Outbreak at a Glance:
- Between 1 January to 22 May 2022, the health authorities of the Republic of Iraq notified the World Health Organization (WHO) of 212 cases of Crimean-Congo Hemorrhagic Fever (CCHF), of which 115 were suspected and 97 laboratory-confirmed.
- There were 27 deaths, 14 in suspected cases and 13 in laboratory confirmed cases; with 13% total mortality rate.
- Cases have been reported in several areas (governorates) in Iraq, but concentrated in southern governorates.
- Crimean-Congo Hemorrhagic Fever is an endemic disease in Iraq.
Epidemiology:
- CCHF is a widespread disease, caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. The CCHF virus causes severe viral hemorrhagic fever (VHF) outbreaks. It was named after the place, where the disease was first characterized in the Crimea, and then in the Congo in the 1950s.
- Ticks of the genus Hyalomma are the principal vector.
- CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north, which is the geographic distributions of tick-borne diseases and their primary tick vectors.
- The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as: agricultural workers, slaughterhouse workers and veterinarians.
- Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies.
Symptoms:
- The incubation period of the virus inside the human body ranges from 5 to 13 days.
- The onset of symptoms is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light).
- There may be other symptoms, such as: nausea, vomiting, diarrhea, abdominal pain and sore throat early on, then followed by sharp mood swings and confusion.
- After two to four days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement).
- Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to larger rashes called ecchymosis, and other hemorrhagic phenomena.
- There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after the fifth day of illness.
- The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness.
- In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.Diagnosis:
The CCHF virus infection can be diagnosed by several different laboratory tests:
- Enzyme-linked immunosorbent assay (ELISA);
- Antigen detection;
- Reverse transcriptase polymerase chain reaction (RT-PCR) assay; and
- Virus isolation by cell culture.
Treatment:
- General supportive care with treatment of symptoms is the main approach to managing CCHF in people.
- The antiviral drug «Ribavirin» has been used to treat CCHF infection with apparent benefits.
Prevention and Control:
- There are no vaccines available to protect animals or humans from infection with the virus.
- Wear protective clothing (long sleeves, long trousers).
- Wear light colored clothing to allow easy detection of ticks on the clothes.
- Use approved acaricides (chemicals intended to kill ticks) on clothing.
- Use approved repellent on the skin and clothing.
- Regularly examine clothing and skin for ticks; if found, remove them safely.
- Seek to eliminate or control tick infestations on animals or in stables and barns.
- Avoid areas where ticks are abundant and seasons when they are most active.
Reducing the Risk of Animal-to-Human Transmission:
- Wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home.
- Quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.
Reducing the risk of human-to-human transmission:
- Avoid close physical contact with CCHF-infected people.
- Wear gloves and protective equipment when taking care of ill people.
- Wash hands regularly after caring for or visiting ill people.
WHO Recommendations:
- There is an increased risk of further spread of CCHF cases; due to the upcoming religious holiday of Eid Al-Adha, which will witness an increase in acquisition of livestock and mass animal sacrifice.
- WHO recommends that infection prevention control measures be taken to control animal-to-human transmission, as well as human-to-human transmission at health facilities when dealing with infected cases.
- Promoting health awareness among farmers and animal workers, in addition to health practitioners.
- There is no reason to ban travel to and from Iraq.