The epidemiological pattern of seasonal influenza in four sentinel sites in Iraq.

Introduction: Influenza is an acute viral infection with significant morbidity and mortality. It occurs annually each winter, which is called seasonal influenza, and is preventable through safe vaccine. Aim: The aim of this work is to know the epidemiological pattern of patients with seasonal influenza in Iraqi sentinel sites. Methods: A cross-sectional study was carried out on records of patients who attended four sentinel sites and registered to have influenza-like illness (ILI) or severe acute respiratory infection (SARI), and laboratory investigated. Results: The total number of cases was 1124; 36.2% of them aged 19-39 years; 53.9% were female; 74.9% lived in urban areas; 64.3% diagnosed as ILI; and 35.7% as SARI; 15.9% had diabetes, 12.7% had heart disease, 4.8% had asthma, 3% had a chronic lung disease, and 2% had hematological disease; 94.6% did not get influenza vaccine. About COVID-19 vaccine, 69.4% were not vaccinated, 3.5% got only one dose, and 27.1% completed two doses. Only the SARI cases needed admission; among them, 95.7% were cured. 6.5% were diagnosed with influenza-A virus, 26.1% had COVID-19, and 67.5% were negative. Among those with influenza, 97.3% had H3N2 subtype and 2.7% had H1N1 pdm09. Conclusions: The percentage of influenza virus in Iraq is relatively small. The age, classification of case (ILI or SARI), having diabetes, heart disease, or immunological disease, and taking COVID-19 vaccine have a significant association with influenza. Recommendations: It is needed for similar sentinel sites in other health directorates and for rising health education about seasonal influenza and its vaccine.

Emerging pneumococcal serotypes in Iraq: scope for improved vaccine development.

Pneumococcal disease is a global public health concern as it affects the young, aged and the immunocompromised. The development of pneumococcal vaccines and their incorporation in the immunization programs has helped to reduce the global burden of disease. However, serotype replacement and the emergence of non-vaccine serotypes as well as the persistence of a few vaccine serotypes underscores the need for development of new and effective vaccines against such pneumococcal serotypes. In the Middle East, places of religious mass gatherings are a hotspot for disease transmission in addition to the global risk factors. Therefore, the periodic surveillance of pneumococcal serotypes circulating in the region to determine the effectiveness of existing prevention strategies and develop improved vaccines is warranted. Currently, there is a lack of serotype prevalence data for Iraq due to inadequate surveillance in the region. Thus, this review aims to determine the pneumococcal serotypes circulating in Iraq which may help in the development and introduction of improved pneumococcal vaccines in the country.

Uncommon Presentation of COVID-19 With Long Incubation Period and Only Gastrointestinal Symptoms in a Fully Vaccinated Patient: Is There a Relation?

Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease that caused a worldwide pandemic in December 2019. It affected millions of people across the world and forced nations to lockdown their borders and implement curfews to control the spread of the disease. Unusual manifestations of the disease should be reported and be kept in mind among physicians. We report a case of a 33-year-old man who was fully vaccinated with two doses of Pfizer vaccine and presented with fever, epigastric pain, and diarrhea without any respiratory symptoms. The patient had a longer than usual incubation period of 16 days without reporting any signs of respiratory infection for the period of his infection. His laboratory investigations and chest X-ray were all normal. The patient did not require any treatment and his COVID-19 infection lasted for 10 days. Clinicians should understand that post-vaccination COVID-19 cases might present with a longer incubation period than usual and might present with gastrointestinal symptoms as the sole complaint.

Injuries Reported by Selected Health Facilities During the Arbaeenia Mass Gathering at Babel Governorate, Iraq, 2014: Retrospective Records Analysis.

BACKGROUND: Arbaeenia is the largest religious mass gathering in Iraq. The conditions associated with mass gatherings result in high rates of injury. There have been no prior studies on injuries during the Arbaeenia mass gathering. OBJECTIVE: This study describes the injuries observed during the Arbaeenia mass gathering in Babel Governorate in Iraq between November 24 and December 14, 2014. METHODS: The study was conducted in Babel Governorate at the emergency departments of six public hospitals and two major temporary medical units that were located along the three roads connecting the Middle and Southern Iraqi governorates. We used the Iraq Injury Surveillance System modified form to collect information on injured patients treated in the selected facilities. Data on fatal injuries was obtained from the coroner's office. The following data were collected from the patients: demographics, outcome of injury, place and time of occurrence, mode of evacuation and medical care before arriving at the hospital, duration of travel from place of occurrence to hospital, disposition of non-fatal injury, cause and mode of injury, and whether the injury occurred in connection with the Arbaeenia mass gathering. RESULTS: Information was collected on 1564 injury cases, of which 73 were fatal. About half of the reported nonfatal injuries, 687/1404 (48.9%), and a quarter of fatalities, 18/73 (25%) were related to the Arbaeenia mass gathering (P<.001). Most of the reported injuries were unintentional, 1341/1404 (95.51%), occurred on the street, 864/1323 (65.6%), occurred during the daytime 1103/1174 (93.95 %). Most of those injured were evacuated by means other than ambulance 1107/1206 (91.79%) and did not receive pre-hospital medical care 788/1163 (67.7%). Minor injuries 400/1546 (25.9%) and traffic accidents 394/1546 (25.5%) were the most common types of injuries, followed by falls 270/1546 (17.5%). Among fatal injuries, traffic accidents 38/73 (52%) and violence 18/73 (25%) were the leading causes of death. Mass gathering injuries were more likely to occur among individuals aged 21-40 years (odds ratio [OR] 3.5; 95% CI 2.7-4.5) and >41 years (OR 7.6; 95% CI 5.4-10.6) versus those <21 years; more likely to be unintentional than assault (OR 5.3; 95% CI 1.8-15.5); more likely to happen on the street versus at home (OR 37.7; 95% CI 22.4-63.6); less likely to happen at night than during the day (OR 0.2; 95% CI 0.1-0.4); and less likely to result in hospital admission (OR 0.5; 95% CI 0.3-0.7). CONCLUSIONS: The study shows that most injuries were minor, unintentional, and nonfatal, and most people with injuries had limited access to ambulance transportation and did not require hospitalization.