Iraq experience in handling the COVID-19 pandemic: implications of public health challenges and lessons learned for future epidemic preparedness planning.

BACKGROUND: Iraq has been exceptionally challenged by the COVID-19 pandemic due to the already exhausted healthcare system. OBJECTIVES: To describe the epidemiological situation of COVID-19 in Iraq, the government's response to the pandemic, and provide recommendations for further action. METHODS: A desk review of secondary data using the available reports on the epidemiological situation in Iraq as well as official governmental sources was conducted. RESULTS: The major surge in the number of COVID-19 cases occurred in the first week of June and continued to increase dramatically until mid-October when a significant decrease happened. With a few exceptions, the reproductive number R has been consistently above 1. Patients aged 30-39 years (25.6%) were the most affected, while those aged 60-69 years (26.7%) had the highest deaths rates. Iraq tried to contain the pandemic through several regulations: border control, enforcing curfew, mask-wearing, and social distancing, COVID-19 isolation centers, expanding lab capacity, contact tracing, as well as several supportive economic measures. However, the extent of implementing these regulations is questionable. CONCLUSION: Additional administrative and scientific measures with special emphasis on handling mass gathering, coordination with media and better training of healthcare workers particularly on infection prevention and control.

A retrospective study of Crimean-Congo hemorrhagic fever in Iraq.

Background: CCHF is transmitted via ticks biting and directly by contact with tissue or blood of infected patients or viremic animals. This study intends to determine the occurrence of CCHF in Iraq between 2015 and 2019. Methods: This study was designed as a retrospective and descriptive cross-sectional study. It was approved the occurrence of CCHF in Iraq with relation to some epidemiological and demographic data reported in the Iraqi Communicable Diseases Control Center (CDC)/zoonotic diseases section between 2015-2019. Results: Out of 206 suspected cases, only 17 were diagnosed as CCHF with a total fatality ratio of 52%, 25%, and 80% in 2015 and 2018 respectively. However, no mortality was reported during 2016, 2017, and 2019. The mean age of the patients was 33 years± 18 SD, in males mainly (76%). Moreover, the risk groups were 29 %, 23 %, 18 % 12 %, and 6 % for butchers, animal dealers, gainers, both housewives and students and children respectively. Conclusion: Strict precautions and precise surveillance should be implemented to control the disease and protect the community by improving the diagnosis and treatment of CCHF. The authors recommend another future study to detect the genotyping and sequencing of CCHFV in Iraq.

Large outbreak of Crimean-Congo haemorrhagic fever in Iraq, 2022.

Background: Crimean-Congo haemorrhagic fever (CCHF) is reported sporadically in Iraq. The lack of preventive veterinary activities during 2 years of the coronavirus disease 2019 pandemic (2020 and 2021) led to the largest CCHF outbreak in Iraq since 1979. Objective: To describe the epidemiological characteristics of CCHF cases that occurred during the first half of 2022 in Iraq in terms of age, sex, residence, history of contact with another case, and history of contact with animals. Materials and methods: This descriptive study included laboratory-confirmed cases of CCHF between 1st January 2022 and 26th June 2022. Frequencies and percentages were used to describe the demographic and epidemiologic criteria of the cases. The epidemic curve of the cases was used to describe the timing and duration of the outbreak. Results: In total, there were 219 confirmed cases of CCHF from 1st January 2022 to 26th June 2022. The first confirmed case was reported in March 2022, and cases continued to occur through June 2022. The median age of the cases was 34.5 years. The majority of cases were male (n=130, 59.4%), had an unspecified job (n=126, 57.5%) and lived in southern Iraq (n=142, 64.8%). The first case was reported in week 10 of 2022. Case numbers peaked in week 24 (30 cases were reported), and subsequently declined in week 25 (24 cases were reported). The case fatality rate was 16.4%. Conclusion and recommendations: The CCHF outbreak in 2022 was the largest in Iraq since the disease was first reported four decades ago. Identification of CCHF strains in Iraq is recommended, together with exploration of the knowledge, attitudes and practices of high-risk groups for CCHF, and a national survey of CCHF vectors in Iraq.