Crimean-Congo hemorrhagic fever, a real health problem in Iraq?

Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne viral disease worldwide. CCHF was not recognized in Iraq before 1979, after which many outbreaks occurred, and the disease became endemic with the re-emergence of outbreaks. This study aimed to analyze the epidemiology of the largest outbreak in Iraqi history in 2023.

This retrospective study included human CCHF cases from 2023.

2186 suspected cases were investigated. There were 587 confirmed cases, and 83 deaths, and an overall case fatality rate (14%). Among the confirmed cases, only 539 cases had complete data, and the analysis was performed on these cases. The majority 70.9% of patients lived in the southern provinces. Approximately 58% of the patients were male and up to half of the patients resided in rural areas. Approximately 45% of cases were in the 25-44 years age group. The occupations of the patients were as follows: 30% were housewives, 22% were butchers, 18% were animal owners, 30% had other occupations, and up to 60% had a history of exposure to fresh raw meat.

The 2023 outbreak was the largest in Iraq in decades. The absence of preventive and control activities during the COVID-19 pandemic played an important role in the rise of cases and the presence of unlicensed and freelance slaughterers, especially during religious events played an important role in this epidemic.