Date: 30 May 2018
Source: Tehran Times [edited]
<http://www.tehrantimes.com/news/424102/Crimean-Congo-fever-death-toll-increases-to-10>

Crimean-Congo haemorrhagic fever (CCHF) has caused 10 deaths in Iran since the beginning of the current Iranian calendar year (21 Mar 2018), Fars reported on Wed 30 May 2018.

CCHF is a widespread disease caused by a tick-borne virus. The disease outbreak normally occurs in spring, and it becomes more severe with the beginning of the livestock breeding season.

In spite of receiving the best medical care, in general, 10 percent of the patients affected by the virus face death, Mohammad Nabavi, deputy director for the communicable diseases department of the Ministry of Health said.

Every year, a number of people die of the fever, Nabavi said, adding that some 10 percent of the people who are diagnosed with Crimean-Congo fever and receive proper medical care may die, while this number increases to 50 percent for the people who do not get any treatment.

Annually, some 100 to 150 cases of Crimean-Congo fever are reported in Iran.
===================
[The report above mentions 10 deaths due to CCHF, which is in contradiction to the earlier posted report on ProMED on 24 May 2018; Crimean-Congo hem. fever - Iran (02) http://promedmail.org/post/20180524.5813248. According to that report, 10 confirmed CCHF cases with one death have been reported so far in 2018. A clarification in this regard from the concerned persons will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Iran: <http://healthmap.org/promed/p/128>]
Date: Tue 22 May 2018
Source: Tehran Times [edited]
<http://www.tehrantimes.com/news/423832/10-cases-of-Crimean-Congo-haemorrhagic-fever-reported-in-Iran>

Since the beginning of the current Iranian calendar year [21 Mar 2018], 10 cases of Crimean-Congo haemorrhagic fever [CCHF] have been reported, director of the Health Ministry's communicable diseases control department has said. "Out of the 10 reported cases unfortunately one has passed away," ISNA news agency quoted Mohammad Mehdi Gouya as saying on [Tue 22 May 2018]. The disease outbreak normally occurs in spring and it becomes more severe with the beginning of the livestock breeding season, Gouya said, adding that every year some 100 to 150 cases of Crimean-Congo haemorrhagic fever are reported in Iran. The family members and healthcare providers are trained to avoid catching the virus, he concluded.

According to World Health Organization (WHO), CCHF is a widespread disease caused by a tick-borne virus. CCHF is endemic in Africa, the Balkans, the Middle East, and Asia, in countries south of the 50th parallel north. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent. There is no vaccine available for either people or animals. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep, and goats. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers, and veterinarians. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles, and contamination of medical supplies.

Onset of symptoms is sudden, with fever, myalgia (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes, and photophobia (sensitivity to light). There may also be nausea, vomiting, diarrhea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion. After 2 to 4 days, the agitation may be replaced by sleepiness, depression, and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). General supportive care with treatment of symptoms is the main approach to managing CCHF in people. Additionally, the antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit. Death normally occur in the second week of illness. In patients who recover, improvement generally begins on the 9th or 10th day after the onset of illness.

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they should take to reduce exposure to the virus, including wearing protective clothing (long sleeves, long trousers); use of approved repellent on the skin and clothing; avoiding areas where ticks are abundant and seasons when they are most active; wearing gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home; avoiding close physical contact with CCHF-infected people, and wearing gloves and protective equipment when taking care of ill people.
=======================
[The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep, and goats. There is no apparent disease in these animals. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites.

Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

It is difficult to prevent or control CCHF infection in animals and ticks as the tick-animal-tick cycle usually goes unnoticed and the infection in domestic animals is usually not apparent. Furthermore, the tick vectors are numerous and widespread, so tick control with acaricides (chemicals intended to kill ticks) is only a realistic option for well-managed livestock production facilities (<http://www.who.int/news-room/fact-sheets/detail/crimean-congo-haemorrhagic-fever>).

Ticks are among the factors of many diseases including CCHF, Lyme disease, tick paralysis, brucellosis, plague, salmonellosis, listeriosis, and babesiosis. Activity periods of ticks are seasonal because they need a certain temperature and moisture. Vector ticks movements increase during hot seasons. Ticks, which are the sources of infection, live in the wildlife intertwined with oak forests, close to the mountain slopes or in forests, agricultural land, while others live close to places inhabited by humans and animals. Climate does not affect only the life of ticks, it also affects the multiplicity of host ecology, tick-borne diseases in some regions indirectly, and the causes of the emergence and disappearance in other areas as well (<http://www.academicjournals.org/article/article1380710363_Yigit.pdf>)

As mentioned in the report above, sporadic cases of CCHF are reported from Iran every year since the disease and its vector are essentially endemic.

