Pattern of Viral Infections among Kurdish Chemical Attack Survivors: An Observational Study

Abstract

Background: Survivors of chemical attacks can experience permanent immune-related changes that can affect their vulnerability to viral infections. The paper compared seroprevalence rates of hepatotropic viruses and herpesviruses in Kurdish survivors of chemical attacks and those who were not exposed to the chemical. Methods: This observational study will involve 321 participants (a sample size of 221 survivors and 100 controls), who will be recruited in Iraqi Kurdistan, between November 2023 and May 2024. Enzyme-linked immunosorbent assay was used to test serum samples using Hepatitis B virus (HBV), Hepatitis C virus (HCV), Hepatitis D virus (HDV), Cytomegalovirus (CMV), Epstein–Barr virus (EBV), and Varicella –Zoster virus (VZV). Results: HBV positivity was detected in 5.4% of survivors and 2.0% of controls, and no significant difference was detected (P = 0.240). The seropositivity of HCV was also significantly higher among survivors (4.5% vs. 0.0%, P = 0.034). Only survivors were found to have HDV (1.4% vs. 0.0%), but this was not significant. CMV immunoglobulin G (IgG) was common in both groups (56.6% vs. 61.0%, P = 0.467), but CMV IgM was identified exclusively in survivors (7.7% vs. 0.0%, P = 0.002). The EBV IgG was very high and similar in the two groups (91.4 and 92.0, P = 1.000), but EBV IgM was uncommon and only observed in survivors (1.8 and 0.0). VZV IgG was also found to be significantly lower in survivors compared to controls (81.4% vs. 91.0% P = 0.031), whereas VZV IgM was only detected in survivors (2.7% vs. 0.0%). Conclusion: Survivors showed higher HCV seropositivity and exclusive IgM positivity in herpesviruses, which can indicate more opportunities to be exposed to the virus or altered immune regulation in chemical-attack victims.