Background: Staphylococcus aureus is a common commensal bacterium of the human body and a potential pathogen, causing public health hazards. Due to various virulent factors and growing antibiotic resistance, bacteria could cause various infections, ranging from minor skin infections to life-threating sepsis. Objectives: The present study aimed to evaluate the prevalence rate of S. aureus and determine its antimicrobial sensitivity profile in the secondary school students in Duhok City, Iraq. Methods: Samples were collected from the anterior nares of 492 volunteers aged more than 16 years in different cities, including Akre, Amedye, Bardarash, and Duhok. Conventional laboratory tests were performed for the identification of the bacterial isolates. In addition, the antimicrobial sensitivity test was carried out in accordance with the Clinical and Laboratory Standards Institute (CLSI). Results: Out of 492 subjects, 185 cases (37.6%) were carriers of S. aureus, including 57/185 (30.8%) males. The oxacillin resistance rate was estimated at 41.08%, while the resistance rate against tetracycline, fusidic acid, ciprofloxacin, gentamicin, vancomycin, clindamycin and rifampicin was 27.02%, 19.46%, 9.19%, 8.65%, 7.56%, 3.78%, and 1.08%, respectively. All the isolates were susceptible to teicoplanin. Conclusions: According to the results, the prevalence rate of S. aureus was high, and the species were more common in females. Therefore, further investigations are required to monitor the S. aureus antimicrobial profile and implement proper plans to manage the associated issues.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a serious concern of the global health sector and more recently, an escalating problem in the community. Objectives: This study was performed to investigate the incidence of MRSA in hospital staff and community students in Duhok, Kurdistan, Iraq, and make a molecular comparison between the strains based on the detection of mecA gene and Panton-Valentine Leukocidin (PVL) gene. Methods: We obtained 109 and 103 samples from the nares of hospital staff and community students, respectively. Conventional laboratory tests were performed for the detection of Staphylococcus aureus (S. aureus) and antibiotic sensitivity testing to identify MRSA isolates. Besides, PCR was utilized for molecular analysis. Results: All isolates from hospital staff were identified as S. aureus. Out of the 109 isolates, 55 (50.4%) were MRSA carrying the mecA gene, among which 4/55 (3.7%) were MRSA-PVL positive. Additionally, 54/109 (49.5%) isolates were methicillin-sensitive S. aureus (MSSA) but four isolates (3.7%) were MSSA-PVL positive. Furthermore, 23/103 (22.3%) samples from community students were identified as S. aureus, among which 5/23 (21.7%) and 17/23 (73.9%) isolates were MSSA-PVL positive and MSSA-PVL negative, respectively. Moreover, 1/23 (4.3%) was found as MRSA and was PVL gene-positive. Conclusions: The results showed that MRSA is swarming in hospitals and community in Duhok, Iraq. The highest rate of PVL was associated with community-acquired-MSSA (CA-MRSA). With further genotypic study, immediate action is needed to control and reduce the spread of MRSA clones, determine their clonal relations, and conduct epidemiological investigations.

A B S T R A C TObjectives: The aim was to investigate methicillin-resistant Staphylococcus aureus (MRSA) carriage rates and to characterize the staphylococcal cassette chromosome mec (SCCmec) among Syrian refugees and the host community in Duhok, Iraq. Methods: A total of 492 host community and 355 Syrian refugee subjects were recruited. Participant bioinformation was collected using a study questionnaire. MRSA carriage was identified as recommended in the Clinical and Laboratory Standards Institute guidelines. PCR was performed for typing the mecA gene and SCCmec groups. Results: In the host community, 76/492 (15.4%) carried MRSA, whereas 49/355 (13.8%) Syrian refugees carried MRSA (p = 0.505). Refugees were classified according to their arrival date; 36/278 (13%) existing refugees and 13/77 (16.9%) new refugee arrivals were identified as MRSA carriers (p = 0.375). Regarding the risk factors influencing MRSA spread, no association was found between MRSA prevalence and risk factors. The most common types of SCCmec in both communities were types IVa and V: 67.1% and 5.26%, and 49% and 2.04%, respectively. Conclusions: It is inferred that the effect of MRSA in refugees on the host community will be negligible. However, the refugee carriage rate is higher than that found in Western countries, the final destination of refugees. Therefore, screening for MRSA is mandated and the rapid detection of carriers would prevent its spread.

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious public health problem. There is limited information regarding the genetics of MRSA strains among the native Iraqi and incoming Syrian refugee communities. We aimed to characterize the genotypes and different virulence factors of MRSA in strains isolated from these two communities. Frozen MRSA strains (125) isolated from the native Iraqi and Syrian refugee communities were used in this study. PCR (singleplex and multiplex) and agr typing was used for the genotypic analysis of different virulence genes. We tested for the presence of virulence genes including pvl, arcA, tst, lukE/lukD, hla, hlb, eta, etb and agr. Prevalence of arcA MRSA in the Iraqi community (56.58%) was significantly higher (p = 0.008) than that in the Syrian refugee community (32.66%). Prevalence of lukE-lukD was also significantly higher (p = 0.001) in the Iraqi (82.89%) compared to that in the Syrian refugee community (57.14%). Further, prevalence of hla MRSA in the Iraqi community was (93.4%) and in the Syrian refugee community was (71.4%); (p = 0.0008). No significant differences were observed in the prevalence of pvl, tst, eta, etb and hlb. The most dominant agr types in both Iraqi (76.1% and 10.5%) and Syrian refugee (44.9% and 18.37%) communities were I and III. To sum up, no significant differences were observed between the groups for a majority of virulence factors. This is the first investigation of MRSA genotypes and virulence in both these communities. These results could be useful for further studies that assess the genetic relatedness of strains in the region for epidemiological and monitoring purposes, which would be crucial to limiting the spread of MRSA.

