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\begin{document}

\title{Crimean Congo Hemorrhagic Fever Epidemic During COVID-19 in Iraq: A
``double whammy''?}



\author[1]{Omer Ahmed Shaikh}%
\author[1]{Manahil Shekha}%
\author[2]{Gulrukh Shaikh}%
\author[3]{Irfan Ullah}%
\author[4]{Zoia E. Khattak}%
\author[5]{Abdulqadir Nashwan}%
\affil[1]{Ziauddin University Faculty of Medicine}%
\affil[2]{Liaquat National Hospital and Medical College}%
\affil[3]{Gandhara University Kabir Medical College}%
\affil[4]{Peshawar Medical College}%
\affil[5]{Hamad Medical Corp Department of Nursing and Midwifery Education and Research}%


\vspace{-1em}



  
  \date{May 19, 2024}


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\selectlanguage{english}
\begin{abstract}
The Nairovirus causing the Crimean Congo Hemorrhagic Fever (CCHF) is
transferred mainly via ticks and farm animals. Its incidence is spread
over several countries broadly categorized into continents, including
Europe, Asia, and Africa. This editorial is shedding light on this
concerning pathogen and suggesting several strategies to tackle it.%
\end{abstract}%



\sloppy


\subsubsection*{\texorpdfstring{Crimean Congo Hemorrhagic Fever Epidemic
During COVID-19 in Iraq: A ``double
whammy''?}{Crimean Congo Hemorrhagic Fever Epidemic During COVID-19 in Iraq: A double whammy?}}

{\label{crimean-congo-hemorrhagic-fever-epidemic-during-covid-19-in-iraq-a-double-whammy}}

Omer A. Shaikh\textsuperscript{1}, Manahil Shekha\textsuperscript{1},
Gulrukh Shaikh\textsuperscript{2}, Irfan Ullah\textsuperscript{3,4},
Zoia E. Khattak\textsuperscript{5}, Abdulqadir J.
Nashwan\textsuperscript{6*}

\begin{enumerate}
\tightlist
\item
  Department of Medicine, Ziauddin Medical University, Karachi
\item
  Department of Medicine, Liaquat National Hospital and Medical College,
  Karachi
\item
  Department of Internal Medicine, Kabir Medical College, Gandhara
  University, Peshawar, Pakistan
\item
  Institute of Public Health and Social Science (IPH\&SS), Khyber
  Medical University, Peshawar, Pakistan
\item
  Khyber Medical College, Peshawar, Pakistan
\item
  Hamad Medical Corporation, Doha, Qatar
\end{enumerate}

\textbf{Correspondence}

Abdulqadir J. Nashwan anashwan@hamad.qa

Nursing Department, Hamad Medical Corporation

Tel: (+974) 40240487

Mob: (+974) 66473549

P.O.Box 3050 Doha, Qatar

\textbf{Abstract}

The Nairovirus causing the Crimean Congo Hemorrhagic Fever (CCHF) is
transferred mainly via ticks and farm animals. Its incidence is spread
over several countries broadly categorized into continents, including
Europe, Asia, and Africa. This editorial is shedding light on this
concerning pathogen and suggesting several strategies to tackle it.

\emph{Keywords: Nairovirus; Crimean Congo Hemorrhagic Fever; COVID-19}

\textbf{Key Clinical Message}

The rapid spread of the Crimean Congo Hemorrhagic Fever in Iraq is a
cause of great concern, especially with Eid-ul-Adha being around the
corner when the presence of sacrificial cattle acts as an optimum
breeding ground for the virus.

