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Review 3: "Epidemiological Profile of Crimean-Congo Hemorrhagic Fever, Iraq, 2018"

The reviews for this preprint present contrasting perspectives.

Published onApr 13, 2024
Review 3: "Epidemiological Profile of Crimean-Congo Hemorrhagic Fever, Iraq, 2018"
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key-enterThis Pub is a Review of
Epidemiological Profile of Crimean-Congo Hemorrhagic Fever, Iraq, 2018
Epidemiological Profile of Crimean-Congo Hemorrhagic Fever, Iraq, 2018
Description

Abstract Background Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal tick-borne disease that is widely distributed in Africa and Eurasia countries. It is caused by the CCHF virus of the Nairovirus genus of the Bunyaviridae family.This study aims to describe the 2018 CCHF epidemic wave in Iraq and epidemiological pattern to assist implantation of preventive and control measures and adherence of physicians to the standard case definition.Methods This descriptive study reviewed all records of suspected and confirmed CCHF cases. Three types of data sources were used: the case investigation forms of all suspected cases, case sheets of all confirmed cases, and the laboratory results from the central public health laboratory.Results The total number of suspected cases was 143. Most of the cases were males (59.4%), 15-45 years old (62.2%), and live in urban areas (58.7%). About three quarters of the cases (68.5%) did not fit the standard case definition adopted by Iraq Center of Disease Control. Most of the suspected cases were reported in Diwaniya province (20.3%). Nearly half of them (64, 44.7%) occurred in June.Only 7.0% (n=10) of suspected cases were positive when tested by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One third of confirmed cases (3, 30.0%) occurred in Diwaniya province. During the 2018 epidemic wave, there were 10 confirmed cases with 8 deaths and 2 improved cases.Conclusion Despite the fact that CCHF is uncommon in Iraq, sporadic cases or outbreaks could occur.Recommendations Given the known method of transmission, banning of random livestock slaughtering and the practice of raising livestock inside residential areas are expected to have a major role in CCHF infection control.

RR:C19 Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: The preprint describes the details of unconfirmed and confirmed cases of CCHF in Iraq in 2018. Cases are described by location, and date and both recorded symptoms and treatments are tabulated. here is a clear seasonal and geographic peak.

Overall this manuscript is well presented and well written. I would change a few things around and add a few details, as detailed below. The most significant is that some tables are included but not described in the text.
I would also do a proper copy edit for the English which as quite a few minor grammatical errors , though not enough to obscure the meaning of the content.

Minor Comments below:

  • Abstract - “Given the known method of transmission, banning of random livestock slaughtering and the practice of raising livestock inside residential areas…”: This isn’t really a recommendation, which would require you to suggest some actions.

  • Methods - “The variables collected include the reporting directorate of health, time of reporting, primary diagnosis…”: This sentence is repeated.

    Also there are a few minor grammatical errors in the English spread throughout the text, which therefore needs some careful copy editing.

  • Results - “…CDC/ Iraq, only (31.5%) fit to the standard case definition…”: Might be good to specify what the case definition includes.

  • Table 5: Don’t see any reference to this table or the following one in the text.  Either refer to tables and contents  or remove them.

  • Discussion - “The tissue prepared from ticks also was negative for CCHFV [16].”: Might be useful to at least say which tick were tested

  • Discussion - “The majority of confirmed cases occurred in summer and this is in accordance…”: You write about the risk factors for these unconfirmed cases as if they were in fact CCHF.  If they weren’t confirmed, should you be doing that?

  • Recommendation - “All DsoH in Iraq have to strictly follow the WHO case definition…”: This is a strange topic on which to finish  - it may be better placed in the introduction?

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