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