Evaluating the burden and transmission dynamics of chikungunya virus infections in the Eastern Mediterranean Region: a systematic review and meta-analysisShaik, Riyaz Ahamed; Ahmad, Mohammad Shakil; Miraj, Mohammad; Sami, Waqas; Azam, Alashjaee Ahmed; Okwarah, Patrick
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae165pmid: 39801330
The Chikungunya virus (CHIKV) presents substantial public health challenges in the Eastern Mediterranean Region (EMR), with its prevalence and interaction with other arboviruses (ABVs) remaining poorly understood. This systematic review and meta-analysis aimed to assess the prevalence of CHIKV and its association with other ABVs, such as dengue virus (DENV), Rift Valley fever virus (RVFV), malaria, and yellow fever virus (YFV), in the EMR. We systematically searched databases including PubMed, Embase, Web of Science, Scopus, Cochrane Library, CINAHL, PsycINFO, and ScienceDirect to identify epidemiological studies that report CHIKV prevalence and provide odds ratios (ORs) for CHIKV compared to other ABVs. Data analysis was performed using a random-effects model. Heterogeneity was evaluated using the χ2 test and I2 statistic. The GRADE approach was used to evaluate the quality of the studies while the AXIS tool, NOS tool, and AHRQ checklist assessed the risk of bias. The meta-analysis revealed a significant prevalence of CHIKV in the EMR. However, the studies exhibited heterogeneity, indicating variability in the results. A comparison of CHIKV with other ABVs did not show any statistically significant differences in prevalence. The meta-analysis found a notable prevalence of CHIKV in the EMR. The results also indicated that the prevalence of CHIKV is comparable to that of other ABVs in the region. These findings provide an overview of the burden of CHIKV in the EMR.
Epidemiological analysis and potential factors affecting the 2022–23 Crimean-Congo hemorrhagic fever outbreak in IraqKodama, Chiori; Alhilfi, Riyadh Abdulameer; Aakef, Ihab; Khamasi, Adnan; Mahdi, Sinan; Hasan, Hameeda Mohammed; Khaleel, Raghad Ibrahim; Naji, Mazin Mahdi; Esmaeel, Noor Khalid; Haji-Jama, Sundus; Legand, Anais; Keiser, Olivia; Eckerle, Isabella; Formenty, Pierre B H
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae147pmid: 39801332
Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne disease with a case fatality rate of up to 40% in humans, posing a significant health threat. This study investigates the 2022–23 CCHF outbreaks in Iraq, the highest recorded to date, and analyzes potential factors at the human–animal–environmental interface. Data from the Iraqi government, the World Health Organization, and the World Bank were used to analyze CCHF trends and affecting factors. This included epidemiological reports, clinical data, tick infestation and seroprevalence studies, and climate data. Descriptive and statistical analyses examined case trends, geographic and demographic characteristics, clinical manifestations, risk factors, seasonal patterns, and influencing factors. A sudden rise in CCHF cases began in southern Iraq in April 2022 and expanded across all governorates, with a shift toward urban areas. Higher incidence was observed among males, aged 25–44, and those involved in slaughtering. The most common clinical manifestation was fever (97%), followed by hemorrhagic symptoms (54%). Bleeding from the gums or mouth and subcutaneous bleeding were more frequent in patients with fatal outcomes. Seasonal patterns showed peaks during spring and fall, correlating with tick activity and potentially exacerbated by climate change. Tick infestation and seroprevalence studies indicated a high prevalence of Hyalomma ticks and CCHF seropositivity among domestic animals in southern Iraq (60%), consistent with the distribution of CCHF human cases. Iraq’s ongoing CCHF outbreak demands multidisciplinary One Health strategies. The Iraqi government has adopted such a control strategy, contributing to regional and global efforts to enhance pandemic preparedness.
Isolation and characterization of the midgut microbiota of Aedes albopictus to identify suitable candidates for paratransgenesisDarbandsari, Mersa; Asgari, Majid; Abaei, Mohammad R; Ghorbanzadeh, Zahra; Derikvand, Maryam; Okwarah, Patrick; Djadid, Navid Dinparast; Raz, Abbasali
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae110pmid: 39801338
Aedes albopictus is a widely recognized carrier of various pathogens. Its resilient characteristics enable it to easily spread across diverse climates. The microbiota in the midgut of mosquitoes plays a crucial role in the interactions between the host and pathogens and can either enhance or reduce the ability of the insect to transmit diseases. Hence, determining the microorganisms present in the mosquito’s digestive system could be a promising approach to developing an effective method of controlling them. Hence, the aim of this study was to investigate the microbial compositions in the midguts of Ae. albopictus mosquitoes collected from the fields of Sistan and Baluchestan Province. The midguts of 60 female mosquitoes were dissected, and their related bacteria were determined using the culture-dependent method. Different colonies were differentiated using the biochemical tests followed by 16S rRNA gene sequencing. The isolated bacteria were identified as belonging to the Asaia, Delftia, Serratia, Aeromonas, Paracoccus, and Planomicrobium genera based on biochemical and molecular analysis. The findings obtained in this study were largely consistent with earlier studies conducted on mosquitoes gathered from different regions throughout the world. Overall, the findings could enhance our understanding of the microbial diversity in Ae. albopictus and aid in the identification of a potent and widespread bacterium for the development of a paratransgenesis tool to combat Aedes-borne infectious diseases.
