Health-related factors of the Iraqi adult population during the 2020 COVID-19 pandemic: physical activity, eating behavior, quality of life, general health, and mood states cross-talk.

BACKGROUND: The lockdown and social distancing caused by Coronavirus disease 2019 (COVID-19) may have changed Physical Activity Level (PAL), eating behavior, and health habits due to long-term confinement worldwide. OBJECTIVE: This study aimed to evaluate the PAL, eating behavior, Quality of Life (QoL), General Health (GH), and mood states during COVID-19 confinement in a large sample of Iraqi adults. METHODS: 3738 healthy adults (age 18-70 years) residing in Halabjeh, Iraq answered the online questionnaires including the short form of international physical activity, GH, three-factor eating (TFEQ-R18), and a short form of the profile of mood states (POMS-SF) questionnaires. Data analysis was done by Chi-square, and Spearman's correlation using SPSS statistical software at a significant level of (P < 0.05). RESULTS: The results showed unfavorable PAL, eating behavior, QoL, GH, and mood states in the total population. Low PAL was observed in 69.96% of the men and 75.99% of the women; only 3.60% of the men and 0.77% of the women had a high PAL. There was a significantly positive relationship between low PAL and the incidence of COVID-19 both in men and women (P = 0.801; r = 0.001; and P = 0.682; r = 0.011), respectively; While a significant negative relationship was observed between the moderate and high PAL and the incidence of COVID-19 in men (P = 0.011; r=-0.682 and P = 0.027, r=-0.589), and women (P = 0.001; r=-0.796 and P = 0.018, r=-0.623). No significant relationships were observed between PAL and eating behavior (men: P = 0.086; r = 0.256 and women: P = 0.365, r=-0.121); While, the results show significant positive relationships between PAL with QoL in men (P = 0.012; r = 0.623) and women (P = = 0.001; r = 0.837). based on the results, significant negative relationships between PAL with GH and mood state scores were observed in both men (P = 0.001; r=-0.837 and P = 0.001, r=-0.786) and women (P = 0.010; r=-0.652 and P = 0.001, r=-0.745), respectively. CONCLUSIONS: The Iraqi adult population showed low PAL, GH, QoL, and mood state during COVID-19 which might be due to the confinement. Also, the significant relationships between low PAL with GH, and mood state recommends physical activity as a valuable health optimizing factor during the COVID-19 pandemic.

Associated effects of clinical characteristics, risk factors, and comorbidity on disease severity and mortality among patients with COVID-19 in Sulaimani City/ Kurdistan Region of Iraq.

The effects of clinical symptoms, laboratory indicators, and comorbidity status of SARS-CoV-2-infected patients on the severity of disease and the risk of death were investigated. Questionnaires and electronic medical records of 371 hospitalized COVID-19 patients were used for data collection (demographics, clinical manifestation, comorbidities, laboratory data). Association among categorical variables was determined using Kolmogorov-Smirnov test (P-value ≤0.05). Median age of study population (249 males, 122 females) was 65 years. Roc curves analysis found that age ≥64 years and age ≥67 years are significant cut-offs identifying patients with more severe disease and mortality at 30 days. CRP values at cut-off ≥80.7 and ≥95.8 significantly identify patients with more severe disease and mortality. Patients with more severe disease and risk of death were significantly identified with platelet value at the cut-off ≤160,000, hemoglobin value at the cut-off ≤11.7, D-Dimer values ≥1383 and ≥1270, and with values of neutrophil granulocytes (≥8.2 and ≤2) and lymphocytes (≤2 and ≤2.4). Detailed clinical investigation suggests granulocytes together with lymphopenia may be a potential indicator for diagnosis. Older age, several comorbidities (cancer, cardiovascular diseases, hypertension) and more laboratory abnormalities (CRP, D-Dimer, platelets, hemoglobin) were associated with development of more severity and mortality among COVID-19 patients.

Assessment of the implementation of preventive measures by Iraqis people to reduce the spread of coviD-19 pandemic.

