Equine piroplasmosis in China, 2000 to 2025: a systematic review and meta-analysis of prevalence and risk factors.

Prioritize PCR and serology combined in febrile equids; China's EP prevalence remains stable at ~31%.

This PRISMA-guided systematic review and meta-analysis synthesized 80 studies published between 2000 and 2025 to estimate the pooled prevalence of equine piroplasmosis (EP) in China and identify associated risk factors. EP is a tick-borne disease caused by Theileria equi, Babesia caballi, and Theileria haneyi. Among 2,626 records screened, the overall pooled prevalence was 31%, with species-specific estimates of 24.28% for T. equi and 18.37% for B. caballi. T. haneyi data were insufficient for pooling and were reported descriptively. Subgroup analyses revealed significantly higher prevalence in horses compared to donkeys and mules, in febrile versus afebrile equids, and in studies using PCR versus ELISA (36.40% vs. 23.97%), underscoring the importance of detection method selection. Climate class also influenced prevalence, with Dwb climates showing the highest rates and Cfa the lowest. No significant differences were identified by geographic region, age, sex, season, management system, or sampling year, and meta-regression demonstrated no significant temporal trend over the study period. These findings highlight the endemicity of EP across China and support risk-based surveillance strategies. The authors recommend prioritizing testing in febrile equids and employing combined serological and molecular diagnostics to differentiate active infection from prior exposure, which has important implications for treatment decisions, import/export regulations, and disease control programs.

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