Rabies in Iraq: Trends in Human Cases 2001–2010 and Characterisation of Animal Rabies Strains from Baghdad

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.

Epidemiological Characteristics of Human and Animal Rabies in Azerbaijan

“…The reported human rabies incidence for 2009 in Azerbaijan (0.07 cases per 100,000 population) is similar to Georgia (0.13) and higher than for Turkey (0.025) and neighbouring Iran (0.02), but much lower than Iraq (0.89) (Aylan et al., ; Horton et al., ). The proportion of rabies cases in children in Azerbaijan is lower than reported in similar studies in other countries, where a reoccurring feature is over‐representation of rabies among children under 15 years (Knobel et al., ).…”

Current status of rabies and prospects for elimination

“…Rabies is regarded as under-reported in many regions, 1 due in part to a lack of surveillance and laboratory infrastructure, confounded by cultural or social taboos. [2][3][4] The absence of accurate data on disease incidence in turn tends to reduce rabies as a priority for policy makers and public health professionals. 5,6 Estimates of the global burden, based on models of incidence of dog bites, have been updated and augmented to include country-specifi c data from published studies and online surveys, giving a more comprehensive global estimate.…”

Rabies in Saudi Arabia: a need for epidemiological data

“…3 In Yemen, the majority of cases are reported in feral dogs. 4 Rabies is also endemic in countries bordering the north of the Peninsula: Iraq, in which most cases are reported in dogs and sporadically in wildlife, 5 and Jordan, in which cases are reported mostly in dogs and, to a lesser extent, in cattle, sheep, and goats. 6 Although Saudi Arabia is the largest country in the Peninsula, little has been published about the rabies situation in the country.…”