BACKGROUND AND AIM: The new outbreak "Coronavirus disease 2019 (COVID-19)" happened in china is caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). Consequently, it spreads across the globe and is affecting wellbeing frameworks and the global economy. This pandemic disease places a heavy burden on governments in general, so individuals must adhere to WHO's instructions to limit its spread. The current study was applied to find out the extent of commitment among the Iraqi people to the standards of prevention measures against the coronavirus. MATERIALS AND METHODS: A cross sectional study was conducted with 1153 respondents widely in all governorates of Iraq to identify the commitment of the Iraqis to the preventive measures against COVID-19 in Iraq. This study covered the Iraqis in three main regions (Southern, middle, and Northern) for data collection. It was conducted between the 17th and 25th of March 2020, and Iraqis were administered with a structured questionnaire comprising of three domains. RESULTS: The results showed that the majority of the respondents (52%) were female, and most of them (42.3%) were observed between the age group of 31-40 years. About 82% of the respondents were residents of urban areas. CONCLUSION: This study reveals the excellent implementation of preventive measures by the population. It is observed that the application of prevention standards in the countryside is less than in the city.

Prevalence and determinants of anxiety and stress in the general population during COVID-19 pandemic in Iraq: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic and its prevention and control measures, such as social distancing, self-isolation, and quarantine, have a negative impact on the population's mental health. This study aimed to determine the prevalence of anxiety and stress among the general population during the outbreak of COVID-19 and assess their associated factors. METHODS: We carried out a cross-sectional study in Erbil governorate, Iraqi Kurdistan Region, from July 18 to September 12, 2020. We used an online survey questionnaire to collect data from a sample of Erbil population. The 10-items Perceived Stress Scale and the 7-item Generalized Anxiety Disorder scale were used to measure the levels of stress and anxiety. RESULTS: A total of 851 persons responded to the survey. The prevalence of moderate and high perceived stress was 59.6% and 16.6%, respectively. The prevalence of moderate and severe anxiety was 24.7% and 22.7%, respectively. Age, gender, economic level, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with stress levels. Age, gender, economic level, employment status, having symptoms of COVID-19, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with anxiety levels. CONCLUSION: A high proportion of people experienced stress and anxiety during the COVID-19 outbreak in Erbil, Iraqi Kurdistan Region. Females, younger age, poor, and unemployed reported significantly higher stress and anxiety levels. There is a need to establish mechanisms at the population level to decrease the stress and anxiety risks and provide mental health coping measures in times of crisis, such as education about positive thinking, stress management programs, and the role of social support.

The epidemiological pattern of seasonal influenza in four sentinel sites in Iraq.

Introduction: Influenza is an acute viral infection with significant morbidity and mortality. It occurs annually each winter, which is called seasonal influenza, and is preventable through safe vaccine. Aim: The aim of this work is to know the epidemiological pattern of patients with seasonal influenza in Iraqi sentinel sites. Methods: A cross-sectional study was carried out on records of patients who attended four sentinel sites and registered to have influenza-like illness (ILI) or severe acute respiratory infection (SARI), and laboratory investigated. Results: The total number of cases was 1124; 36.2% of them aged 19-39 years; 53.9% were female; 74.9% lived in urban areas; 64.3% diagnosed as ILI; and 35.7% as SARI; 15.9% had diabetes, 12.7% had heart disease, 4.8% had asthma, 3% had a chronic lung disease, and 2% had hematological disease; 94.6% did not get influenza vaccine. About COVID-19 vaccine, 69.4% were not vaccinated, 3.5% got only one dose, and 27.1% completed two doses. Only the SARI cases needed admission; among them, 95.7% were cured. 6.5% were diagnosed with influenza-A virus, 26.1% had COVID-19, and 67.5% were negative. Among those with influenza, 97.3% had H3N2 subtype and 2.7% had H1N1 pdm09. Conclusions: The percentage of influenza virus in Iraq is relatively small. The age, classification of case (ILI or SARI), having diabetes, heart disease, or immunological disease, and taking COVID-19 vaccine have a significant association with influenza. Recommendations: It is needed for similar sentinel sites in other health directorates and for rising health education about seasonal influenza and its vaccine.

Molecular Study of ACE2 Gene Polymorphism of COVID-19 Infection among the Kurdish Population in Kurdistan Region- Iraq.

