J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 251 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Original Article Epidemiological Characterizations, New Localities, and a Checklist of the Known Scorpions in the Kurdistan Region, Northern Iraq Fenik Hussen1, *Hamid Kachel2, Gzng Hama3, Edi Kachal2, Masoud Slo2, Ihsan Hiwil2, Ayoub Ahmed4 1Department of Biology, College of Science, Salahaddin University, Erbil, Iraq 2Department of General Science, College of Basic Education, University of Zakho, Zakho, Iraq 3Department of Biology, Faculty of Science, University of Sulaymaniyah, Sulaymaniyah, Iraq 4Department of Plant Protection, Khabat Technical Institute, Erbil Polytechnic University, Erbil, Iraq *Corresponding author: Dr Hamid S Kachel, E-mail: hamid.kachel@uoz.edu.krd (Received 15 Nov 2021; accepted 13 Aug 2022) Abstract Background: Annually, thousands of scorpion stings and rare mortalities are recorded in the Kurdistan Region of Iraq. In the present study, we prepared a checklist for the geographical distribution of scorpion fauna composition, new localities data, and scorpion sting profile for the years 2019–2020 in the region. Methods: Random field surveys for scorpion collection were carried out in 22 localities in the Kurdistan Region from June 2020 to October 2021. Clinical data related to scorpion stings in 2019 and 2020 were obtained from the medical records of public health offices in the region. Results: In this survey, 166 specimens were collected. They were composed of seven scorpion species belonging to three families including: Buthidae, Hemiscorpiidae, and Scorpionidae. The collected species were Androctonus crassi- cauda, Compsobuthus matthiesseni, Hottentotta saulcyi, Mesobuthus mesopotamicus, Orthochirus fomichevi, Hemiscorpius lepturus, and Scorpio kruglovi. Moreover, three scorpion species comprising Buthacus tadmorensis, Hottentotta mes- opotamicus, and Calchas anlasi were recorded in the previous study conducted in the Kurdistan region. In 2019–2020, 3726 scorpion stings were reported, with a peak in the summer season. Most of the patients were 15–49 years old. In the current study, medically significant scorpion species have been identified. Conclusion: The outcome of the present work will increase the awareness of the Kurdish community regarding the distribution of dangerous scorpion species and consequently reduce their stings. Keywords: Scorpion; Scorpion sting; Distribution; Scorpionism; Iraq Introduction The Kurdistan Region is located in north- ern Iraq and has a population of around six million people. The total area of the region is approximately 40,643km². The region covers Erbil, Duhok, and Sulaymaniyah provinces. It is located at 36°04′59″N; 44°37′47″E. The re- gion has borders with three countries that have higher scorpion diversity than Iraq (19 species) (1). Iran, in the west, has the highest scorpion species diversity (78 species, 2 subspecies) as compared to the other neighbouring countries (2), followed by Turkey in the north with 41 species and 3 subspecies (3); then Saudi Arabia in the east with 26 species (4) and Syria with 21 species (5). Scorpion stings are unpleasant but rarely endanger life. Children and older adults are at the highest risk for severe complications. Among the 2710 species of known scorpions (6), only about 50 of them develop venom toxic enough to be lethal to humans (7). Each year, more than one million scorpion stings occur. Deaths from these stings are a major public health concern in tropical countries where access to medical care is limited (8). According to recent publications, 4162 scor- Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license (https://creativecommons.org/licenses/by- nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. http://jad.tums.ac.ir/ mailto:hamid.kachel@uoz.edu.krd https://creativecommons.org/licenses/by-nc/4.0/ https://creativecommons.org/licenses/by-nc/4.0/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 252 http://jad.tums.ac.ir Published Online: Sep 30, 2022 pion stings were recorded in primary health care centres in the Kurdistan Region in 2017 and 2018 (9). Based on the envenomation ep- idemiological data of the neighbour countries, Androctonus crassicauda (Olivier, 1807), An- droctonus bicolor (Ehrenberg, 1828) and Hemiscorpius lepturus (Peters, 1861) are con- sidered the most dangerous scorpions among the known species in Iraq and they are respon- sible for the most death cases related to scor- pion stings (10–11). Knowledge of scorpion stings and diversi- ty in Iraq generally, and the Kurdistan Region in particular is extremely poor. According to recent studies on the scorpion fauna of the Kurdistan