Prevalence and risk factors of Cryptosporidium in humans in China: A systematic review and meta-analysis

Objective Cryptosporidium is a globally distributed protozoan parasite and a major cause of diarrheal disease, particularly among immunocompromised individuals. Despite its growing recognition as an important zoonotic pathogen, large-scale epidemiological data specific to the Chinese population remain scarce. Methods We systematically retrieved articles on the occurrence of Cryptosporidium in humans in China, through a search in the following six databases: PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Chinese Journal Database, following PRISMA guidelines. Results A total of 193 studies were included, covering data from 27 provinces. Pooled prevalence and 95% confidence intervals (CI) were estimated using a random-effects model. The pooled prevalence of Cryptosporidium infection in humans in China was estimated at 5%. Higher infection rates were observed in Northern China (6.61%, 95% CI: 3.20–11.13) and among individuals aged 17–30 years (8.43%, 95% CI: 3.55–14.61). A significant decline in prevalence was noted in studies conducted after 2015. C. parvum and C. hominis were identified as the main infecting species. Additionally, higher infection rates in HIV-positive individuals (7.63%, 95% CI: 5.34–10.28) and rural populations (5.18%, 3.46–7.23). Conclusion These findings highlight the need for improved surveillance, accurate diagnostics, and targeted prevention strategies in high-risk regions and populations. In particular, attention should be given not only to young children but also to adults, who may face overlooked exposure risks.