An epidemiological risk assessment of imported malaria cases and potential local transmission in QatarBansal, Devendra; Assaad, Nada; Mohamed, Hend Omar; Shanmugakonar, Muralitharan; Pacate, Dorothy; Mohamed, Khider; Balakrishnan, Perumal; Ramiscal, Redentor Cuizon; Ganesan, Nandakumar; Al-Shamali, Maha Hammam M A; Sultan, Ali A; Munir, Waqar; Abukhattab, Mohammed; Schaffner, Francis; Al-Maslamani, Muna A; Eid Al-Romaihi, Hamad; Al-Thani, Mohammed; Al Khayat, Fatima; Farag, Elmoubashar Abd
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae127pmid: 39801336
Preventing local transmission of malaria from imported cases is crucial for achieving and maintaining malaria elimination. This study aimed to investigate the epidemiological characteristics of imported malaria cases and assess the distribution of malaria vectors in Qatar. Data from January 2016 to December 2022 on imported malaria, including demographic and epidemiological characteristics, travel-related information, and diagnostic results, were collected and analysed using descriptive statistics. Field surveys conducted in 2021–22 collected mosquitoes using various traps across Qatar. The collected samples underwent morphological and molecular characterization at Qatar University. A total of 2693 cases were reported, with a mean incidence of 13.5/100 000 population, decreasing from 18.8/100 000 in 2016 to 5.5/100 000 in 2020. Most cases were Plasmodium vivax (57.4%) followed by P. falciparum (40.4%). The median age was 32.9 ± 12.5 years, primarily males (86.7%), expatriates (99.6%) and notified during the hot months (July to September). Cases were mainly imported from the Eastern Mediterranean Region followed by the African and South-East Asia Region with no deaths and indigenous cases. Anopheles stephensi was identified as a widely distributed species, but none carried the Plasmodium pathogen. Despite no reports of local transmission, the presence of An. stephensi and favourable environmental conditions pose a risk in Qatar. Strengthening surveillance for imported malaria and reviewing epidemic protocols are necessary. Conventional field studies are imperative to address knowledge gaps in Anopheles mosquito ecology and biting habits in Qatar, accurately assessing the risk of local malaria transmission to support Qatar’s malaria-free status.
Bartonellosis in World Health Organization Eastern Mediterranean Region, a systematic review and meta-analysisTahmasebi Ashtiani, Zahra; Bagheri Amiri, Fahimeh; Ahmadinezhad, Mozhgan; Mostafavi, Ehsan; Esmaeili, Saber
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae123pmid: 39801335
Bartonella is a vector-borne zoonotic pathogen, which could also be transmitted directly and cause a variety of clinical illnesses. This study aimed to investigate the prevalence of Bartonella in countries in the WHO Eastern Mediterranean Region (WHO-EMR) region. We searched using the keywords Bartonella and the name of each country in the WHO-EMR in databases such as PubMed, ISI (Web of Science), Scopus, and Google Scholar, with a publication date range of 1990–2022 and limited to English articles. We evaluated the quality of the studies using the STROBE 6-item checklist and used the random effects model to integrate the findings of the included studies. A total of 45 papers out of 240 were included in the analysis. The results showed the prevalence of Bartonella infection among endocarditis patients was 3.8% (95% CI: 0.2–7.4) and the seroprevalence of Bartonella among other people was 27.5% (95% CI: 13.5–41.5). The overall prevalence of Bartonella spp. among animals, as determined by molecular, serological, and culture methods, was 11.9% (95% CI: 5.7–18.2), 38.9% (95% CI: 27.5–50.2), and 1.7% (95% CI: 0.5–2.9), respectively. Furthermore, the prevalence of Bartonella spp. in ectoparasites was 3.9% (95% CI: 3.5–5.2), with fleas (6.2%) showing a higher prevalence compared to lice (4.9%) and ticks (1.0%). The detection of Bartonella in all animal and ectoparasites species and human populations in the WHO-EMR with prevalence ranging from 0.3% to 23% is concerning, emphasizes the importance of conducting more comprehensive studies to gain a deeper understanding of the spread of Bartonella in these areas.