Coronavirus Disease 2019 (COVID-19) is a current pandemic infection of the human respiratory system, which is caused by which caused by Sever Acute respiratory syndrome virus 2 (SARS-CoV-2). The infection was classified by World Health Organization (WHO) as a universal pandemic in February 2020; there have been 494.587.638 confirmed cases and 6.170.283 deaths. The present study investigated the molecular genetics of the Angiotensin Converting Enzyme 2 (ACE2) gene in correlation to COVID-19 patients in the Kurdish population. Eighty-six individuals were clinically diagnosed with COVID-19 and control groups. After the genomic DNA extraction these participants the target 1, 2 and 8 exons of the ACE2 gene were amplified using the PCR technique, and then the Sanger sequencing technique was performed to analyze genetic variants of the ACE2 gene in 70 DNA samples of COVID-19 hospital patients at Emergency Hospital in Erbil city, Sarchnar Hospital in Sulaymaniyah city, Lalav Hospital in Duhok city and Wafa Hospital in Halabja city from Kurdistan Region of Iraq. The current study was designed into two groups control group and a patient group. The patient group was divided into two subgroups, severe and mild patients of different ages and genders. As a result, there were no mutations at the positions 1, 2 and 8 exons sequences, while single nucleotide polymorphisms (SNPs) were detected and identified three different types of mutation at intron position: twenty-six of c.12405 del T, two of c.12407 T>G, and two of c.12406 G>A in a total 86 participants. This result shows that genetic difference does not impact the COVID-19 infection severity among the Kurdish population regarding ACE2 gene polymorphism.

The association of ABO blood group distribution and clinical characteristics in patients with SARS-CoV-2.

INTRODUCTION: SARS-COV-2, the novel severe acute respiratory syndrome coronavirus, has become a life-threatening public health crisis. This kind of pandemic is frightening the world with clinical, psychological, and emotional distress and leading to an economic slowdown. To explore any association between the ABO blood type and the susceptibility to coronavirus disease 2019 (COVID-19), we compared ABO blood group distribution among 671 COVID-19 patients with the local control population. METHODOLOGY: The study was conducted in Blood Bank Hospital in Erbil, Kurdistan Region, Iraq. The ABO-typed blood samples were obtained from 671 patients infected with SARS-CoV-2 between February and June 2021. RESULTS: Our results demonstrated that the risk of SARS-COV-2 was higher for patients with blood group A than those with not-A blood type patients. Of the 671 patients with COVID-19, 301 had type A (44.86%), 232 had type B (34.58%), 53 had type AB blood (7.9%), and 85 had type O (12.67%). CONCLUSIONS: We concluded that the Rh-negative blood type has a protective effect on SARS-COV-2. Our results also indicate that the decreased susceptibility of individuals with blood group O and the increased susceptibility of individuals with blood group A to COVID-19 could be linked to the presence of natural anti-blood group antibodies, particularly anti-A antibody, in the blood. However, there might be other mechanisms that require further study.

A cross-sectional analysis of the predictors of COVID-19 vaccine uptake and vaccine hesitancy in Iraq.

BACKGROUND: Vaccine hesitancy poses a significant risk to global recovery from COVID-19. To date however, there is little research exploring the psychological factors associated with vaccine acceptability and hesitancy in Iraq. AIM: To explore attitudes towards COVID-19 vaccination in Iraq. To establish the predictors of vaccine uptake and vaccine hesitancy in an Iraqi population. METHODS: Using a cross-sectional design, 7,778 participants completed an online questionnaire exploring their vaccination status, likelihood of infection, perceived severity infection, benefits of vaccine, barriers to vaccine, anticipated regret, subjective norms, and trust in government. FINDINGS: Vaccination rates increased with age and were greater in males, those who were married, divorced or widowed, those with children and those with underlying conditions. Vaccine hesitancy was widespread with 61.40% of unvaccinated individuals reported an unwillingness to receive a COVID-19 vaccine. In unvaccinated groups, vaccine hesitancy was associated with lower trust in the government, more negative social norms, greater perceived barriers to vaccination and reduced perceived benefits. CONCLUSIONS: There is significant COVID-19 vaccine hesitancy in Iraq. Public health institutions should be aware of the influence of demographic factors, as well as personal beliefs and social norms, on individuals' decisions to vaccinate. Public health messaging should therefore aim to be tailored to address the concerns of citizens.

Analysis of Proinflammatory Cytokines in COVID-19 Patients in Baghdad, Iraq.

