Nawfal R Hussein.
Department of Biomedical Sciences, College of Medicine, University of Zakho, Kurdistan Region of Iraq.
Correspondence to: Nawfal R Hussein. Department of Biomedical Sciences, College of
Medicine, University of Zakho, Kurdistan Region of Iraq. E-mail: Nawfal.email@example.com
Published: November 1, 2022
Received: August 23, 2022
Accepted: October 16, 2022
Mediterr J Hematol Infect Dis 2022, 14(1): e2022077 DOI 10.4084/MJHID.2022.077
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To the editor
first cases of Covid-19 were reported in Iraq in February 2020. Since
then, the country has passed through four devastating waves of
Covid-19, with a death toll reached to 25000 deaths.[1,2]
The already debilitated health system, which suffered from two wars, a
long period of international sanction, and sectarian tension, could not
handle the numerous COVID patients, particularly those who needed
intensive care unit admissions. After the fourth
wave of the Omicron variant subsided, healthcare providers breathed a
sigh of relief, thinking they would get a rest period. However, a
hidden outbreak was lurking around the country. Between January 2022
and July 2022, the Iraq health authority reported 269 cases of
Crimean-Congo Hemorrhagic fever. During this
period, 36 patients lost their lives, giving a case fatality of 36/269
(13.38%). Such an infection is caused by a tick-borne virus
(Nairovirus) of the Bunyaviridae family. The infection is transmitted
to humans by tick bite or through contact with infected blood, with a reported case fatality of 10- 40%.
Additionally, worse came to worst when the Iraq health authority
announced a cholera outbreak after 13 cases were confirmed across the
country in June 2022. Cholera is an infectious disease caused by Vibrio cholerae. The infection occurs by ingesting contaminated water or food.
During the last outbreak, it was felt that the government was reluctant
to confirm all cases. As a result, while thousands of patients with
symptoms and signs of cholera visited hospitals, only 449 cases were
confirmed with the infection, with 48 deaths among confirmed cases.
The outbreaks in Iraq may exhaust the health system in the country with
political and sectarian tension these days. As a result, the situation
may worsen, and the country is prone to increased cases of the three
diseases. Such an increase is expected due to prolong upcoming
religious rituals of Al-Arbaeen and related religious events where
millions of people gather in one small city. During those days, people
share food and slaughter animals as a part of the holy ritual of
Al-Arbaeen. We believe that the Iraqi health authority is incapable of
controlling these and upcoming outbreaks due to the lack of a clear
infection control plan and the unavailability of emergency units in the
health system. It is worth mentioning that such outbreaks may chart a
pathway beginning with emergence, followed by localscale transmission,
movement beyond borders, and possibly global scale. Therefore,
international collaboration is needed to combat such infections.
Infectious diseases are a global thread rather than a local issue. The
globalization of infectious diseases is intensified by international
travel, migration, and animal and plant trade.
Therefore, more international collaboration is needed to conduct
research focusing on infectious diseases circulating in developing
countries. Additionally, it is unwisely and mistakenly thought that the
war against old infections, such as cholera, Crimean-Congo hemorrhagic
fever, TB, or polio, is won. International research to address these
old enemies can be co-opted and adapted for emerging threats. Finally,
future plans request to align with a global view of disease risk. We
must understand that we share the risks from infectious diseases
globally in our world today. The lesson of the COVID-19 pandemic,
including the swift spread and quickly evolved strains, teaches us the
requirement for a collaborative, worldwide framework for infectious
disease research and control.
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NR, Naqid IA, Saleem ZSM, Almizori LA, Musa DH, Ibrahim N. A sharp
increase in the number of COVID-19 cases and case fatality rates after
lifting the lockdown in Kurdistan region of Iraq. Annals of medicine
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NR, Naqid IA, Saleem ZSM. A retrospective descriptive study
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- WHO. Situation Report Iraq 2022 [Available from: https://iraq.un.org/sites/default/files/2022-07/WHO-Iraq-SitRep_Week29.pdf
- Appannanavar SB, Mishra B. An update on crimean congo hemorrhagic Fever. J Glob Infect Dis. 2011;3(3):285-92. https://doi.org/10.4103/0974-777X.83537 PMid:21887063 PMCid:PMC3162818
- Weil AA, Ryan ET. Cholera: recent updates. Current Opinion in Infectious Diseases. 2018;31(5):455-61. https://doi.org/10.1097/QCO.0000000000000474 PMid:30048254
RE, Mahmud AS, Miller IF, Rajeev M, Rasambainarivo F, Rice BL, et al.
Infectious disease in an era of global change. Nature Reviews
Microbiology. 2022;20(4):193-205. https://doi.org/10.1038/s41579-021-00639-z PMid:34646006 PMCid:PMC8513385