"In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

Public health advice should focus on several aspects:

I. Reducing the risk of tick-to-human transmission:
- wear protective clothing (long sleeves, long trousers);
- wear light coloured clothing to allow easy detection of ticks on the clothes;
- use approved acaricides (chemicals intended to kill ticks) on clothing;
- use approved repellent on the skin and clothing;
- regularly examine clothing and skin for ticks; if found, remove them safely;
- seek to eliminate or control tick infestations on animals or in stables and barns; and
- avoid areas where ticks are abundant and seasons when they are most active.

II. Reducing the risk of animal-to-human transmission:
- wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home;
- quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter. III. Reducing the risk of human-to-human transmission in the community:
- avoid close physical contact with CCHF-infected people;
- wear gloves and protective equipment when taking care of ill people;
- wash hands regularly after caring for or visiting ill people."
(<http://www.who.int/news-room/fact-sheets/detail/crimean-congo-haemorrhagic-fever>) - ProMED Mod.UBA]

[HealthMap/ProMED-mail map
Iran: <http://healthmap.org/promed/p/128>]
Date: Sun 20 May 2018 00:52 MSK
Source: RT News [edited]
<https://www.rt.com/news/427220-iran-mushroom-poisoning-victims/>

More than 700 people have been poisoned after eating wild mushrooms in Iran, the country's emergency services said. At least 9 people have died, while dozens more remain in critical condition, [according to a] local media report.

"The latest emergency statistics show 721 people have been poisoned by poisonous mushrooms, of which 190 were hospitalized, 523 were cleared, and 9 died," Mojtaba Khalidi, an emergency services spokesman, told Iran's ISNA news agency.

At least 50 of the victims who were hospitalized across Iran's 8 provinces are in critical condition, with some requiring liver transplants to save their lives, the emergency services said.

The country's Ministry of Health attributed the incident to spring rain across the mountainous regions of the country, and issued a warning advising people to "avoid eating wild and unfamiliar mushrooms," and refrain from even touching them because "skin toxicity is present in some species of fungi."

Authorities advised the public not to buy mushrooms from street vendors. Those who experience abdominal pain, nausea, vomiting, or severe dizziness are advised to drink a lot of fluids and visit a health center immediately.
=======================
[There are multiple species of toxic mushrooms in the world. The photograph in the news article closely resembles a mushroom of the _Amanita_ spp. However, it should be noted that there is no way to know if the mushrooms in this photo are the mushrooms causing the problem.

"The fatality rate for amanitin poisoning is about 50 percent without prompt, knowledgeable medical treatment, but is about 10 percent in the US and Canada where good medical care is readily available. [Clearly other countries can offer similar care, yet there remain some which may not have the necessary capabilities to treat this toxin or offer organ transplants. - ProMED Mod.TG].

Amatoxins are doubly dangerous due to the fact that the symptoms are delayed for 6 to 24 hours after ingestion, by which time the toxins have been completely absorbed by the body and after the initial state of gastric distress, the patient may appear to recover about day 2 or day 3 and be sent home. Monitoring of liver enzyme function is critical in cases of delayed onset GI distress!

"Amanitins are a group of complex cyclic polypeptides which damage tissues by inhibiting RNA synthesis within each individual cell. Onset of symptoms manifests itself in 4 stages:

- 1st stage is a latency period of 6 to 24 hours after ingestion, in which the toxins are actively destroying the victim's kidneys and liver, but the victim experiences no discomfort;

- 2nd stage is a period of about 24 hours characterized by violent vomiting, bloody diarrhea, and severe abdominal cramps;

- 3rd stage is a period of 24 hours during which the victim appears to recover (if hospitalized, the patient is sometimes released!); - 4th stage is a relapse, during which kidney and liver failure often occurs, leading to death. Patients may also "bleed out" and die due to the destruction of clotting factors in the blood. There may be more than one relapse. [Those surviving would need liver and/or kidney transplants. - ProMED Mod.TG]

"If you have any reason to suspect that someone has ingested an amanitin-containing mushroom, DON'T WAIT for symptoms to appear! There is no antidote for amanitin poisoning, and the best hope is to rush the person to the hospital where the toxins can be removed before being fully absorbed into the body.

"Seeking prompt medical treatment when amatoxin poisoning is suspected is critical. Since the symptoms (NOTE: in the most serious cases, severe diarrhea can begin in as little as 6 hours post ingestion) typically do not appear until 12 or more hours after ingestion of an amatoxin containing species, activated charcoal to remove the toxins from the GI tract is ineffective. In all but the most severe cases, aggressive IV fluid treatment can slowly flush the toxins from the system in the excreted urine.