Due to the pandemic of COVID -19 disease and the fact that the effective variables in the severity and control of the disease have not been established, numerous factors have been investigated, including the study of inflammatory factors. A cross-sectional study was carried out to investigate the proinflammatory cytokines in patients with COVID -19, conducted in Baghdad, Iraq. The age of the patients was above > (15) years old, with confirmed infection documented by polymerase chain reaction (PCR). The subjects were 132 patients, 69 (52.3%) males, and 63 (47.7%) females. Patients were divided into three pathological groups: mild patients (45), moderate patients (34), and severe patients (53), each group was divided into four weeks according to symptoms onset date. The most common clinical symptoms were cough, fever, and headache, while sore throat, gastrointestinal symptoms, chest pain, and loss of taste and smell were less common in COVID -19 patients. Sandwich-Enzyme-Linked Immunosorbent Assay kits were used to evaluate levels of proinflammatory cytokines, including IL-1ß, IL-6, IL-8, and TNF-α. The results IL-6 and TNF-α were significantly elevated in mild during the four weeks with (P=0.0071) and (0.0266) respectively, levels of IL-1ß were increased with highly significant differences (P=0.0001) while levels of IL-8 were decreased with highly significant differences (P=0.0001) during the four weeks. In moderate patients, levels of (IL-1ß, IL-6, and IL-8) increased without significance (P=0.661, 0.074, 0.0651), respectively; in contrast, the levels of TNF-α increased with significant (P=0.0452) across four weeks. Severe COVID-19 patients showed significantly increased differences in levels of (IL-6, IL-8, and TNFα) (P=0.0438, 0.0348, 0.0447), respectively, while no significant differences in the level of IL-1ß (P=0.0774). This study showed that investigating inflammatory factors in the COVID-19 pandemic is crucial in controlling and treating.

SARS-CoV-2 Omicron Variant Genomic and Phylogenetic Analysis in Iraqi Kurdistan Region.

Omicron variants have been classified as Variants of Concern (VOC) by the World Health Organization (WHO) ever since they first emerged as a result of a significant mutation in this variant, which showed to have an impact on transmissibility and virulence of the virus, as evidenced by the ongoing modifications in the SARS-CoV-2 virus. As a global pandemic, the Omicron variant also spread among the Kurdish population. This study aimed to analyze different strains from different cities of the Kurdistan region of Iraq to show the risk of infection and the impact of the various mutations on immune responses and vaccination. A total of 175 nasopharyngeal/oropharyngeal specimens were collected at West Erbil Emergency Hospital and confirmed for SARS-CoV-2 infection by RT-PCR. The genomes of the samples were sequenced using the Illumina COVID-Seq Method. The genome analysis was established based on previously published data in the GISAID database and compared to previously detected mutations in the Omicron variants, and that they belong to the BA.1 lineage and include most variations determined in other studies related to transmissibility, high infectivity and immune escape. Most of the mutations were found in the RBD (receptor binding domain), the region related to the escape from humoral immunity. Remarkably, these point mutations (G339D, S371L, S373P, S375F, T547K, D614G, H655Y, N679K and N969K) were also determined in this study, which were unique, and their impact should be addressed more. Overall, the Omicron variants were more contagious than other variants. However, the mortality rate was low, and most infectious cases were asymptomatic. The next step should address the potential of Omicron variants to develop the next-generation COVID-19 vaccine.

EVALUATION OF HUMAN ABO BLOOD GROUPS AND BLOOD COMPONENTS AMONG IRAQI PATIENTS INFECTED WITH CORONAVIRUS DISEASE 2019 (COVID-19).

OBJECTIVE: The aim: To evaluate the differences in blood groups, gender and type of Rh factor, as well as the levels of hemoglobin, white blood cells and platelets among patients infected with COVID-19. PATIENTS AND METHODS: Materials and methods: A cross-sectional study was performed on 202 patients diagnosed with sever COVID-19 infection who were admitted to the Al-Shefaa center in Al- Hakeem hospital in Al-Najef city.Haematological investigations involved the types of blood groups, Rh factors, haemoglobin (Hb), white blood cells (WBCs), and platelets. In addition, the demographic features including age, gender and presence of any prescribed medications before or at the time of the study were also included. RESULTS: Results: This study indicated that COVID-19 infected patients with type A blood group are at higher risk of hospitalization than other blood groups, and the majority of these patients were Rh positive. Additionally, WBCs counts indicated that the majority of patients had increased risk of getting infections which demonstrated lower WBC counts than normal. Platelet and Hb levels were normal for the majority of patients. CONCLUSION: Conclusions: The findings of this study may help in the diagnosis of the pandemic infection with COVID-19, and prediction of the incidence of some complications caused by COVID-19. Further researches are warranted to confirm our findings.