\textbf{Dear Editor,}

\emph{Hyalomma marginatum} ticks and farm animals transmit the
Nairovirus that causes the Crimean Congo Hemorrhagic Fever (CCHF). Due
to the rising incidence of CCHF across the globe, which has been long
recognized in a vast geographic area, including Europe, Asia, and
Africa, as well as the potential for viral growth into new locations, it
has been a serious public health issue.\textsuperscript{1}

As the world struggles to contain the devastating COVID-19 pandemic,
which has already worn down the underfunded health care systems in the
developing world, particularly in Iraq, with more than 2.3 million
confirmed cases and 25,000 fatalities as of June 26,
2022.\textsuperscript{2}

Iraq has been notified of a CCHF outbreak by WHO, which might prove to
be a catastrophic calamity, particularly since Eid-ul-Adha draws near
and the majority of Iraq's health initiatives are focused on COVID-19
control. By May 22, 2022, the country reported~212 cases of CCHF since
the year began, of which 169 were reported only in the
preceding~two~months. Out of the 212 cases, 97 were confirmed by
polymerase chain reaction (PCR), 13 of which were fatal (Case Fatality
Ratio: 13\%). Twelve of Iraq's 18 governorates indicated CCHF
prevalence, with the majority of cases occurring in Thiqar (48\%) and
Missan~(13\%), followed by Muthanna~(7\%) and
Wasit~(6\%).\textsuperscript{3}

Every year, during the Islamic occasion of Eid-Ul-Adha, countless
livestock animals are slaughtered, including goats, cows, sheep, and
camels. Worldwide, it is customary to buy animals ahead of Eid-Ul-Adha,
most of which are kept in residential zones. In addition, untrained
butchers, animal slaughter in public locations, improper disposal
techniques, and handling of animal blood, tissues, and skin are some
variables that aid in the transfer of CCHF from animal to human and pose
a significant threat to the general populace.\textsuperscript{4}

There is a critical need to control the migration of people and animals
from areas where the CCHF is endemic and to provide immediate training
for medical personnel so that animal health can be monitored and
reported. In addition, conducting public awareness campaigns and
ensuring that local authorities effectively collect and dispose of waste
and the carcasses of the slaughtered animals hold strategic importance
to prevent the disease from becoming more and more burdensome during the
current COVID-19 pandemic, along with collaborative efforts between
infectious disease researchers, medical professionals, and veterinarians
for prompt diagnosis and management of CCHF, are some of the crucial
steps that could be taken at the earliest.

\textbf{Declarations}

\textbf{Acknowledgments}

Open Access funding was provided by the Qatar National Library.

\textbf{Conflict of Interest Statement}

The authors have no conflicts of interest to declare.

\par\null

\textbf{Funding Sources}

None

\textbf{Author Contributions}

Omer A. Shaikh, Manahil Shekha, Gulrukh Shaikh, Irfan Ullah, Zoia E.
Khattak, Abdulqadir J. Nashwan: Manuscript writing \& Editing

All authors read and approved the final manuscript

\textbf{Transparency Declaration}

The lead author (Dr. Omer A. Shaikh) affirms that this manuscript is an
honest, accurate, and transparent account of the study being reported;
that no important aspects of the study have been omitted; and that any
discrepancies from the study as planned (and, if relevant, registered)
have been explained.



\textbf{References}

1. Fill\selectlanguage{ngerman}âtre P, Revest M, Tattevin P. Crimean-Congo hemorrhagic fever: An
update. \emph{Medecine et maladies infectieuses.} 2019;49(8):574-585.

2. Al-Mandhari AS, Brennan RJ, Abubakar A, Hajjeh R. Tackling COVID-19
in the eastern Mediterranean region. \emph{The
Lancet.}2020;396(10265):1786-1788.

3. Ahmad S, Hashmi N, Siddiqui JA, et al. The nosebleed fever outbreak
in Iraq: Challenges, efforts and recommendations. \emph{Annals of
Medicine and Surgery.} 2022;79.

4. Butt MH, Ahmad A, Misbah S, Mallhi TH, Khan YH. Crimean\selectlanguage{english}-Congo
hemorrhagic fever and Eid\selectlanguage{english}-Ul\selectlanguage{english}-Adha: A potential threat during the
COVID\selectlanguage{english}-19 pandemic. \emph{Journal of Medical Virology.} 2021.

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