Determining the bacterial and viral meningitis trend in Iraq from 2007 till 2023 using joinpoint regression.

Background: Acute meningitis is a disease with case fatality and disability rate that is dependent on the causative agent. Objective: Determine the meningitis trend in Iraq from 2007 to 2023 using a joinpoint regression at national and sub-national levels and describe the epidemiology. Methods: Joinpoint regression model was used on surveillance data from Jan 2007 until May 2023, to calculate annual and average annual percent changes to determine the trend. Meningitis total count was modelled by year of reporting and province using the log transformation and Poisson variance. Best-fit model was chosen based on the weighted BIC criteria as the final point. Results: Bacterial meningitis was higher than viral meningitis from 2007 to 2018, then viral meningitis started to exceed till 2023. Meningococcal meningitis was lower than other bacterial and viral meningitis from 2007 to 2023. Most meningitis cases across the years were lower than 15 years, at almost 80 %, while 20 %-40 % were lower than one year. Across all years, 55 % of the cases were males; apart from 2019, 70 % were females. Conclusion: In Iraq, viral meningitis has been the predominant type since 2018. Most meningitis patients were lower than 15-year-old males. The meningitis trend in Iraq was stable from 2007 till 2023.

Management of infodemics in outbreaks or health crises: a systematic review.

Introduction: The World Health Organization (WHO) defined an infodemic as an overabundance of information, accurate or not, in the digital and physical space, accompanying an acute health event such as an outbreak or epidemic. It can impact people's risk perceptions, trust, and confidence in the health system, and health workers. As an immediate response, the WHO developed the infodemic management (IM) frameworks, research agenda, intervention frameworks, competencies, and processes for reference by health authorities. Objective: This systematic review explored the response to and during acute health events by health authorities and other organizations operating in health. It also assessed the effectiveness of the current interventions. Methods: On 26 June 2023, an online database search included Medline (Ovid), Embase, Cochrane Library, Scopus, Epistemonikos, and the WHO website. It included English-only, peer-reviewed studies or reports covering IM processes applied by health organizations that reported their effectiveness. There was no restriction on publication dates. Two independent reviewers conducted all screening, inclusion, and quality assessments, and a third reviewer arbitrated any disagreement between the two reviewers. Results: Reviewers identified 945 records. After a final assessment, 29 studies were included in the review and were published between 2021 and 2023. Some countries (Pakistan, Yemen, Spain, Italy, Hong Kong, Japan, South Korea, Singapore, United Kingdom, United States, New Zealand, Finland, South Korea, and Russia) applied different methods of IM to people's behaviors. These included but were not limited to launching media and TV conservations, using web and scientific database searches, posting science-based COVID-19 information, implementing online surveys, and creating an innovative ecosystem of digital tools, and an Early AI-supported response with Social Listening (EARS) platform. Most of the interventions were effective in containing the harmful effects of COVID-19 infodemic. However, the quality of the evidence was not robust. Discussion: Most of the infodemic interventions applied during COVID-19 fall within the recommended actions of the WHO IM ecosystem. As a result, the study suggests that more research is needed into the challenges facing health systems in different operational environments and country contexts in relation to designing, implementing, and evaluating IM interventions, strategies, policies, and systems.

Alarming update on incidence of Crimean-Congo hemorrhagic fever in Iraq in 2023.

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.

Low type I interferon response in COVID-19 patients: Interferon response may be a potential treatment for COVID-19.

Interferons (IFN) are antiviral cytokines that mitigate the effects of invading viruses early on during the infection process. SARS-CoV and MERS induce weak IFN responses; hence, the clinical trials which included recombinant IFN accompanied with other antiviral drugs exhibited improved results in terms of shortening the duration of illness. The aim of the present study was to evaluate the type I IFN response in COVID-19 patients to determine whether it is sufficient to eliminate or reduce the severity of the infection, and whether it can be recommended as a potential therapy. Total RNA samples were converted to cDNA and used as templates to evaluate the gene expression levels of IFN regulatory factor (IRF)3 and IFN-ß in COVID-19 patients or control. The results showed that IRF3 gene expression was upregulated ~250-fold compared with the negative samples. In contrast, IFN-ß expression increased slightly in COVID-19 patients. Consistent with other coronaviruses, such as SARS-CoV and MERS, COVID-19 infection does not induce an efficient IFN response to reduce the severity of the virus. This may be attributed to an incomplete response of IRF3 in activating the IFN-ß promoter in the infected patients. The results suggest IFN-ß or α may be used as potential treatments.