Background: Staphylococcus aureus is a frequent infectious agent that is responsible for various infections in hospitals and communities. Objectives: We aimed to study the nasal carriage rate and antimicrobial susceptibility profile of S. aureus among Syrian civilians in Duhok City, Iraq. Methods: A total of 335 participants were included from Syrian refugees in Duhok City, Iraq. Conventional lab tests such as Gram staining, mannitol fermentation, catalase, and coagulase were used for bacterial identification. Antibiotic susceptibility testing was carried out by using the Kirby-Bauer disk diffusion method and agar dilution assay, according to the Clinical Laboratory Standard Institute. Results: Out of the 355 samples, 140 (39.4%) were confirmed as S. aureus. The highest resistance rate was against oxacillin (35%) followed by fusidic acid (27.86%). The resistance rates against tetracycline, gentamicin, vancomycin, and ciprofloxacin were 22.1%, 17.86%, 11.4%, and 8.57%; respectively. Teicoplanin showed no resistance. Conclusions: We recommend that the antibiotic profile of S. aureus among Syrian refugees needs to be monitored. We found resistance against most of the antibiotics used in the study, and the highest rate of resistance was against oxacillin.

Background Despite vaccine and antiviral treatment availability, hepatitis B virus (HBV) continues to circulate among pregnant women in Iraq. HBV spread is due to many factors. This study evaluated HBV prevalence among pregnant women and Syrian refugees residing in Zakho city, Iraq, and identified risk factors associated with infection. Materials and methods Demographic data were collected from 2,054 pregnant women via a questionnaire assessing risk factors associated with HBV infection. Blood samples were collected for hepatitis B surface antigen (HBsAg) and were screened using an enzyme-linked immunosorbent assay. Results Tests revealed that 1.1% of pregnant women in Zakho and 11.3% of Syrian refugees (p = 0.001) were positive for HBsAg. The average age of HBsAg-positive patients was 31.4286 ± 6.6746 years (p = 0.002). Average rates of parity and abortion in HBV-infected subjects were 3.5 ± 2.6874 and 0.1785 ± 0.5479, respectively (p = 0.044 and 0.012, respectively). The following were identified as associated risk factors for HBV infection: nationality, (Zakho versus the city centre), tattoos, and polygamy (p = 0.001, 0.03, 0.007, and 0.001, respectively). No significant associations between HBV prevalence and blood transfusion, prior injection history, dental procedures, or surgical procedures were found. Conclusion The prevalence of HBV infection among Syrian refugees was higher than that of indigenous participants. Several risk factors were significantly associated with HBV positivity, which may facilitate effective preventive program implementation and decrease mother-to-child transmission risk. This will likely reduce infant and childhood HBV chronicity, and mortality rates.

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation ( p -value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87–2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74–1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90–2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-023-27197-6.

Objective This population-based study aimed to evaluate the seroprevalence of antibodies to SARS-CoV-2 in Duhok City, Kurdistan Region of Iraq. Methods We analyzed the national COVID-19 database that contains data regarding COVID-19 testing, management, and clinical outcomes in Duhok. For this study, different subdistricts within each district of Duhok were considered distinct clusters. Blood samples were collected from and questionnaires were administered to eligible and consenting participants who were members of different families from the subdistricts. Immunoassays were conducted to detect antibodies against SARS-CoV-2, and the associations between certain variables were investigated. Results The average number cases of COVID-19 before November 2020 was 23141 ± 4364, which was significantly higher than the average number of cases between November 2020 and February 2021 (3737 ± 2634; P = 0.001). A total of 743 individuals agreed to participate and were enrolled in the study. Among the participants, 465/743 (62.58%) were found to have antibodies against severe acute respiratory syndrome coronavirus 2. Among the participants with antibodies, 262/465 (56.34%) denied having any history of COVID-19-related symptoms. The most common symptom was fever (81.77%), followed by myalgia (81.28%). We found that antibody levels increased steadily with age (Pearson correlation coefficient = 0.117; P = 0.012). A significant association was found between antibody levels and the presence of symptoms (P = 0.023; odds ratio = 1.0023; 95% confidence interval = 1.0002-1.0061). Conclusions A significant reduction in the number of COVID-19 cases was observed. This might be due to the high prevalence of SARS-CoV-2 antibodies in Duhok. However, infection-prevention measures should be followed as it remains unclear whether acquired immunity is protective against reinfection. It expected that the infection rates during the next wave will not be as high as the first wave due to the high infection rate in the society.