The Association of Angiotensin-Converting Enzyme 2 Polymorphism and SARS-CoV-2 Infection in the Iraqi Population.

The quick and advancing prevalence of the new coronavirus SARS-CoV-2 produced a global crisis surge with a profound impact on human health and worldwide economic constancy. The virus is known as one strain of coronavirus, which causes the respiratory infection responsible for the current pandemic of COVID-19. The virus spike protein has a high binding affinity to human ACE2, depending on crystallization analysis and biochemical interaction studies. Studies consistently reveal that rs2285666, a polymorphism found in ACE2, diverse significantly between Europeans and Asians, changing ACE2 expression. The alternating allele TT of rs2285666 SNP increased gene expression to 50%; thus, it may have a role in SARS-COV-2 infection vulnerability. This study aimed to investigate rs2285666 SNP association with SARS-CoV2 infection as a first report in the Iraqi population. Fifty (20 Male/30 Female) Covid-19 patients with severe symptoms with mean age (of 41.5±10.7) and 50 (20 Male/30 Female) healthy people as a control group with mean age (of 41.5±10.7) were included in this study. Sample of a patient tested as a mutant genotype (TT) by RFLP assay. The results reveal a MAF value of 0.3 for this gene in Iraqi samples, more than Europeans (0.2) and less than East Asians (0.55). The codominant model had significant OR of both alleles CT and TT (OR=4.26 & 6.7; P-value=0.012 & 0.023 respectively). In conclusion, there is an association between increased severity of SARS-Cov-2 infection and rs2285666 polymorphism of the codominant genotype model of the Iraqi population. However, several other factors may affect disease severity, such as ethnic group differences, sex, comorbidity, virus strain, and others.

Assessment of COVID-19 vaccination among healthcare workers in Iraq; adverse effects and hesitancy.

Several messenger ribonucleic acid (mRNA) and inactivated COVID-19 vaccines are available to the global population as of 2022. The acceptance of the COVID-19 vaccine will play a key role in combating the worldwide pandemic. Public confidence in this vaccine is largely based on its safety and effectiveness. This study was designed to provide independent evidence of the adverse effects associated with COVID-19 vaccines among healthcare workers in Iraq and to identify the attitudes of healthcare workers who rejected the vaccination. We conducted a cross-sectional study to collect data on the adverse effects of the Pfizer, AstraZeneca, and Sinopharm vaccines. Data were collected between October 2021 and February 2022. A total of 2,202 participants were enrolled in the study: (89.97%) received injections of the COVID-19 vaccines and (10.03%) were hesitant to receive the vaccination. Participants received either the Pfizer vaccine (62.9%), AstraZeneca vaccine (23.5%) or Sinopharm vaccine (13.6%). Most adverse effects were significantly less prevalent in the second dose than in the first dose. Notably, the adverse effects associated with the Pfizer vaccine were significantly more prevalent in females than in males. Following the first dose, the participants experienced more adverse effects with the AstraZeneca vaccine. Following the second dose, more adverse effects were associated with the Pfizer vaccine. Interestingly, the prevalence of COVID-19 infection in participants who received two doses of the Pfizer vaccine was significantly reduced compared to those who received two doses of either the AstraZeneca or Sinopharm vaccines. According to vaccine-hesitated participants, insufficient knowledge (29.9%), expeditious development (27.6%) and lack of trust in the vaccines (27.1%) were the three major reasons for refusing the vaccines. The results of our study indicated that these adverse effects do not present a significant problem and should not prevent successful control of the COVID-19 pandemic.

Molecular and Physiological Study in Patients with Coronavirus in Thi-Qar Province Iraq.

