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ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

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  • ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

    Archive Number 20100505.1464
    Published Date 05-MAY-2010
    Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever - Iraq: (NI), RFI

    ************************************************** **********************
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    Date: Wed 5 May 2010
    Source: Aswat al Iraq [machine translation, abbrev. & edited]

    Hemorrhagic fever deaths after eating contaminated meat
    The director-general of health of Nineveh, on Mon 5 May 2010, announced
    that the deaths of 4 people in Mosul during the past 2 days were due to a
    "haemorrhagic fever" as a result of eating contaminated meat.

    Dr Salah al-Din told the Voices of Iraq Agency that 4 people "had died in
    the past 2 days after contracting a haemorrhagic fever that has spread in
    Mosul", indicating that a virus had been contracted from contaminated red
    meat slaughtered in an unhealthy way.

    He reported that the Mosul Health Department "had closed a number of shops
    selling meat in the Jerusalem district (Mosul east), the area where the
    victims resided which had sold meat slaughtered in an unhealthy way". He
    stated that the Health Department "had sprayed the butcher's shop and the
    homes of the victims with pesticide [disinfectant?]."

    [It was announced that] the burial of the dead with the disease "should be
    deep enough underground for fear of transmission of the virus". The people
    of Mosul were warned only "to purchase red meat from licensed premises and
    to avoid purchasing meat from street vendors for their own safety."

    Mosul is the capital city of Ninawa (Nineveh) province, situated 405 km
    [252 miles] north of Baghdad.

    communicated by:

    Date: Wed 5 May 2010
    Source: Alesbuyia [machine translation, abbrev. & edited]
    <;E4%ED%E4%E6% EC%20-%20%C7%C8%D1%C7%E5%ED%E3%20%DD%C7%C6%DE>

    A total of 4 people have died and another 3 are under observation in the
    Al-Salam Hospital in Mosul, suspected to have contracted a viral
    haemorrhagic fever. An employee of a hospital [stated] that 7 patients
    suffering from a viral haemorrhagic fever had been admitted to the
    emergency department of the hospital on 29 Apr 2010. The employee said that
    4 of these 7 affected people had died in hospital and the 3 others remained
    in isolation.

    The employee explained that the hospital administration had closed the
    emergency department of the hospital for 3 days and only reopened it after
    thorough disinfection. The source added that all the victims had purchased
    meat from a private butcher who had not slaughtered animals in an abattoir
    inspected by the Health Department [perhaps "had slaughtered animals in an
    abattoir not inspected..." - Mod.SH].

    The source stated that the patients exhibit symptoms compatible with viral
    haemorrhagic fever, with extensive bleeding that resulted in death within
    36 hours of exposure.

    communicated by:

    [Viral haemorrhagic fevers contracted from exposure to raw meat are likely
    to be caused by either Crimean-Congo haemorrhagic fever virus (CCHFV) or
    Rift Valley fever virus (RVFV). CCHFV is endemic in the region and the
    favoured candidate for this outbreak in northern Iraq. In 2009 an outbreak
    of Crimean-Congo haemorrhagic fever was recorded among abattoir works in
    neighbouring Iran

    Rift Valley fever has never been recorded as far north as Mosul. The only
    previous outbreaks of Rift Valley fever outside of the African continent
    occurred in the south of Saudi Arabia and in Yemen. Currently the only
    known cases of Rift Valley fever are occurring in South Africa. Further
    information is awaited.

    A map of the provinces of Iraq, showing the location of the province of
    Ninawa (Nineveh; formerly Mosul province), can be accessed at
    The HealthMap/ProMED-mail interactive map of Iraq is available at
    <>. - Mod.CP]

  • #2
    Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

    Dr. Feras Ismail
    10th May. 2010 WHO Medical Officer; Ninawa

    Country: IRAQ Governorate: Ninawa
    Emergency situation: Hemorrhagic Fever (HF) outbreak in Mosul Report: 3
    Reported cases of HF
     Old reported cases: 9 cases, 7 (5 old + 2 new) are confirmed to be positive (3 deaths) by Central Public Health Laboratory CPHL in Baghdad. 2 cases confirmed negative by the same lab. and one cancelled by the reported site as the clinical presentation and investigations done at the hospital was not fit with HF.
     New suspected cases: 3 cases, 1 case confirmed to be positive and another one as negative by CPHL today 10th May. Blood sample of a new case was sent to CPHL.
    Total: 8 positive, 2 negative, 1 pending, 1 cancelled. See Epicurve and map of HF cases in Ninawa downward
    Current situation
    On 6th of May, 40 years female presented with abdominal pain, malaise and coffee color vomits. She was resident in Al Qudis sector and had no history of contact to animals or to previous confirmed cases but history of buying meat from local butchers (could be the same butcher of the previous cases). She consulted Ibn Sena hospital on 1st of May and was diagnosed as peptic ulcer after doing endoscope for her and referred to Al Shifaa fever hospital for sampling and isolation as a suspected case of HF as well based on address and contact with suspected meat. Blood sample was collected on 9th May and lab. result was positive on the next day. On 8th May, Al Salaam hospital reported one suspected cases. She was 30 years female presented with fever, GIT symptoms and brown black vomits. Her address was Ayser district, Al NAbi Younis inside Mosul and she had no history of contact with animals or confirmed case or suspected meat. Blood sample was collected for her and sent to Baghdad on 9th May and the result received today as a negative case. On 10th May, a 23 years butcher from Aymen district consulted Al Shifaa fever hospital complaining from fever for the last few days and heamaturia for the last day. His platelets count showed decline in the titer and blood sample was collected and will be send to Baghdad tomorrow.
     Governor of Ninawa headed a meeting this evening 10th May to discuss the interventions taken to control this outbreak. The meeting attended by the mayor of Mosul, DG of Mosul DoH, Director of police, managers of Al Shifaa hospital, PHC Department, CDC, veterinary hospital, food inspection and WHO focal point in Mosul. The meeting recommended the followings:
    - the veterinary hospital and veterinary units in the districts to continuo their
    campaign of dipping sheep, treat cattle with pesticides and spraying animal
    farms with pesticides in coordination with the directorate of agriculture.
    - Control the movement of animals across the boarders.
    - Banning of unofficial slaughtering and direct observation from the
    veterinary side on the slaughtering house and on the butchers.
    - Re-checking the license of all the butchers and to put a penalty on each one
    proved to have slaughtering outside slaughter house.
    - Provision of kits to test suspected animals using PCR technique in the
    veterinary collage.
    - Concentrate on social mobilization and health education measures to rise the
    awareness among livestock harbors, butchers and the community using all
    the available tools including TV, Radio, posters and flix and cloth
    announcement (already 40 out of 100 were printed and distributed in
    different locations inside Mosul City .
     All cases were managed properly.
     Tomorrow there will be a training meeting for the laboratory technicians in the
    hospitals on the epidemiology of the disease, lab. investigation and safe
    dealing with the patients using proper PPEs.
     All reported cases were deeply investigated and their relatives and contacts
    were investigated and monitored by teams from PHCCs in their catchments
    Needs  Support the displaying of health messages in the local satellites and radio.$File/full_report.pdf
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.


