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Published on: April 6, 2019
Alarming update on incidence of Crimean-Congo hemorrhagic fever in Iraq in 2023
Zeenah Atwan1, Riyad Alhilfi2, Alaa K Mousa3
1Central Laboratory, College of Medicine, University of Basrah, Basrah, Iraq & WHO Collaborating Centre for Public Health Education and Training, Imperial College London, UK.
Insights
Crimean-Congo hemorrhagic fever (CCHF) cases surged in Iraq during 2023, with a 12.7% fatality rate. Regional variations and holiday surges highlight the need for targeted public health interventions to control this viral outbreak.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Crimean-Congo hemorrhagic fever (CCHF) outbreaks have been increasing in Iraq since 2021.
- Lack of significant control measures has exacerbated the CCHF situation.
- Awareness and intervention strategies are crucial for managing CCHF cases.
Purpose of the Study:
- To analyze the epidemiological trends of CCHF in Iraq from January to August 2023.
- To identify regional variations in CCHF case fatality rates (CFR).
- To highlight factors contributing to CCHF outbreaks and inform public health strategies.
Main Methods:
- Retrospective analysis of 1827 suspected CCHF cases from 18 provinces.
- Confirmation of 511 CCHF cases using polymerase chain reaction (PCR).
- Statistical analysis, including independent t-test, to compare CFR across provinces.
Main Results:
- 511 out of 1827 suspected cases were confirmed positive for CCHF.
- The overall case fatality rate (CFR) was 12.7%, with significant provincial variations (Erbil: 38.5%, Sulaimaniya/Anbar: 0%).
- CCHF cases showed significant surges post-Iftar and Adha holidays, with higher CFR in provinces west and south of Baghdad.
Conclusions:
- Provincial CFR disparities and holiday-related surges necessitate a unified public health intervention strategy.
- Environmental factors like increased temperatures influencing tick vector behavior and uncontrolled animal movement are critical.
- Further clinical and laboratory research is needed to understand virus or host determinants influencing CCHF mortality.
Objectives:
In 2021, large outbreak of Crimean-Congo hemorrhagic fever (CCHF) was reported in Iraq and cases have increased without any significant control measures. To raise awareness about the increasing cases in different regions of Iraq, hence remind the necessity to tackle contributing factors and potential outbreak interventions.
Methods:
The study included 511 polymerase chain reaction-confirmed CCHF infection cases out of 1827 suspected cases from 18 Provinces from January to August 2023. Approval from the Ministry of Health for data analyzed.
Results:
Out of 1827 suspected cases, 511 were confirmed positive by polymerase chain reaction. The total case fatality rate (CFR) was 12.7 with varying severity levels among provinces. Erbil had the highest CFR, 38.5, while Sulaimaniya and Anbar report no deaths. Independent t-test showed a significant difference in CFR between provinces west and south of Baghdad compared to north (P <0.05). Trend showed significant surges after Iftar and Adha holidays.
Conclusion:
Differences in CFR among provinces around the religious ceremonies, highlight the need for one public health intervention strategy. Increased temperatures affected vector behavior. Uncontrolled animal movement with neighboring countries is an important factor. Virus or host determinants can shape the clinical case outcomes, which need clinical and extensive laboratory studies to unravel the reasons leading to death.
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