An epidemiological analysis of acute flaccid paralysis and its surveillance system in Iraq, 1997-2011.

BACKGROUND: Acute flaccid paralysis surveillance (AFP) is an essential strategy of the WHO's Polio Eradication Initiative. This is the first study conducted to estimate the incidence, etiology, distribution, and surveillance performance of AFP in Iraq. METHODS: Surveillance data about the AFP cases under the age of 15 years reported from Iraq during January 1997 to December 2011 were depended in the current study. RESULTS: A total of 4974 cases of AFP were reported from Iraq during the study period, with an annual incidence of 2.5/100,000 population. Guillain-Barré syndrome represented more than half of the reported cases (N = 2611, 52.5%), followed by traumatic neuritis (N = 715, 14.4%), and other CNS infections (N = 292, 5.9%). Poliomyelitis accounted for 166 (3.3%) of cases, the last reported case being in January 2000. Surveillance performance showed that all, but two, indicators were below the required WHO recommended levels. CONCLUSIONS: AFP surveillance remains the gold standard method for poliomyelitis detection. It witnessed dramatic changes over the last two decades. This has raised people's and clinicians' awareness to the importance of promptness in notifying suspected cases and timely transportation of stool specimens to the National Poliovirus Laboratory in Baghdad, or alternatively having more than one laboratory for poliovirus detection in the country, all of which are very useful measures to increase the surveillance performance in the country.

Guillain-Barré syndrome as a cause of acute flaccid paralysis in Iraqi children: a result of 15 years of nation-wide study.

BACKGROUND: Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis (AFP) in the post-poliomyelitis eradication era. This is the first study done to identify the epidemiology, clinical features, and outcome of GBS in Iraqi children over 15 years. METHODS: The surveillance database about AFP cases < 15 years reported during January 1997-December 2011 was used. RESULTS: GBS represented 52.5% of AFP cases, with an incidence of 1.33 case/100,000 population < 15 years/year. There was a higher incidence in the Southern provinces, age group 1-4 years, males, and outside the capital city of province, with no significant seasonal variations (p = .22). Survival probability after the 1 year of onset for those with respiratory muscle involvement was .76 (95% CI: .60-.86), versus .97 (95% Cl: .96-.98) for those who did not develop it (p < .001); and .97 (95% CI: .96-.98) for those living inside the capital city, versus .94 (.93-.95) for those living outside (p = .001). Cumulative incidence of residual paralysis for patients living inside the capital city was .21 (95% CI: .18-.24), versus .27 (95% CI: .25-.29) for those living outside (p < .001). CONCLUSIONS: The incidence, age and gender distribution, and seasonality of GBS among Iraqi children is similar to those reported from other previous studies. It is the most important cause of AFP, especially in those between the age of 1 to 4 years living in rural areas.

Morbidity and mortality of Crimean-Congo hemorrhagic fever in Iraq: cases reported to the National Surveillance System, 1990-2010.

Although Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Middle East, its incidence in Iraq has not been well described since the early 1980s. To document trends and patterns of CCHF occurrence, we analyzed CCHF case reports from Iraq's National Surveillance System in 2010 and aggregate reports from previous years. A suspected case was defined as fever, hemorrhagic symptoms and a history of animal contact. Serologic testing was conducted for confirmation. Between 1998 and 2009, the annual number of confirmed cases ranged from zero to six. In 2010, 11 confirmed and 28 suspected cases were reported. The case fatality rate was 36% among confirmed cases, 4% among suspected cases. Most confirmed cases occurred during a three-week period in a single province. While CCHF is uncommon in Iraq, sporadic cases and outbreaks do occur. Surveillance could be strengthened by updating the case definition and case investigation forms.

Epidemiological analysis of measles and evaluation of measles surveillance system performance in Iraq, 2005-2010.

OBJECTIVES: The objectives of this study were to identify the risk factors for measles and low vaccination rates, to evaluate the performance of surveillance, and to calculate vaccine effectiveness and failure in Iraq for the years 2005 to 2010. METHODS: Logistic regression was used on measles surveillance data from Iraq obtained during the period 1 January 2005 to 31 December 2010; adjusted odds ratios were calculated. The performance of surveillance was evaluated according to World Health Organization (WHO) guidelines. RESULTS: Of 18,746 suspected cases, a measles diagnosis was made for 81.4%. Children aged 1-5 years were the most affected (>48%). The odds of measles were significantly higher in the central and southern provinces than in the northern provinces. Those vaccinated with at least one dose of measles-containing vaccine had a 3.7-times lower risk of contracting measles than those who were not vaccinated. Lower odds of vaccination were noted for adults aged 18 years and older and those living in central and southern provinces, as well as those living outside the capital city of a province. Three WHO performance indicators were lower than the recommended cut-off levels. A vaccine failure rate of 66.1% and effectiveness of 90.03% were estimated. CONCLUSIONS: Measles continues to be an important cause of morbidity in Iraq. Improvements in vaccine coverage, proper vaccine handling, and prompt reporting of suspected cases are all necessary to eliminate measles from Iraq.