Common infections in travelers are gastrointestinal infections. Chronic and latent infections in immigrants (and long-term residents) include tuberculosis, echinococcosis, cutaneous leishmaniasis, and brucellosis.
Vector-borne infections: Malaria is present in focal areas of Iran, Iraq, Oman, Saudi Arabia, Syria, Turkey, and Yemen. Epidemic dengue activity occurred in Saudi Arabia and Yemen in 2002. Cutaneous leishmaniasis is widespread and common, especially in countries bordering the Mediterranean. Transmission of visceral leishmaniasis occurs focally in Turkey, Iraq, Saudi Arabia, and Syria. Other vector-borne infections include murine typhus, spotted fever due to R. conorii, tick-borne encephalitis (in Turkey), Crimean-Congo hemorrhagic fever* (in Iran, Iraq, and the Arabian peninsula) (an outbreak occurred in Turkey in 2006), tick-borne relapsing fever, sandfly fever, and West Nile fever. Lymphatic filariasis and onchocerciasis are endemic in focal areas of Yemen.
Food- and water-borne infections: Risk of hepatitis A is high in many parts of the area; typhoid fever occurs sporadically and in outbreaks. Outbreaks of hepatitis E have been reported in Iran and Jordan. An outbreak of polio (478 virus-confirmed cases) occurred in Yemen in 2005 following importation of poliovirus from Nigeria. Cholera was reported from Iran and Iraq in 2004. Brucellosis is widespread and common in parts of the region.
Airborne and person-to-person transmission: Pilgrims to the Hajj (Saudi Arabia) have acquired meningococcal infections caused by serotypes A and W-135, as well as influenza infections. The annual incidence of tuberculosis per 100,000 population is estimated to be 100-300 in Iraq, 50-100 in Yemen and 25-50 in most of the rest of the region. Measles continues to be reported from the region.
Sexually transmitted and blood-borne infections: The prevalence of hepatitis B chronic infection is >8% in Saudi Arabia and 2%-7% in much of the rest of the region. The prevalence of HIV is estimated to be lower than 0.5% throughout the region.
Zoonotic infections: Anthrax* is enzootic in Turkey, and sporadic cases occur in most of the region except for Oman. Rabies is widespread in the region. Endemic foci of plague* have been identified in the region in the past. Q fever* is common in most countries in the region. Echinococcosis* is endemic in many rural areas. Outbreaks of oropharyngeal tularemia* have been reported from Turkey. Brucellosis is common in Syria (annual incidence of >500 per 100,000 population) and has an incidence of 50-500 cases per 100,000 population in most of the rest of the region (18).
Highly pathogenic H5N1 influenza virus has been found in poultry in Turkey, Iraq, and Israel. Human cases and deaths were confirmed in Iraq and Turkey in 2006.
Soil- and water-associated infections: Schistosomiasis has been found in focal areas in Saudi Arabia, Yemen, Iraq, and Syria.
Other hazards: Motor vehicle accidents, intentional injuries, and injuries related to ongoing conflicts occur. Snake and scorpion bites are an additional hazard. Screening of blood before transfusion is inadequate in many hospitals.
