Viral haemorrhagic fevers in the Middle East

Viral haemorrhagic fevers (VHFs) are a group of infectious, devastating and severe diseases caused by enveloped single-stranded RNA viruses. The endemicity, emergence or re-emergence of different VHF viruses and lack of vaccines and antiviral therapy for most VHFs result in a significant global threat. Most VHF viruses are restricted to specific parts of the world, and the dramatic expansion of their geographical distribution beyond their original habitats would greatly affect global public health. In the past few decades alone, several outbreaks have affected the Middle East, a part of the world containing arid to semi-arid, hot and water-scarce countries. Political instability, natural and humanitarian crises, direct contact with domesticated animals and climate change are the main factors in the dissemination of different zoonotic diseases, including vector-borne diseases. Some VHF viruses have been introduced into the Middle East (e.g. Alkhurma haemorrhagic fever) and others have been re-introduced and have become endemic in the region. Dengue fever, Crimean Congo haemorrhagic fever, Rift Valley fever and hantavirus haemorrhagic fever with renal syndrome are examples of re-emerging or endemic viruses in the region. The temporal and spatial extension of VHF distribution mandates a particular engagement from all the actors in the fields of animal, human and environmental health. The One Health concept is a multidisciplinary and multisectoral approach for promoting collaboration, coordination and communication among different nations, sectors and disciplines, which is highly relevant to the fight against endemic, emerging and re-emerging infectious agents at the human-animal-environment interface. The adoption of the One Health approach is a promising solution to addressing public health threats in the Middle East.