Liver enzymes levels and blood clotting factors must be closely monitored. In severe cases (as measured by liver enzyme levels and blood clotting factors) experimental use of IV silibinin and other measures may help enough that a liver transplant can be avoided. Use of penicillin is no longer considered effective. For a full review of treatment strategies see "Amatoxin Poisoning in North America 2015-2016" at  <http://namyco.org/docs/Amatoxin_Poisoning_2015-16.pdf>"

This mushroom is known to cause liver failure, and as such some of the victims would likely need a liver transplant. This same mushroom can also make people seriously ill.

This is a large number of people needing a liver transplant. Hopefully people will heed the warnings about not eating roadside mushrooms, as they may be toxic and potentially deadly.

Portions of this comment were reproduced from
<https://www.namyco.org/mushroom_poisoning_syndromes.php>. - ProMED Mod.TG]

[HealthMap/ProMED-mail map
Iran: <http://healthmap.org/promed/p/128>]
Date: Wed 2 May 2018 14:10 (UTC+04:00)
Source: Trend News Agency [edited]
<https://en.trend.az/iran/society/2897052.html>

Crimean-Congo haemorrhagic fever [CCHF] has caused the death of one man in Iran in recent days, Bashir Khaleghi, an Iranian MP, said.

Kaleghi, who is a member of the Parliament's Health Commission, said that at least 4 people have so far caught the disease in the recent days, ILNA [Iranian Labour News Agency] news agency reported.

The cases have been reported in Iran's south eastern province of Kerman (3 cases) and southern province of Fars (one case), he added.

Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral disease that is endemic in Africa, the Balkans, the Middle East, and Asia. The virus is a member of the Bunyaviridae family of RNA viruses.

It is a zoonotic disease carried by several domestic and wild animals. While clinical disease is rare in infected animals, it is severe in infected humans, with a mortality rate of 10-40 percent.

Since 2000, at least 1000 cases of Crimean-Congo fever have been reported in Iran, according to the Iranian officials.

In last fiscal year, ended March 2018, some 120 people caught the virus, 8 of them died.
======================
[Crimean-Congo haemorrhagic fever (CCHF) is a zoonotic viral disease that is asymptomatic in infected livestock, but a serious threat to humans. Human infections begin with nonspecific febrile symptoms, but progress to a serious haemorrhagic syndrome with a case fatality rate of 2-50 percent. Although the causative virus is often transmitted by ticks, livestock-to-human and human-to-human transmissions also occur.

The disease is one of the most widely distributed viral haemorrhagic fevers occurring in Africa, the Middle East, Asia, and some parts of Europe.

In a study by Chinikar et al published in 2010 (J Clin Virol. 2010; 47(2):110-4. doi: 10.1016/j.jcv.2009.10.014), among 1297 probable CCHF human sera collected from different provinces of Iran from the years 2000 to 2008, 534 were confirmed as CCHF positive, covering 23 out of 30 provinces in Iran.

It is clear that control of tick populations in endemic regions can play an important role in prevention and incidence of CCHF disease. Climate changes such as drought and warming of the broad geography of Iran and adjacent countries resulted in increased tick populations and consequently in the numbers of CCHF cases during the last decade. Human and veterinary surveillance of CCHF is an important aspect for planning detection and response to outbreaks associated with arboviruses and viral haemorrhagic fevers. - ProMed Mod.UBA]

[Maps of Iran:
<http://www.mapsofworld.com/iran/maps/iran-political-map.jpg> and
<http://healthmap.org/promed/p/128>]
Date: Thu, 19 Apr 2018 11:02:48 +0200

Tehran, April 19, 2018 (AFP) - A moderately strong 5.9-magnitude earthquake Thursday hit Iran's southern region of Bushehr, home to the country's only nuclear power plant, without causing casualties or damage, media reported.   "The earthquake had no effect on the activity of the plant," Mahmoud Jafari, project manager at the Russian-built Bushehr nuclear plant, said according to the Telegram news channel of Iran's state television.

The University of Tehran's seismology centre said the epicentre of the earthquake that hit at 0634 GMT was in the sparsely populated Kaki region, around 80 kilometres (50 miles) from the Bushehr plant.   The head of emergency services said no one was killed or wounded in the quake, media reported.   Bushehr has a 1,000 megawatt reactor built by Russia that became operational in 2011 and reached full capacity the following year.   Iran sits atop several fault lines and has been hit by a series of earthquakes since November 2017, when a 7.3-magnitude tremor killed 620 people in the western province of Kermanshah and eight in Iraq.
More ...