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Rabies in Iraq: trends in human cases 2001-2010 and characterisation of animal rabies strains from Baghdad.

Horton DL, Ismail MZ, Siryan ES, Wali AR, Ab-dulla HE, Wise E, Voller K, Harkess G, Marston DA, McElhinney LM, Abbas SF, Fooks AR - PLoS Negl Trop Dis (2013)

Bottom Line: There is no laboratory confirmation of disease or virus characterisation and no systematic surveillance for rabies in animals.Bayesian phylogenetic analysis using partial nucleoprotein gene sequences derived from the samples demonstrated the viruses belong to a single virus variant and share a common ancestor with viruses from neighbouring countries, 22 (95% HPD 14-32) years ago.These include countries lying to the west, north and east of Iraq, some of which also have other virus variants circulating concurrently.

View Article: PubMed Central - PubMed

Affiliation: Animal Health and Veterinary Laboratories Agency, Weybridge, United Kingdom. daniel.horton@ahvla.gsi.gov.uk

ABSTRACT
Control of rabies requires a consistent supply of dependable resources, constructive cooperation between veterinary and public health authorities, and systematic surveillance. These are challenging in any circumstances, but particularly during conflict. Here we describe available human rabies surveillance data from Iraq, results of renewed sampling for rabies in animals, and the first genetic characterisation of circulating rabies strains from Iraq. Human rabies is notifiable, with reported cases increasing since 2003, and a marked increase in Baghdad between 2009 and 2010. These changes coincide with increasing numbers of reported dog bites. There is no laboratory confirmation of disease or virus characterisation and no systematic surveillance for rabies in animals. To address these issues, brain samples were collected from domestic animals in the greater Baghdad region and tested for rabies. Three of 40 brain samples were positive using the fluorescent antibody test and hemi-nested RT-PCR for rabies virus (RABV). Bayesian phylogenetic analysis using partial nucleoprotein gene sequences derived from the samples demonstrated the viruses belong to a single virus variant and share a common ancestor with viruses from neighbouring countries, 22 (95% HPD 14-32) years ago. These include countries lying to the west, north and east of Iraq, some of which also have other virus variants circulating concurrently. These results suggest possible multiple introductions of rabies into the Middle East, and regular trans-boundary movement of disease. Although 4000 years have passed since the original description of disease consistent with rabies, animals and humans are still dying of this preventable and neglected zoonosis.

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National statistics on human rabies incidence and dog bites.Data reported to National Zoonosis Centre, Baghdad from all 18 Governorate regional health offices. A. Annual reported incidence of human rabies deaths in Iraq, B Annual reported incidence of human rabies in Baghdad. C Annual reported dog bites in Baghdad. (nd = no data).
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pntd-0002075-g001: National statistics on human rabies incidence and dog bites.Data reported to National Zoonosis Centre, Baghdad from all 18 Governorate regional health offices. A. Annual reported incidence of human rabies deaths in Iraq, B Annual reported incidence of human rabies in Baghdad. C Annual reported dog bites in Baghdad. (nd = no data).

Mentions: Data on reported rabies cases were supplied by all 18 regional public health offices. In the 10 years between 2001 and 2010, there was an average of 17 (SD 6.9) human rabies cases reported annually in Iraq (Figure 1a). There was a three-fold increase in reported cases between 2003 and 2005 and, although the number of cases has varied from year to year, there has not been less than 15 cases reported per year since 2005. Human rabies incidence for Iraq during 2009 is estimated from these data at 0.89 deaths per million population, using a population estimate of 30 million [13] (Table 1). Children are over represented among rabies cases in Iraq. An estimated 40% of the population is under 15 years of age [13], yet 63% of cases occur in this age group (X2 = 48.4, p = 0.0001). Rabies is also more frequently reported in rural areas than urban areas, with 83% of cases reported in rural areas despite only 29% of the population living in rural areas [13] (X2 = 283, p = 0.0001). However, there has also been an apparent three-fold increase in the number of cases reported in Baghdad over the past ten years (albeit not statistically significant), with an average of 2 cases per year reported in between 2001 and 2002, and 6 cases reported per year between 2009 and 2010 (Figure 1b). There is an extreme bias towards males, with eight cases in males reported for every one case in a female despite a population sex ratio of 1∶1 [13] (X2 = 122, p = 0.0001). There is regional variation in the number of reported cases, with Governorates in the centre of the country reporting the highest incidence per 100,000 population during 2001–2010 (Figure 2 and Table S2).


