Systematic review and meta-regression analysis of the prevalence of Crimean-Congo hemorrhagic fever in humans, ticks and animals in Sub-Saharan Africa from 1980 to 2025

Crimean-Congo hemorrhagic fever virus (CCHFV) is an emerging infectious tick-borne virus that continues to impact public health globally. To re-evaluate and improve CCHFV control strategies in sub-Saharan Africa (SSA), there’s a need to aggregate CCHFV prevalence data and explore the factors which affect observed variations in prevalence in humans, animals and ticks. Articles reporting prevalence of CCHFV in humans, animals and ticks in SSA between 1980 and 2025 were retrieved from five research databases, namely: Scopus, PubMed, Springer Nature, Web of Science and Science Direct. A random effects model was fit using a binomial generalised linear mixed effects model with a logit link to estimate pooled prevalences for each host species, along with their 95% confidence intervals. Between study-variation (heterogeneity) was assessed using index statistic (I 2 ). Subgroup analyses, meta-regressions and sensitivity analyses were performed using trim and fill and leave-one-out methods to identify sources of variation and reliability of results, respectively. Evidence of asymmetry was assessed using the Luis-Furuya Kanamori (LFK) index. Following PRISMA guidelines, 114 studies from 31 SSA countries that obtained samples from twenty-two host species were included in the analysis. Molecular and serological detection methods estimated a CCHFV pooled prevalence of 1.15% (95% CI: 0.70–1.89) , 31.11% (95% CI: 21.56–42.81) among humans and cattle respectively and pooled pool-positivity of 1.04% (95% CI: 0.57–1.90) in ticks. East and southern African countries accounted for the highest prevalence among humans and cattle, respectively. The diagnostic method used and region where the study was conducted accounted for the majority of variation in prevalence of CCHFV in cattle and humans respectively. In this study, we detected widespread circulation of CCHFV in non- Hyalomma ticks, signaling a need to explore the potential role of other tick species in transmission of CCHFV in SSA, as well as a need to evaluate the impact tick acaricide resistance might have on the persistence and maintenance of CCHFV in ticks. Despite limitations, such as under-representation of countries in central Africa and other host species, such as wildlife and birds, the data generated in this review can be an important tool in the design of regional and cross-continental control strategies for CCHFV .