Gene Expression of Promyelocytic Leukemia Proteins and IFN-γ Is Reduced in Rotavirus-Infected Children

Background: Rotavirus infection is one of the most common gastroenteritis in the world, and a million cases are registered to enter hospital every year. Promyelocytic leukemia proteins (PMLs) are IFN-up-regulated proteins, and one of their critical functions is working as antiviral proteins. Recently, promyelocytic leukemia isoform II (PML-II) has been depicted as an isoform responsible for the antiviral function. Methods: Rotavirus prevalence determination was achieved by PCR and Rapid Adeno/Rota Virus test, while the relative expression assay was carried out by real-time PCR technique. Blood and stool samples were collected from 34 children under five years admitted to the hospital with acute gastroenteritis showing signs of dehydration. RNA samples were extracted from blood specimens and converted to cDNA to be used in gene expression analysis of PML, PML-II, and IFN-γ in rotavirus positive or negative samples. Results: Rapid Adeno/Rota Virus Antigen Combo Test and PCR assay could detect the virus in stool samples in 45% and 17.6% of cases, respectively. PML in positive samples decreased to 104fold less than the level in negative ones. The same trend was noticed in the level of IFN-γ and PML-II expression as their expression reduced to 104 or 13fold in rotavirus-infected samples compared to the control, respectively. Conclusion: Altogether, our data showed that the gene expression of PML, PML-II, and type II IFN considerably diminished in rotavirus-infected samples compared to the negative control.

Promyelocytic leukemia protein isoform II inhibits infection by human adenovirus type 5 through effects on HSP70 and the interferon response.

Promyelocytic leukemia (PML) proteins have been implicated in antiviral responses but PML and associated proteins are also suggested to support virus replication. One isoform, PML-II, is required for efficient transcription of interferon and interferon-responsive genes. We therefore investigated the PML-II contribution to human adenovirus 5 (Ad5) infection, using shRNA-mediated knockdown. HelaΔII cells showed a 2-3-fold elevation in Ad5 yield, reflecting an increase in late gene expression. This increase was found to be due in part to the reduced innate immune response consequent upon PML-II depletion. However, the effect was minor because the viral E4 Orf3 protein targets and inactivates this PML-II function. The major benefit to Ad5 in HelaΔII cells was exerted via an increase in HSP70; depletion of HSP70 completely reversed this replicative advantage. Increased Ad5 late gene expression was not due either to the previously described inhibition of inflammatory responses by HSP70 or to effects of HSP70 on major late promoter or L4 promoter activity, but might be linked to an observed increase in E1B 55K, as this protein is known to be required for efficient late gene expression. The induction of HSP70 by PML-II removal was specific for the HSPA1B gene among the HSP70 gene family and thus was not the consequence of a general stress response. Taken together, these data show that PML-II, through its various actions, has an overall negative effect on the Ad5 lifecycle.

The Human Adenovirus Type 5 L4 Promoter Is Negatively Regulated by TFII-I and L4-33K.

UNLABELLED: The late phase of adenovirus gene expression is controlled by proteins made in the intermediate phase, including L4 proteins of 22,000- and 33,000-Da apparent molecular mass (L4-22K and -33K proteins) that are expressed initially from the L4 promoter (L4P). The L4P is activated by a combination of viral proteins and cellular p53 and is ultimately inhibited again by its own products. Here, we have examined the L4P of human adenovirus type 5 in detail and have defined its transcription start site, which our data suggest is positioned by a weak TATA box. Rather than contributing positively to promoter activity, a putative initiator element at the transcription start site acts as a target for negative regulation imposed on the L4P by cellular TFII-I. We show that this TFII-I inhibition is relieved by one of the previously defined viral activators of the L4P, the E4 Orf3 protein, which alters the pool of TFII-I in the cell. We also explore further the negative regulation of the L4P by its products and show that the L4-33K protein is more significant in this process than L4-22K. It is the combined actions of positive and negative factors that lead to the transient activation of the L4P at the onset of the late phase of adenovirus gene expression. IMPORTANCE: The adenovirus replication cycle proceeds through multiple phases of gene expression in which a key step is the activation of late-phase gene expression to produce proteins from which progeny particles can be formed. Working with human adenovirus type 5, we showed previously that two proteins expressed from the L4 region of the viral genome perform essential roles in moving the infection on into the late phase; these two proteins are produced by the action of a dedicated promoter, the L4P, and without them the infection does not proceed successfully to progeny generation. In this new work, we delineate further aspects of L4P activity and regulation. Understanding how the L4P works, and how it contributes to activation of the late phase of infection, is important to our understanding of natural infections by the virus, in which late gene expression can fail to occur, allowing the virus to persist.