Achievement of one health multi-sectoral collaboration in containment of Rift Valley Fever outbreak, Sudan, Red Sea State 2019Hussein, Hanadi E; Hassanain, Sara; Okwarah, Patrick; Mohamedahmed, Hanan; Elbadri, Omer; Alzaki, Zaafran; Hashim, Mohamed; Magboul, Babiker
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae163pmid: 39801337
Rift Valley Fever is endemic in Sudan, with a notable outbreak declared in 2019, affecting multiple states. In this study, we examine the Red Sea State, Sudan’s experience in applying the One Health approach, to contain Red-Sea RVF outbreak. A retrospective analysis of national and sub-national data and a review of literature were conducted to assess the application of One Health response and to derive lessons learned. The analysis revealed a total of 576 human cases and two deaths, with a case fatality rate of 0.35%, from 25 September 2019 to 25 January 2020. Most cases (99%) were from the Red Sea and River Nile States, and only six sporadic cases were from other five states. The Red Sea State reported 322 human and 74 animal cases, including 74 abortions and 12 animal deaths. Triggers and risk factors include floods, uncontrolled movement of animal, close contact with animals, poor disposal, and unsafe burial practices for animals. One Health approach was utilized all through the defeat of outbreak. A multi-sectoral response plan was implemented, leading to the declaration of the end of the outbreak in 2020 which was reviewed and lessons were derived. One Health approach provided a coordinated action between health, veterinary, and environmental authorities at national and subnational levels. Synergistic efforts have minimized risk of RVF spreading among human and animal. The experience was leveraged to strengthen response approaches for zoonotic diseases. Structural and capacity gaps and financial constraints were identified as implementation challenges.
Molecular diagnosis and phylogenetic analysis of a Middle East respiratory syndrome coronavirus human case in JordanAbu-Basha, Ehab A; Ismail, Zuhair B; Alboom, Mohammad H; Alkofahi, Ayesha; Amarneh, Basil H; Al-Omari, Omar; Fahmawi, Alaa; Alshammari, Abdullah; Lakaideh, Mais; Shaban, Shereen; Al-Omari, Bilal; Talafha, Hani; Hijazeen, Zaidoun; Daradkeh, Yasmin; El-Shesheny, Rabeh; Kayali, Ghazi; Bagge, Whitney; Karesh, William B
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae106pmid: 39801333
Middle East respiratory syndrome coronavirus (MERS-CoV) is an important zoonotic pathogen. The aim of this paper is to report one polymerase chain reaction (PCR)-positive case of MERS-CoV in a 27-year-old man who was involved in a nationwide longitudinal surveillance study of certain zoonotic diseases in Jordan including MERS-CoV. Whole-blood and nasal swab samples were collected from the man and five camels in the vicinity of his living area. The samples were subjected to enzyme-linked immunosorbent assay (ELISA) and real-time reverse-transcription PCR (RT-PCR) to detect MERS-CoV-specific antibodies and MERS-CoV genetic material, respectively. Genomic sequencing and phylogenetic analysis were also performed to detect similarities with known strains of the virus in the region. In January 2021, an ongoing surveillance study detected a MERS-CoV-positive nasal swab sample from an asymptomatic male and camels using RT-PCR. Phylogenetically, the MERS-CoV isolated in this case belonged to clade B and is clustered with other strains originating in the Arabian Peninsula. The case report represents the first PCR-positive case of MERS-CoV in an asymptomatic individual in Jordan, indicating active circulation of the virus within the population.
Assessing the diversity of zoonotic bacterial agents in rodents and small mammals in IranRezaie, Niloofar; Latifian, Mina; Ghasemi, Ahmad; Mahmoudi, Ahmad; Baseri, Neda; Omidi, Amir Hossein; Esmaeili, Parisa; Esmaeili, Saber; Mostafavi, Ehsan
2025 European Journal of Public Health
doi: 10.1093/eurpub/ckae132pmid: 39801339
The purpose of this study was to assess the prevalence of zoonotic bacteria, including Coxiella burnetii, Bartonella spp., Rickettsia spp., Brucella spp., Borrelia spp., and Ehrlichia spp., among small mammalian in Iran. We examined 618 small mammals collected between 2016 and 2020 from different parts of Iran. We extracted DNA from spleen samples and used quantitative real-time PCR to identify specific genes. We found 559 (90.45%) samples infected with at least one of the analyzed pathogens. Among the studied specimens, 86.08% tested positive for Bartonella spp., 2.42% for Ehrlichia spp., 0.80% for Borrelia spp., 0.64% for C. burnetii, 0.48% for Brucella spp., and 0% for Rickettsia spp. Bartonella krasnovii (25.81%) and Bartonella taylorii (25.81%) were the most prevalent among the Bartonella species. This study identified a rodent infected with Brucella abortus. Among the Borrelia-positive samples, four out of five were identified as Borrelia duttonii. Among the positive cases in the Ehrlichia genus, Ehrlichia canis, Candidatus Ehrlichia shimanensis, and Neoehrlichia mikurensis were identified. Meriones persicus was the most prevalent captured rodent with 315 specimens (51.22%). Our study revealed that a large proportion of the small mammals analyzed were infected with one or more of the targeted pathogens. M. persicus exhibited significant infection rates with C. burnetii, Bartonella spp., Ehrlichia spp., Brucella spp., and Borrelia spp. This suggests that this rodent species could serve as a crucial reservoir for zoonotic pathogens in Iran.