Crimean-Congo hemorrhagic fever, a real health problem in Iraq?

Objectives: Crimean-Congo hemorrhagic fever (CCHF) is the most widespread tick-borne viral disease worldwide. CCHF was not recognized in Iraq before 1979, after which many outbreaks occurred, and the disease became endemic with the re-emergence of outbreaks. This study aimed to analyze the epidemiology of the largest outbreak in Iraqi history in 2023. Methods: This retrospective study included human CCHF cases from 2023. Results: 2186 suspected cases were investigated. There were 587 confirmed cases, and 83 deaths, and an overall case fatality rate (14%). Among the confirmed cases, only 539 cases had complete data, and the analysis was performed on these cases. The majority 70.9% of patients lived in the southern provinces. Approximately 58% of the patients were male and up to half of the patients resided in rural areas. Approximately 45% of cases were in the 25-44 years age group. The occupations of the patients were as follows: 30% were housewives, 22% were butchers, 18% were animal owners, 30% had other occupations, and up to 60% had a history of exposure to fresh raw meat. Conclusions: The 2023 outbreak was the largest in Iraq in decades. The absence of preventive and control activities during the COVID-19 pandemic played an important role in the rise of cases and the presence of unlicensed and freelance slaughterers, especially during religious events played an important role in this epidemic.