Morbidity and mortality of Crimean-Congo hemorrhagic fever in Iraq: cases reported to the National Surveillance System, 1990-2010

Although Crimean-Congo hemorrhagic fever (CCHF) is endemic in the Middle East, its incidence in Iraq has not been well described since the early 1980s. To document trends and patterns of CCHF occurrence, we analyzed CCHF case reports from Iraq's National Surveillance System in 2010 and aggregate reports from previous years. A suspected case was defined as fever, hemorrhagic symptoms and a history of animal contact. Serologic testing was conducted for confirmation. Between 1998 and 2009, the annual number of confirmed cases ranged from zero to six. In 2010, 11 confirmed and 28 suspected cases were reported. The case fatality rate was 36% among confirmed cases, 4% among suspected cases. Most confirmed cases occurred during a three-week period in a single province. While CCHF is uncommon in Iraq, sporadic cases and outbreaks do occur. Surveillance could be strengthened by updating the case definition and case investigation forms.