Pooled prevalence of infectious diseases among first responders in the prehospital setting: A systematic review with meta-analysis by occupation

First responders often work in unpredictable, uncontrolled environments, where exposure to infected patients and contaminated environments heighten the risk of communicable disease transmission. Their higher infection prevalence compared with the general population has driven the implementation of personal protective equipment, vaccination requirements, safety protocols, and infection prevention education. The aim of this systematic review and meta-analysis was to estimate the pooled prevalence of infections among first responders in the prehospital workers including paramedics, emergency medical technicians, patient transport staff, firefighters, police, and police officers. Embase, CINAHL, Web of Science and PUBMED/Medline were systematically searched. Pooled prevalence estimates were calculated using random-effects models with restricted maximum likelihood estimation, with Freeman–Tukey double-arcsine transformation and back-transformation to the original prevalence scale. Heterogeneity was assessed using I², τ², and 95% prediction intervals. Meta-regression was used to examine potential sources of between-study heterogeneity, and small-study effects and potential publication bias were assessed using funnel plots and Egger’s regression test. Risk of bias was investigated using the AXIS tool. Following the initial search, 34,874 articles were identified, of which 88 were full-text screened. Of these, 22 studies representing 19,188 first responders were included in this systematic review. The pooled prevalences of hepatitis B and C were 6.2% (95% CI 4.5%-8.2%) and 1.8% (95% CI 0.9%-2.9%), respectively. Around 4% (95% CI 2.6%- 5.9%) of the first responders had MRSA colonisation. Current or past infection with COVID-19 among non-vaccinated first responders was 13.6% (95% CI 4.8%- 25.9%), which reduced to 7.3% (95% CI 3.6%- 12%) after exclusion of studies with high risk of bias. Of the known study characteristics, geographic region significantly contributed to heterogeneity, explaining 36.7% of between-study variance, p = 0.039. Infectious disease prevalence varied across pathogens, occupations, and geographical settings among first responders. These findings should be interpreted in light of substantial heterogeneity and limitations in the available evidence but may help inform infection prevention, occupational health policy, vaccination strategies, and future research in first responder services.