. Among all other viruses, human cytomegalovirus (HCMV) is the most frequent cause of congenital infection worldwide. Strain variation in HCMV may predict severity or outcome of congenital HCMV disease. Previous studies have associated a particular genotype with specific sequelae or more severe illness, but the results were contradictory. There are no previous studies addressing the genotype of HCMV in Iraq. Therefore, the present study is aimed at molecular detection and genotyping of HCMV isolated from symptomatic congenitally/perinatally infected neonates. This prospective study comprised 24 serum samples from symptomatic neonates with congenital/perinatal infection. Viral DNA was extracted from these serum samples; nested polymerase chain reaction was used to amplify the HCMV gB ( UL55 ) gene. Polymerase chain reaction products of the second round of amplification were subjected to direct Sanger sequencing. Bioedit and MEGA5 software (EMBL-EBI, Hinxton, Cambridgeshire, UK) were used for alignment and construction of a phylogenetic tree. Human cytomegalovirus DNA was detected in 23 of 24 samples (95.8%). According to the phylogenetic analysis, three genotypes of the virus were identified; gB1, gB2, and gB3 genotypes. However, the gB4 genotype was not detected. Human cytomegalovirus gB3 was the most frequent genotype: 14 of 24 (58.33%) among symptomatic infected infants, followed by gB1 (6/24; 25%) and gB2 (4/24; 16.67%). A mixed HCMV infection with gB3/gB1 was detected in only one case. Human cytomegalovirus gB3 was the most predominant genotype among symptomatic congenitally/perinatally HCMV-infected neonates. No association was found between B3 genotype and specific clinical presentation. Jaundice was the most common clinical feature among symptomatically infected neonates, followed by hepatosplenomegaly.

Early detection and prompt response are crucial measures to prevent and control outbreaks. Public health agencies, therefore, designed the Communicable Disease Surveillance System (CDSS) to obtain essential data instantaneously to be used for appropriate action. However, a periodic evaluation of CDSS is indispensable to ensure the functionality of the system. For this reason, this study aims to assess the performance of the core and support functions of the CDSS in the Kurdistan Region of Iraq. A descriptive cross-sectional study was used. From a total of 291 health facilities HFs (Primary health care centers and Hospitals) in the Kurdistan region of Iraq that have surveillance activities, 74 HFs were selected using a random stratified sampling approach. The World Health Organization (WHO) generic questionnaire has been used to interview the surveillance staff, together with direct collection of the data. Our analysis shows a lack of surveillance guiding manual in the HFs. Even at the district level, where a surveillance manual existed, case definitions, thresholds, and control measures were still missing. To note, more than 93% of HFs had organized and comprehensive patients registers for the collection of their clinical and secondary data. Also, all HFs had functioning laboratories. The majority of them (almost 93%) were equipped to collect, process, and store blood, stool, and urine specimens. About 72% of these laboratories were also able to transport timely the specimens to more specialized laboratories. At all levels, data reporting to the higher level exceeded the recommended minimum rate of 80%. The reporting system at the district level was based on emails, while in the periphery on hand-delivered in paperbased formats (50%), telephone (22%), and social media (22%). Furthermore, our analysis highlights the lack of data analysis: only 3.8% of Primary Health Care Centers conduct simple data analysis regularly, while hospitals do not do any sort of analysis. Also, only a few HFs investigated an outbreak, though using system routine sources to capture these public health events. Our findings show a lack in epidemicThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Background: Human Metapneumovirus (hMPV) is an important respiratory viral pathogen among children, and it is one of the causes of pediatric hospital admissions due to acute respiratory tract infections. Objective: This study was done to predict the seroprevalence of anti-hMPV antibodies among hospitalized children presenting with acute respiratory tract infections in Suleimani Governorate, Kurdistan Region/Iraq. Place and Duration: This study was done at the department of microbiology, school of medicine, suleimani University, between April 2011 and March 2012. Methods: Indirect immunofluorescent assay (IIFA) was performed to detect serum anti-hMPV antibodies (IgM and IgG antibodies) from three hundred hospitalized children less than 5 years old with acute respiratory tract infections. Results: IgM anti-hMPV antibodies were positive in thirty six (12%) out of three hundred children. The highest seroprevalence was found in the age group <1 year old, while the