Rabies in Iraq: trends in human cases 2001-2010 and characterisation of animal rabies strains from Baghdad.

Horton DL, Ismail MZ, Siryan ES, Wali AR, Ab-dulla HE, Wise E, Voller K, Harkess G, Marston DA, McElhinney LM, Abbas SF, Fooks AR - PLoS Negl Trop Dis (2013)

National statistics on human rabies incidence and dog bites.Data reported to National Zoonosis Centre, Baghdad from all 18 Governorate regional health offices. A. Annual reported incidence of human rabies deaths in Iraq, B Annual reported incidence of human rabies in Baghdad. C Annual reported dog bites in Baghdad. (nd = no data).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585036&req=5

pntd-0002075-g001: National statistics on human rabies incidence and dog bites.Data reported to National Zoonosis Centre, Baghdad from all 18 Governorate regional health offices. A. Annual reported incidence of human rabies deaths in Iraq, B Annual reported incidence of human rabies in Baghdad. C Annual reported dog bites in Baghdad. (nd = no data).
Mentions: Data on reported rabies cases were supplied by all 18 regional public health offices. In the 10 years between 2001 and 2010, there was an average of 17 (SD 6.9) human rabies cases reported annually in Iraq (Figure 1a). There was a three-fold increase in reported cases between 2003 and 2005 and, although the number of cases has varied from year to year, there has not been less than 15 cases reported per year since 2005. Human rabies incidence for Iraq during 2009 is estimated from these data at 0.89 deaths per million population, using a population estimate of 30 million [13] (Table 1). Children are over represented among rabies cases in Iraq. An estimated 40% of the population is under 15 years of age [13], yet 63% of cases occur in this age group (X2 = 48.4, p = 0.0001). Rabies is also more frequently reported in rural areas than urban areas, with 83% of cases reported in rural areas despite only 29% of the population living in rural areas [13] (X2 = 283, p = 0.0001). However, there has also been an apparent three-fold increase in the number of cases reported in Baghdad over the past ten years (albeit not statistically significant), with an average of 2 cases per year reported in between 2001 and 2002, and 6 cases reported per year between 2009 and 2010 (Figure 1b). There is an extreme bias towards males, with eight cases in males reported for every one case in a female despite a population sex ratio of 1∶1 [13] (X2 = 122, p = 0.0001). There is regional variation in the number of reported cases, with Governorates in the centre of the country reporting the highest incidence per 100,000 population during 2001–2010 (Figure 2 and Table S2).

Bottom Line: There is no laboratory confirmation of disease or virus characterisation and no systematic surveillance for rabies in animals.Bayesian phylogenetic analysis using partial nucleoprotein gene sequences derived from the samples demonstrated the viruses belong to a single virus variant and share a common ancestor with viruses from neighbouring countries, 22 (95% HPD 14-32) years ago.These include countries lying to the west, north and east of Iraq, some of which also have other virus variants circulating concurrently.

View Article: PubMed Central - PubMed

Affiliation: Animal Health and Veterinary Laboratories Agency, Weybridge, United Kingdom. daniel.horton@ahvla.gsi.gov.uk

ABSTRACT
Control of rabies requires a consistent supply of dependable resources, constructive cooperation between veterinary and public health authorities, and systematic surveillance. These are challenging in any circumstances, but particularly during conflict. Here we describe available human rabies surveillance data from Iraq, results of renewed sampling for rabies in animals, and the first genetic characterisation of circulating rabies strains from Iraq. Human rabies is notifiable, with reported cases increasing since 2003, and a marked increase in Baghdad between 2009 and 2010. These changes coincide with increasing numbers of reported dog bites. There is no laboratory confirmation of disease or virus characterisation and no systematic surveillance for rabies in animals. To address these issues, brain samples were collected from domestic animals in the greater Baghdad region and tested for rabies. Three of 40 brain samples were positive using the fluorescent antibody test and hemi-nested RT-PCR for rabies virus (RABV). Bayesian phylogenetic analysis using partial nucleoprotein gene sequences derived from the samples demonstrated the viruses belong to a single virus variant and share a common ancestor with viruses from neighbouring countries, 22 (95% HPD 14-32) years ago. These include countries lying to the west, north and east of Iraq, some of which also have other virus variants circulating concurrently. These results suggest possible multiple introductions of rabies into the Middle East, and regular trans-boundary movement of disease. Although 4000 years have passed since the original description of disease consistent with rabies, animals and humans are still dying of this preventable and neglected zoonosis.

Show MeSH
Related in: MedlinePlus