Global Emergence and Expansion of the Beijing Lineage of Mycobacterium tuberculosis: A Systematic Review and Meta-Analysis

Objectives The Beijing Lineage of Mycobacterium tuberculosis is a globally widespread family of strains, notable for its high transmissibility and association with multidrug resistance. Its ongoing expansion threatens global tuberculosis control, necessitating an updated understanding of its prevalence and distribution to guide public health interventions.Methods We conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, Embase, Web of Science, and Scopus for genotyping-based studies on Beijing Lineage prevalence published before December 31, 2024. Pooled prevalence was calculated using a random-effects model. Subgroup analyses were performed by Molecular typing method, WHO region, and time period. Heterogeneity (I²) and publication bias were assessed.Results Analysis of 356 studies yielded a global pooled Beijing Lineage prevalence of 41% (95% CI 38%-43%), but this estimate should be interpreted with caution given substantial heterogeneity (I² = 99.8%) and publication bias.Prevalence varied significantly by WHO region, being highest in the Western Pacific (63%) and lowest in the Eastern Mediterranean (6%). High-resolution genotyping (whole-genome sequencing) reported a higher prevalence (47%) compared to low-resolution methods (31%), suggesting that WGS should be considered the gold standard for accurate detection. A temporal peak of 48% was observed in 2014-2018, declining to 42% in 2019-2024, potentially linked to COVID-19 disruptions. WHO region was the primary source of heterogeneity. Publication bias was present.Conclusions This systematic evaluation demonstrated a 41% global prevalence of the Beijing lineage of M.tuberculosis with substantial geographical variation and the critical impact of genotyping methodology on prevalence estimates, providing essential evidence for targeted tuberculosis control strategies.