| This systematic review and meta-analysis, conducted in full accordance with the PRISMA 2020 guidelines, aimed to provide an updated and comprehensive estimate of fasciolosis prevalence in ruminants (cattle, sheep, and goats) across the Mediterranean basin during the period 2015–2025. To ensure maximal coverage, an extensive literature search was performed in four major scientific databases—PubMed, Scopus, Web of Science, and ScienceDirect—without any restriction on language or publication country. The search strategy combined a structured set of keywords related to Fasciola hepatica, Fasciola gigantica, ruminant hosts, and the broader Mediterranean region. Studies were considered eligible when they reported primary data on animal-level prevalence, provided clear sample sizes, employed validated diagnostic techniques (including coproscopy, serological assays, molecular detection, or post-mortem inspection), and were published in peer-reviewed journals. Following screening and quality assessment, a total of 11 studies originating from eight Mediterranean countries—Algeria, Tunisia, Egypt, Turkey, Spain, France, Italy, and Greece—met the inclusion criteria. Altogether, these studies encompassed 23,020 examined ruminants and revealed a wide range of prevalence estimates, from less than 1% to as high as 57%, reflecting substantial regional and methodological variation. Species-specific prevalence averages were 7.9% in sheep, 5.2% in goats, and 25% in cattle, confirming the generally higher susceptibility and exposure risk in bovine populations. The pooled prevalence obtained through a random-effects DerSimonian–Laird model was 13.96% (95% CI: 8.95–21.13). The analysis revealed extremely high heterogeneity (I² ≈ 99%), suggesting that differences in climate, husbandry systems, diagnostic tools, and ecological conditions strongly influence infection levels across the Mediterranean basin. Overall, the highest prevalence values were documented in Spain and France, whereas moderate levels predominated in North African and Eastern Mediterranean countries. These findings underscore the considerable epidemiological variability of fasciolosis in the region and highlight the urgent need for harmonized surveillance methods and standardized diagnostic protocols. Strengthening these aspects would enhance the accuracy of risk assessment, support early detection, and guide the implementation of targeted and cost-effective control strategies. |