The current study aimed to study the effect of Covid-19 disease on some physiological parameters for assessing the physiological effect of Covid-19. The current study included 100 patients, 50 males, and 50 females, whose ages ranged from 10 - 73 years infected with Covid-19 molecularly diagnosed at AL-Imam Hussein Teaching Hospital in Thi-Qar Province from April to August 2021 and 50 people as a control group. The results illustrated a significant decrease in the level of hemoglobin, lymphocyte, and platelet in the patient's group, whereas a significant increase in the count of total white blood cells (WBC) was recorded in patients compared with the control group. The results showed that the hemoglobin level, WBC, and platelet increased significantly in males compared to females, while the lymphocytes increased significantly in female patients. The results of age groups showed non-significant differences in the hematological parameters. The current results illustrated a significant increase in the level of blood urea, serum creatinine, and random blood sugar in the patient's group. According to the gender of patients, the blood urea increased significantly in the female group, while the blood sugar increased significantly in the male group. On the other hand, the serum creatinine had no significant difference. According to age groups, a significant increase in blood urea was recorded in patients over 70 years, but no differences in both creatinine and random blood sugar level were noted. The current study recorded that the concentration of CRP, ferritin, and D. Dimer was significantly higher in patients; according to gender, the level of CRP and ferritin increased non-significantly compared with a male group of patients, while D. Dimer increased significantly in the female group. According to age group, only CRP increased significantly in the first age group compared with other age groups. The sequencing analysis was performed for 10 isolated Covid-19, and the result indicates that only one isolated sample has a sequencing identity of 99,5% with Covid-19 in Iran.

Association between ABO blood groups and the risk of infection with SARS-CoV-2 in Iraq.

OBJECTIVE: The primary goals of this research were to analyze the relationship between ABO blood types and the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and investigate the effect of vaccination in Iraq. METHODS: Data and outcomes were gathered from the medical records of 200 patients. Patients were categorized by blood group and vaccination status in the analysis. RESULTS: In total, 200 hospitalized patients (125 men and 75 women) with confirmed SARS-CoV-2 infection and blood group (ABO) and clinical data were enrolled. Of the 200 patients, 155 (77.5%) were vaccinated against SARS-CoV-2. The results illustrated that 25 patients died, which might have been attributable to a lack of vaccination or older age. Our analysis revealed that blood group O individuals were much less likely to be infected by SARS-CoV-2 than non-O subjects, whereas blood group A individuals carried a higher risk of infection. CONCLUSIONS: Our findings illustrated that immunization significantly reduces COVID-19 risk across all age groups, but there has been an increase in the number of cases because of decreased vaccine efficacy in older patients and persons with comorbidities. However, 45% vaccination coverage lowered the outbreak's peak.

COVID-19 Death Rates in Iran and Iraq: Possible Relations Between Iraq's Pre-COVID-19 Mass Gatherings and Its Low Death Rate.

In recent years, COVD-19 has made millions of death worldwide. When reviewing the death rate, we encountered a very notable difference in death rate of Iran and Iraq, which are two neighboring countries. Investigating the COVID-19 risk factors, parameters, such as ethnicity and vaccination, do not appear not to be affecting our observation. We also could not find important differences in mortality rate being under-reported in the two countries. In this letter, we tried to discuss the possible effect of Iraq pre-COVID-19 mass gatherings on the death rate. The authors would like to highlight the effect of immune system on COVID-19.

COVID-19 infection among dentists in Iraqi Kurdistan Region.

INTRODUCTION: COVID-19 incidence was relatively high among dentists in Iraq, reflecting the high number of cases in the community. Therefore, possible epidemiological features of COVID-19 infection were investigated among dentists in Iraqi Kurdistan Region. METHODOLOGY: A cross-sectional study has been conducted among dentists using a structured questionnaire. The questionnaire included demographic and working characteristics, self-reported COVID-19 history, and prevention practices toward SARS-CoV-2 during the pandemic. An online questionnaire was developed and spread with a snowball method among dentists. RESULTS: We analyzed the responses of 83 participants (31 women and 52 men, mean age 33.8 ± 6.8 years). They had a mean of 10.6 ± 6.5 years of work experience and 20.2 ± 12.6 hours of weekly working time. In total, 46 (55.4%) of the participants reported COVID-19 infection. Only 29 (34.9%) participants always followed the hygiene rules. The most common personal precautions were mask-wearing (98.8%) and hand hygiene as a part of institutional protective precaution (51.8%). Of the infected dentists, 24 (52.2%) did not know the source of infection. Of the remaining 16 (34.8%) were infected from family and/or friends circle, and five (10.9%) from patients. Eleven of them (23.9%) reported transmitting the infection to at least one person. In the multivariate analyses, working in Sulaymaniyah Province (p = 0.031) and working only in a public hospital (p = 0.029) were significant risk factors for COVID-19 infection. CONCLUSIONS: The high risk of COVID-19 infection among dentists in the Iraqi Kurdistan Region relates to their family and friends rather than their occupation.

