchLink fieldCode="AU" term="%22Sulaimon+N%22">Sulaimon N</searchLink>; Institute of Veterinary Medicine of the Tajik Academy of Agricultural Sciences, Dushanbe, Tajikistan.<br /><searchLink fieldCode="AU" term="%22E+El+Shanawany+E%22">E El Shanawany E</searchLink>; Department of Parasitology and Animal Diseases, National Research Centre, Cairo, Egypt.<br /><searchLink fieldCode="AU" term="%22Bold+B%22">Bold B</searchLink>; National Center for Zoonotic Disease, Ulaanbaatar, Mongolia.<br /><searchLink fieldCode="AU" term="%22Bayasgalan+C%22">Bayasgalan C</searchLink>; Department of Infectious Diseases and Microbiology, School of Veterinary Medicine, Mongolian University of Life Sciences, Ulaanbaatar, Mongolia.<br /><searchLink fieldCode="AU" term="%22Zhang+B%22">Zhang B</searchLink>; Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, China; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.<br /><searchLink fieldCode="AU" term="%22Liu+L%22">Liu L</searchLink>; Shandong Institute of Parasitic Diseases, Shandong First Medical University & Shandong Academy of Medical Sciences, Jining, China; School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.<br /><searchLink fieldCode="AU" term="%22Zheng+J%22">Zheng J</searchLink>; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.<br /><searchLink fieldCode="AU" term="%22Guan+S%22">Guan S</searchLink>; Department of Epidemiology and Biostatistics, School of Public Health, Inflammation and Immune-Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Second Affiliated Hospital of Anhui Medical University, Hefei, China.<br /><searchLink fieldCode="AU" term="%22Guo+Z%22">Guo Z</searchLink>; Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK.<br /><searchLink fieldCode="AU" term="%22Duan+L%22">Duan L</searchLink>; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China.<br /><searchLink fieldCode="AU" term="%22Lv+S%22">Lv S</searchLink>; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China.<br /><searchLink fieldCode="AU" term="%22Hu+W%22">Hu W</searchLink>; School of Life Sciences, Inner Mongolia University, Hohhot, China; Department of Infectious Diseases, Huashan Hospital, State Key Laboratory of Genetic Engineering, Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.<br /><searchLink fieldCode="AU" term="%22Zhou+X%22">Zhou X</searchLink>; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention (Chinese Centre for Tropical Diseases Research), Shanghai, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China; WHO Collaborating Centre for Tropical Diseases, Shanghai, China; National Centre for International Research on Tropical Diseases, Shanghai, China. Electronic address: zhouxn1@chinacdc.cn.<br /><searchLink fieldCode="AU" term="%22Feng+X%22">Feng X</searchLink>; School of Global Health, Chinese Centre for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: fengxy@shsmu.edu.cn.
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  Data: <searchLink fieldCode="JN" term="%22101613665%22">The Lancet. Global health</searchLink> [Lancet Glob Health] 2026 Sep; Vol. 14 (9), pp. 104016. <i>Date of Electronic Publication: </i>2026 Jul 30.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier+Ltd%22">Elsevier Ltd </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>101613665 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>2214-109X (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%222214109X%22">2214109X </searchLink><i>NLM ISO Abbreviation: </i>Lancet Glob Health <i>Subsets: </i>MEDLINE
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  Data: Background: Traditional food markets, often referred to as wet markets, live poultry markets, or farmers' markets, remain a major source of animal-origin foods and fresh produce in many low-income and middle-income countries (LMICs). These markets bring humans, domestic animals, wildlife, and the environment into close contact and have been repeatedly implicated in the emergence of zoonotic and foodborne diseases. Yet, the overall global burden, pathogen spectrum, and risk gradients within these settings have not been comprehensively quantified.<br />Methods: We conducted a systematic review and meta-analysis of studies published between Jan 1, 2000, and Oct 31, 2025, following the PRISMA 2020 reporting guidelines. We searched major English and Chinese databases for cross-sectional or baseline studies reporting the detection of zoonotic or foodborne pathogens in traditional food markets or related retail settings. Studies were excluded if they were not conducted in traditional markets, had non-extractable data, had a sample size of fewer than 20, had intervention-related outcomes, had duplicate populations, or did not have prevalence or detection rate reporting. Data were extracted as detection records, defined as unique pathogen-sample type-market setting combinations. Study quality was assessed with the Joanna Briggs Institute tool for prevalence studies. We used random-effects meta-analysis of logit-transformed proportions to estimate pooled prevalence and 95% CIs overall and across major subgroups. Heterogeneity was assessed with I<superscript>2</superscript> and τ<superscript>2</superscript>, and meta-regression was used to examine temporal trends and associations between study quality and prevalence. Robustness was assessed with leave-one-out analyses and small-study effects. This study is registered with PROSPERO, CRD420251267834.<br />Findings: We included 247 studies comprising 597 detection records from 41 countries across 16 regions. The global pooled prevalence of market-source pathogens in traditional markets was 15·32% (95% CI 13·96-16·80). By pathogen kingdom, pooled prevalence was 19·41% (16·21-23·08) for bacteria, 8·40% (7·15-9·83) for viruses, and 27·05% (21·91-32·89) for parasites. Regionally, prevalence was highest in southeast Asia (23·09% [18·43-28·52]), followed by south Asia (15·52% [10·06-23·20]) and east sub-Saharan Africa (14·54% [7·13-27·40]). By market type, fish and seafood markets showed the highest pooled prevalence (37·87% [26·05-51·33]), and by sample type, the highest estimates were observed in fish and seafood, raw meat, and environmental samples. Lower estimates were observed in cooked foods, fruit and vegetables, and worker samples, suggesting a gradient from animal and environmental reservoirs towards ready-to-eat foods and humans. Meta-regression showed no significant global linear temporal trend in prevalence, whereas higher methodological quality was associated with lower reported prevalence. Leave-one-out analyses suggested that no single study substantially altered the overall findings.<br />Interpretation: Traditional markets represent persistent global hotspots for zoonotic and foodborne pathogens, particularly in LMICs and high-risk food chains. The observed exposure gradient highlights crucial intervention points. These findings support a One Health-oriented framework for risk assessment and targeted surveillance, while emphasising the need for harmonised, prospective, multipathogen studies.<br />Funding: Foundation of Key Laboratory of Veterinary Biotechnology, National Key Research and Development Program of China, and the International Joint Laboratory on Tropical Diseases Control in Greater Mekong Subregion.<br /> (Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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  Data: Declaration of interests All authors declare no competing interests.
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