title: Prevalence and occurrence rate of Mycobacterium tuberculosis Haarlem family multi-drug resistant in the worldwide population: A systematic review and meta-analysis.
abstract: BACKGROUND
  Transmission of Mycobacterium tuberculosis (M. tuberculosis) can occur in different ways. Furthermore, drug resistant in M. tuberculosis family is a major problem that creates obstacles in treatment and control of tuberculosis (TB) in the world. One of the most prevalent families of M. tuberculosis is Haarlem, and it is associated with drug resistant. Our objectives of this study were to determine the prevalence and occurrence rate of M. tuberculosis Haarlem family multi-drug resistant (MDR) in the worldwide using meta-analysis based on a systematic review that performed on published articles.
  
  
  METHODS
  Data sources of this study were 78 original articles (2002-2012) that were published in the literatures in several databases including PubMed, Science Direct, Google Scholar, Biological abstracts, ISI web of knowledge and IranMedex. The articles were systematically reviewed for prevalence and rate of MDR. Data were analyzed using meta-analysis and random effects models with the software package Meta R, Version 2.13 (P < 0.10).
  
  
  RESULTS
  Final analysis included 28601 persons in 78 articles. The highest and lowest occurrence rate of Haarlem family in M. tuberculosis was in Hungary in 2006 (66.20%) with negative MDR-TB and in China in 2010 (0.8%), respectively. From 2002 to 2012, the lowest rate of prevalence was in 2010, and the highest prevalence rate was in 2012. Also 1.076% were positive for MDR and 9.22% were negative (confidence interval: 95%).0020.
  
  
  CONCLUSIONS
  Many articles and studies are performed in this field globally, and we only chose some of them. Further studies are needed to be done in this field. Our study showed that M. tuberculosis Haarlem family is prevalent in European countries. According to the presence of MDR that was seen in our results, effective control programs are needed to control the spread of drug-resistant strains, especially Haarlem family.
authors.affiliation: Department of Microbiology, Cellular and Molecular Research Center, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Rashid
authors.initials: R
authors.lastname: Ramazanzadeh
authors.affiliation: Department of Epidemiology and Biostatistics, Medical School, Kurdistan University of Medical Sciences, Sanandaj, Iran ; Kurdistan Research Center for Social Determinants of Health, Medical School, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Daem
authors.initials: D
authors.lastname: Roshani
authors.affiliation: Department of Microbiology, Cellular and Molecular Research Center, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Pegah
authors.initials: P
authors.lastname: Shakib
authors.affiliation: Department of Microbiology, Cellular and Molecular Research Center, Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Rouhi
keywords: Haarlem family; Mycobacterium tuberculosis; multi-drug resistant; prevalence