Sequencing and mutations analysis of the first recorded SARS-CoV-2 Omicron variant during the fourth wave of pandemic in Iraq.

Despite vaccine development and vaccination programs underway around the globe, the coronavirus disease 2019 (COVID-19) pandemic has not been controlled as the SARS-CoV-2 virus is evolving and new variants are emerging. This study was conducted to sequence and molecularly characterize the representing samples from the early fourth SARS-CoV-2 wave in Iraq. Here, we have performed next-generation sequencing of whole-genome sequencing of two representing samples from the country's early beginning of the fourth pandemic wave. The samples were sequenced using Illumina Miseq system, and the reference sequences were retrieved from GISAID database. Phylogenetic analysis was performed through Mega software. This study provides an initial sequence analysis and molecular characterization of the first Omicron variant cases recorded in the country. Our analysis revealed many mutations on the spike glycoprotein, especially on the receptor binding domain, with potential impact on immune escape and infectivity. The study findings suggest considering the highly mutated immunogenic epitope of the Omicron variant as a reference for developing a new vaccine for combating the ongoing pandemic.

Strict social distancing measures helped early control of SARS-CoV-2 spread in Duhok city, Iraq.

The aim of this letter is to discuss the pandemic management measures, including social distancing and community containment, taken in Duhok city in Northern Iraq, where a few patients were infected with COVID-19. During the first three months of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, 15 patients were diagnosed with SARS-CoV-2 in Duhok city. All the patients were asymptomatic and were discharged to their home within 10 ± 3.2 days after throat swabs indicated a negative SARS-CoV-2 Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. The social distancing and lockdown measures taken by the city were implemented in three stages. In the first stage, all educational institutions including schools, colleges and universities were closed. In the second stage, all gatherings were banned. Finally, state-imposed community-wide containment was declared. The social distancing measures helped control infections in the city. Gradual reopening is recommended to avoid the spread of infection.

Cross-sectional study of Middle East respiratory syndrome coronavirus in humans and dromedary camels in Diyala, Iraq.

BACKGROUND: Middle East respiratory syndrome (MERS) is a zoonotic viral disease transmitted from dromedaries to humans. To date, more than 1500 cases of MERS have been reported and 80% of all cases have occurred in the Kingdom of Saudi Arabia (KSA). This cross-sectional study was carried out to figure out the rate of infection among humans and dromedary camels and to explore the risk factors. METHODS: This study was conducted in Diyala Province, Iraq for the period from August 2017 to October 2018. Human subjects included 90 participants; 34 (37.8%) were females and 56 (62.2%) were males. Additionally, 90 dromedary camels were also included, 50 (55.6%) males and 40 (44.4%) females. Serum samples from subjects were collected and tested for the presence of anti-MERS-coronavirus (CoV) immunoglobulin g (IgG). RESULTS: The results revealed that 46 (51.1%) of human subjects were positive for anti-MERS-CoV IgG, (95% confidence interval (CI) for the prevalence rate 40.9-61.3) with a mean titer of anti-MERS-CoV IgG antibodies (Ab) of 81.2 U/mL. The anti-MERS-CoV IgG positivity rate was insignificantly higher, but the mean of anti-MERS-CoV IgG titer was significantly higher among females (p = 0.12 and p < 0.004, respectively). Furthermore, the anti-MERS-CoV IgG positivity rate and Ab titer were significantly higher among those people who visited KSA for Hajj or Umrah (p < 0.001 and p < 0.001, respectively). In camels, 81 (90.0%) were positive for anti-MERS-CoV IgG, (95% CI for the prevalence rate 82.5-94.9), with a mean titer of 99.8 U/mL. DISCUSSION: The MERS-CoV infection rate was high among both Iraqi humans and dromedary camels. Further confirmatory studies are needed, and setting up of national precaution program is essential.