Background Coronavirus disease 2019 (COVID-19) has revealed a series of unprecedented challenges to Communicable Disease Surveillance Systems (CDSS) globally. This study aimed to determine the opportunities of and barriers to CDSS during the COVID-19 pandemic, and the extent to which the disease integrated into the CDSS in the Kurdistan region of Iraq. Methods A descriptive qualitative approach was applied. We conducted 7 semi-structured interviews and one focus group discussions (FGD) with purposefully identified Key Informants (KI) from June to December 2020. All interviews were digitally recorded and transcribed verbatim. We adopted a mixed deductive-inductive approach for thematic analysis of data, facilitated by using MAXQDA20 software for data management. Results Although the CDSS was considered appropriate and flexible, the COVID-19 was interpreted not to be integrated into the system due to political concerns. The lack of epidemic preparedness, timeliness, and partial cessation of training and supervision during the pandemic were the main concerns regarding core and support activities. The existence of reasonable surveillance infrastructure, i.e. trained staff was identified as an opportunity for improvement. The main challenges include: staff deficiency, absence of motivation and financial support for present staff, scarce logistics, managerial and administrative issues, and lack of cooperation, particularly among stakeholders and surveillance staff. Conclusion Our findings revealed that due to political barriers, COVID-19 was not integrated into the CDSS. It also highlighted the main facilitators of and barriers to CDSS in the region. We advocate health authorities and policy-makers to prioritize the surveillance and effective management of communicable diseases.

Background  Human respiratory syncytial virus (HRSV) and human metapneumovirus (HMPV) are responsible for a high percentage of pediatric medical admissions and considered major causes of morbidity and mortality among children in developing countries. Objective To investigate histopathological findings in lungs of BALB/c mice exposed to intranasal inoculation with human respiratory syncytial virus and human metapneumovirus. Materials and Methods Thirty six BALB/c mice were divided into 4 groups (9 mice/group) as follows, Group 1 mice inoculated by viral transport medium (VTM) treated with nasopharyngeal swabs (NPS) obtained from children positive for HRSV; group 2 mice inoculated by VTM treated with NPS obtained from children positive for the HMPV; group 3 mice inoculated by sterile VTM and group 4 mice were free of inoculation. The mice were sacrificed using inhalation anesthesia and their lungs were excised and undergone histopathological processes to prepare tissue sections for microscopic examination. Results Frequency rates of NPS positive for HMPV and HRSV were relatively high but they coincide with the reported incidences of HMPV and HRSV infections among children worldwide. An intense inflammatory response was observed in HRSV-inoculated mice represented mainly by infiltration of mononuclear inflammatory cells in the perivascular and peribronchiolar areas associated with alveolar distortion and bronchiolar epithelial sloughing and also associated with syncytium formation within the epithelial tissue in two mice. On the other hand, HMPV-inoculated mice showed a less intense mononuclear inflammatory response in the perivascular and peribronchiolar areas associated with bronchiolar epithelial sloughing, slight deposition of edematous fluid within the interalveolar septa and distortion of alveolar tissue. Conclusion The direct fluorescent assay (DFA) showed high frequency rates of HRSV and HMPV infection among children admitted to the Pediatric Teaching Hospital in Al Sulaimaniyah city and the histopathological examination of the lungs of mice exposed to intranasal inoculation with HRSV revealed an intense mononuclear inflammatory response, alveolar tissue distortion, bronchiolar epithelial sloughing and syncytium formation compared to less intense mononuclear inflammatory response in lungs of HMPV-inoculated mice.