    • #3
      Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

      Amazing find, RoRo. That article claims to be report #3, but I can't find reports #1 or #2 anywhere, which might illuminate exactly which hemorrhagic fever was confirmed.


      • #4
        Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

        I have been searching all over the internet for more information on this outbreak, and found an Arabic language site with the word "gorillia" in the name (that should let others find it) that I will not link to because it is covered in racist anti-Arab slurs, which identifies this disease as something that translates to "dengue" hemorrhagic fever. I know there was a previous incident in Saudi Arabia (,77793) in which the translator interchanged RVF and dengue, so that might tend toward RVF, but the higher fatality rate here also makes me suspect CCHF. Dengue itself is simply epidemiologically wrong here.

        Of note also is that "gorilla" site does refer to the virus as the same one that caused two cases ten years ago, but I can't find a link to the earlier outbreak either.


        • #5
          Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

          This is almost certainly CCHF.

          Archive Number 20100520.1669
          Published Date 20-MAY-2010
          Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever - Iraq (02): (NI, DA) RFI

          ************************************************** *************************
          A ProMED-mail post
          ProMED-mail is a program of the
          International Society for Infectious Diseases

          Date: Wed 19 May 2010
          Source: UN Office for the Coordination of Humanitarian Affairs (OCHA)
          ReliefWeb, NGO Coordination Committee in Iraq (NCCI) report [edited]

          Iraq: brief emergency report on hemorrhagic fever
          The MoH [has issued an order] to prevent movement of cattle coming
          from Ninawa [Ninevah] governorate to Dohuk [Dahuk governorate] and
          has imposed strict [controls] at entry points to prevent cattle
          smuggling and the transport of meat and dairy produce from Mosul
          because of the spread of [infection] in that city. The MoH earlier
          announced that lab tests on 2 [fatal] cases and 4 suspected cases
          [indicated that the outbreak was the result of infection by [a]
          hemorrhagic fever [virus], and that the spread of [infection] was a
          consequence of consumption of [contaminated] meat sold by street
          traders. The MoH has instituted an awareness campaign in this regard

          [Veterinary officials] in Dohuk within the next few days will
          implement a campaign in the area [around] Ninawa to sterilize animals
          and cattle by showering anti intrusions [that is, carry out tick
          disinfestation measures?] and vaccinating cattle. Also, there will be
          mobile teams from MoH to ensure compliance. They have asked people to
          cooperate with them in the face of this contagion and to follow
          health instructions to prevent this disease from spreading.

          Symptoms of viral hemorrhagic fever include fever, tiredness,
          inappetence, sickness, sweating, flushing, and in severe cases might
          include internal or external bleeding. Children may possibly have
          spasms or go into a coma ending in death.

          This pandemic disease previously [occurred] in Erbil and Dohuk in the
          years 1994-1996 killing one person who was working as a veteran
          assistant in Erbil; there were other infected cases.

          Communicated by:
          Shamsudeen Fagbo, DVM

          [Previously (see ProMED-mail archived report: Undiagnosed hemorrhagic
          fever - Iraq: (NI), RFI 20100505.1464) it was inferred that the viral
          hemorrhagic fever responsible for the deaths and infections in Ninawa
          governorate was Crimean-Congo hemorrhagic fever virus. The identity
          of the agent responsible for this outbreak of disease and the
          consequent controls of livestock movements remains to be confirmed.
          Further information from the region, verifying the identity of the
          etiologic agent would be welcomed.

          A map of the provinces [governorates] of Iraq, showing the location
          of the adjacent provinces of Dohuk and Ninawa (Nineveh; formerly
          Mosul province), can be accessed at
          The HealthMap/ProMED-mail interactive map of Iraq is available at
          <>. - Mod.CP]

          [see also:
          Undiagnosed hemorrhagic fever - Iraq: (NI), RFI 20100505.1464]