The World Health Organization received reports from Iraq of 212 cases of Crimean-Congo Hemorrhagic Fever (CCHF). The cases were broken down as follows:
- 115 (54%) were suspected
- 97 (46%) were laboratory-confirmed
- There were 27 deaths
- 14 deaths in suspected cases
- 13 deaths in laboratory-confirmed cases.
The number of cases reported in the first five months of 2022 is much higher than that reported in 2021 when 33 laboratories confirmed cases were recorded.
The Iraq Central Public Health Laboratory confirmed the cases by polymerase chain reaction (PCR).
Among confirmed cases, most had direct contact with animals and were livestock breeders or butchers. CCHF is a viral tick-borne disease transmitted to humans by bites of infected ticks and direct contact with blood or tissues from infected humans and livestock.
Sheep and cattle farming is widespread in Iraq. Studies have shown that these animals are regularly infested with tick species, mainly Hylomma species, the principal vector of CCHF.
Crimean Congo Hemorrhagic Fever
Signs and Symptoms
The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common. Symptoms may also include jaundice or yellowing of the skin and mood and sensory perception changes in severe cases.
As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on the fourth day of the disease and lasting for about two weeks.
Treatment
Human cases of CCHF are mainly treated with general supportive care. The oral and intravenous formulations of the antiviral drug ribavirin have been used to treat CCHF infection. However, no evidence from randomized clinical trials has demonstrated the effectiveness of ribavirin for treating CCHF. There is currently no vaccine available for either people or animals.
Crimean Congo Hemorrhagic Fever Outcomes
CCHF is deadly. Fatality rates in hospitalized patients have ranged from 9% to 50%. Recovery among survivors is slow. The long-term effects of CCHF infection have not been studied well enough in survivors to determine whether or not specific complications exist.
Iraqi Public Health Response
The epidemiology team conducted an outbreak investigation, including a house-to-house visit of the reported cases and contact tracing. They also conducted entomological research for disease vectors, which included collecting and classifying ticks from each site of reported suspected cases.
The Ministry of Health vector control team sprayed indoor and outdoor acaricides in affected areas, and the veterinary hospital treated domestic animals with acaricides in affected areas.
The Iraqi prime minister has allocated one billion dinars to combat CCHF
WHO Risk Assessment
There is an increased risk of further spread of CCHF within Iraq due to the upcoming religious holiday, Eid al-Adha, in July because more camels, cows, and sheep will be slaughtered.
Additionally, international cross-border transmission cannot be ruled out given the increased population movement and possible animal exportation associated with the holiday. During Ramadan, which took place in March and April 2022, the number of CCHF cases steadily increased, and the geographical spread of the disease expanded to more governorates.
The Iraqi Ministry of Health and the WHO have not explained the increase in CCHF cases this year in Iraq.
Iraqi BioSafety Labs
The U.S. Defense Threat Reduction Agency (DTRA) Biological Threat Reduction Program (BTRP) established a biosafety laboratory and provided biohazard training in Iraq.
Global Biodefense reports that BTRP supports Iraq’s Field Epidemiology Training Program (FETP). The FETPs workforce rapidly identifies and responds to outbreaks, emphasizing pathogens of high consequence (such as biological warfare agents or potentially pandemic pathogens).
Crimean Congo Hemorrhagic Fever is one of the research subjects in the BioSafety Labs in Ukraine that the US Department of Defense maintains. BioSafety laboratories are state-of-the-art labs designed not only to protect researchers from contamination, but also to prevent microorganisms from entering the environment.
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