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

Daniel L Horton,Katja Voller,Mashair Z Ismail,Emma Wise,Graeme Harkess,Salah F Abbas,Eman S Siryan,Anthony R Fooks,Husam E Ab-Dulla,Abdul Raheem A Wali,Denise A Marston,Lorraine M Mcelhinney,Charles E Rupprecht

doi:10.1371/journal.pntd.0002075

Daniel L Horton, Katja Voller + Show 11 more

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https://doi.org/10.1371/journal.pntd.0002075

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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.

Highlights

The first written record of disease consistent with rabies is in the Laws of Eshunna, a Sumerian city in ancient Mesopotamia
The reported incidence of human rabies far exceeds that reported by some neighbouring countries
There was an increase in reported cases for the whole country after 2003 and a three-fold increase in reported cases in Baghdad in the ten years between 2001 and 2010. This increase coincides with a period of intense conflict in Iraq, with the potential to have widespread direct and indirect consequences on disease control

Summary

Introduction

The first written record of disease consistent with rabies is in the Laws of Eshunna, a Sumerian city in ancient Mesopotamia. Some of the earliest archaeological records of the domestication of dogs originate from the area, and dogs are thought to have had religious significance during that time [1]. Those Eshunnian laws, written almost 4000 years ago, warn of fines for owners of uncontrolled ‘mad’ dogs that bite humans [2]. The association of disease with infected dogs is consistent with the knowledge that rabies is spread through the saliva of infected animals, and that dogs are the major reservoir for infections of humans in many endemic areas [3]. It wasn’t until the last century, that rabies virus, a single stranded RNA virus in the family Rhabdoviridae, genus Lyssavirus, was identified as the causative agent [4]

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