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Review 2: "Epidemiological Profile of Crimean-Congo Hemorrhagic Fever, Iraq, 2018"

The reviews for this preprint present contrasting perspectives.

Published onApr 13, 2024
Review 2: "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

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.


Review: Crimean-Congo Hemorrhagic Fever (CCHF) is present and has the potential to cause outbreaks in Iraq. However, the rate of suspected cases reported may exceed the true number of cases.

This is a straightforward study, mostly based around the question of suspected versus confirmed cases of CCHF in Iraq. The authors quantify confirmed cases as making up only 7% of suspected cases in a 2018 outbreak in the country, and discuss the characteristics of the individuals in both groups. The most interesting finding, perhaps, is that most suspected cases were from urban areas, whereas 90% of confirmed cases were from rural areas. The relatively small sample size and non-random sample should be noted here, however. That said, the authors provide a well-considered discussion around these findings, especially with regard to vector ecology and human behavioural risk factors (primarily occupational). The findings here are not surprising or groundbreaking, but are indeed informative and confirm the circulation of CCHF in the region.

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