Overview of the Outbreak
Crimean-Congo Hemorrhagic Fever (CCHF), commonly referred to as “nose-bleed fever,” continues its deadly spread in Iraq. As of 31 May 2022, the death toll has risen to 18, with approximately 120 cases reported since January 2022. This tick-borne viral disease has an estimated case fatality rate ranging from 10% to 40%, making it one of the most dangerous viral hemorrhagic fevers globally.
Key Outbreak Metrics
| Metric | Value |
|---|---|
| Reporting Period | January–May 2022 |
| Total Suspected Cases | ~120 |
| Confirmed CCHF Infections | 97 |
| Total Deaths | 18 |
| Deaths in Latest 2 Weeks | 6–7 |
| Case Fatality Ratio (Confirmed Cases) | ~13% |
| Global Case Fatality Rate | 10–40% (avg. ~30%) |
Epidemiological Timeline
| Date | Event |
|---|---|
| January 2022 | Initial suspected CCHF cases emerge in southern and central Iraq |
| April 2022 | Rapid case escalation in agricultural zones |
| May 2022 | Total of 212 reported cases, including 97 lab-confirmed |
| 31 May 2022 | Death toll confirmed at 18 from ~120 total suspected cases |
| July 2022 (Projected) | Anticipated spike during Eid al-Adha due to livestock slaughtering |
Disease Background: Crimean-Congo Hemorrhagic Fever (CCHF)
CCHF is caused by a nairovirus of the Bunyavirales order and is primarily spread through the bite of infected Hyalomma ticks. Secondary transmission occurs via contact with blood or tissues from infected animals, especially during the slaughtering process. Human-to-human transmission is rare but possible in healthcare settings through exposure to infected bodily fluids.
Incubation Periods
| Transmission Mode | Incubation Duration |
|---|---|
| Tick Bite | 1–9 days |
| Contact with Blood/Tissue | 5–13 days |
Common Early Symptoms
- Sudden high fever (≥ 38°C)
- Intense muscle pain
- Headache and dizziness
- Stiff neck, photophobia
- Nausea, vomiting, diarrhea
- Sore throat
Hemorrhagic Phase (2–4 Days After Onset)
- Petechiae and ecchymosis
- Nasal and gum bleeding
- Gastrointestinal hemorrhages
- Liver dysfunction and renal impairment
Mortality commonly occurs in the second week of illness, often due to multi-organ failure caused by internal bleeding and systemic shock.
Regional Spread in Iraq
CCHF cases have largely emerged from agricultural zones in southern and central Iraq, including Dhi Qar, Wasit, Karbala, and Najaf. These areas feature dense populations of sheep, cattle, and goats, which serve as tick hosts.
Case Distribution by Region (April–May 2022)
| Governorate | Estimated Case Count | Notable Attributes |
|---|---|---|
| Dhi Qar | 30+ | High-density livestock and tick presence |
| Wasit | 20+ | Rural, heavy farming activity |
| Karbala | 15+ | Proximity to slaughterhouses |
| Najaf | 10+ | Livestock movement across provinces |
Transmission Pathways
| Mode of Transmission | Context |
|---|---|
| Tick Bite | Direct contact with Hyalomma-infested animals |
| Contact with Infected Animal Blood | During slaughtering or handling of livestock |
| Human-to-Human | Healthcare exposure to contaminated fluids |
Transmission is particularly likely in livestock handlers, butchers, farmers, and veterinarians, especially in areas lacking proper vector control and biosecurity measures.
Diagnosis and Response Challenges
| Aspect | Details |
|---|---|
| Diagnostic Methods | RT-PCR, ELISA (antigen/RNA/antibodies) |
| Lab Capacity | Delays of 3–5 days in some regions |
| Treatment | No antiviral or vaccine; supportive care only |
| Surveillance Limitations | Low tick sampling, insufficient livestock monitoring |
Delayed diagnosis and limited health infrastructure have hampered containment efforts, allowing CCHF to proliferate in under-monitored zones.
Risk Amplification Drivers
| Driver | Effect |
|---|---|
| Eid al-Adha Livestock Slaughter | Increases direct human contact with blood/tissues |
| Rural Animal Husbandry | High density of tick hosts (cattle, sheep, goats) |
| Cross-border Livestock Trade | Potential import of infected animals from endemic neighboring regions |
| Healthcare Exposure | Lack of PPE in under-resourced facilities increases nosocomial risk |
| Public Awareness Deficits | Low knowledge of tick prevention, improper animal handling |
The Eid al-Adha holiday poses a significant spike risk due to increased animal movement and mass slaughtering events without adequate acaricide use or protective equipment.
Global Context and Recent Cases
| Country | CCHF Status |
|---|---|
| Iraq | 212 cases, 27 deaths by May 2022 |
| Spain | Multiple cases reported since 2016 |
| Portugal | First confirmed fatal CCHF case in July 2024 |
| Balkans | Endemic CCHF zone |
| Turkey | Periodic outbreaks annually |
| Central Asia | Regular CCHF clusters during livestock seasons |
CCHF is endemic in Africa, the Middle East, Eastern Europe, and Asia, with increasing cross-border case documentation.
Public Health Interventions Recommended
| Intervention | Action Plan |
|---|---|
| Tick Surveillance | Testing ticks on livestock using PCR to identify viral load |
| Veterinary Controls | Mandatory acaricide treatment before livestock transport/slaughter |
| Awareness Campaigns | Education programs in rural communities and slaughterhouses |
| Healthcare Protocols | Isolate suspected cases, enforce use of PPE |
| Diagnostic Expansion | Establish regional PCR labs to minimize detection delays |
Improving vector control, early diagnosis, and public health communication remain key pillars in halting the spread.
FAQ
What is “nose-bleed fever”?
It is a nickname for Crimean-Congo Hemorrhagic Fever (CCHF), known for severe bleeding, especially from the nose and mucosal membranes.
How many people have died so far?
As of 31 May 2022, 18 people have died in Iraq due to the outbreak.
How is it transmitted?
Primarily through Hyalomma tick bites or contact with infected animal/human blood.
Can people infect each other?
Yes, but it is rare and usually happens in healthcare settings through contact with bodily fluids.
What symptoms should people watch for?
High fever, muscle pain, vomiting, bleeding from nose or gums, and gastrointestinal distress.
How long does it take to show symptoms?
1–9 days after a tick bite, or 5–13 days after exposure to infected blood or tissue.
Is there a vaccine or cure?
No; only supportive treatment such as fluid replacement and bleeding management is available.
Why is Eid al-Adha mentioned?
It involves mass livestock slaughtering, increasing exposure to blood and ticks.
Who is most at risk?
Farmers, butchers, livestock handlers, and healthcare workers in affected areas.
Is it a global threat?
Yes; it is endemic in parts of Africa, Asia, and Europe, and has appeared in multiple countries including Spain and Portugal.