Region of Iraq, Compsobuthus mat- thiesseni (Birula, 1905), H. lepturus, Hemiscor- pius saulcyi (Simon, 1880), Orthochirus fom- ichevi (Kovařík, Yağmur, Fet and Hussen, 2019), and Scorpio kruglovi (Birula, 1910) were listed in Sulaymaniyha Province. In Duhok Province, A. crassicauda, C. matthiesseni, Hottentotta mes- opotamicus (Lourenço and Qi, 2007), H. saul- cyi, O. fomichevi and S. kruglovi were listed. While in Erbil Province, A. crassicauda, Butha- cus tadmorensis (Simon, 1892), C. matthies- seni, Calchas anlasi (Yağmur, Soleglad, Fet and Kovařík, 2013), H. saulcyi, H. lepturus, M. mesopotamicus, O. fomichevi and S. kruglovi were listed (1, 11, 12). The aim of this paper is to investigate scorpion stings in 2019–2020 and explain the current geographical distribution of different scorpion species from the Kurdistan Region. The outcomes of the present work will in- crease the awareness level of the Kurdish com- munity regarding the scorpion’s type and con- sequently reduce their stings. Materials and Methods Epidemiological data The clinical data relating to the scorpion stings present in this study were obtained from the medical records of primary public health offices of the Kurdistan Region. Statistical da- ta of scorpion envenomation of 2019 and 2020 were checked. The relevant information for each scorpion sting case such as gender, age, and the geographical region of scorpion sting were rec- orded. Excel software is used to analysis data statically and organize it in detailed tables and graphs. Study area This cross-sectional study for scorpion spe- cies collection was conducted in the Kurdistan Region administrative of Iraq. Sulaymaniyah is located at latitude 35°33′26″N, 45°26′08″E at elevation of 882m on the board of Iran. Duhok is located at latitude 36°52′N, 43°0′E at elevation of 565m on the board of Turkey and Syria. Erbil is located at latitude 36° 11'28.0068''N, 44°0'33.0012''E at elevation of 390m on the board of Iran and Turkey. The geographical features of three provinces are roughly identical and consist of two areas: mountains and plains. They have semi-arid climate weather with very warm dry summers and cool wet winters. The Kurdistan area provinces are separated into 32 districts to better understand the geographical distribution of each scorpion species. Twenty-two sites were randomly selected for this study survey (Fig. 3). Scorpion survey A random field survey for scorpion col- lection was carried out in twenty-two stations in rural and urban areas of the three provinces of Kurdistan during the period of June 2020 to October 2021. Sampling at night was done by using a black ultraviolet light (UV) to de- tect scorpions above ground, while during sun- ny days the ground was examined by search- ing under stones, rocks, and tree barks. All the collected scorpion specimens were placed in 80% ethyl alcohol and kept at the Zoology La- boratory at the University of Zakho. All spe- cies were identified based on the descriptions and taxonomic keys published by Levy and Amitai (13) and Kovařík (14). http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 253 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Review of the Scorpion fauna of Kurdistan In this section, we reviewed all the data in previous studies related to the identified lo- calities of scorpions in Kurdistan. Then we build a district-based checklist for the geo- graphical distribution of each scorpion species recorded in Kurdistan. Results Epidemiological data A total of 3726 scorpion sting cases were dealt with by the public hospitals in three prov- inces of the Kurdistan Region, Iraq during the 2-year period from January 2019 until De- cember 2020. According to the recorded evi- dence on scorpion stings, the highest numbers of cases were reported in 2019 and the lowest in 2020 (Table 1). The scorpion sting victims were mostly between the ages of 15 and 49, accounting for 42.8% of all cases, followed by 30.1% of those between the ages of 4 and 14 (Table 1). Those over 50 and less than 4 accounted for 13.4% and 13.7% of the cases, respectively. Summer was the most common season for scorpion stings (51.9%), with autumn being the next most common season (32.2%). In con- trast, scorpion stings were reported at a very low rate of 12.2% and 3.7% in the spring and winter, respectively (Fig. 1). The number of male and female scorpion sting victims was 2079 (55.8%) and 1647 (44.2%), respectively. Table 2 summarizes the monthly occurrence of scorpion sting cases by gender. Scorpion fauna composition Out of all the 166 specimens collected in different sites of this survey, the Buthidae family involves five species: A. crassicauda, C. matthiesseni, H. saulcyi, M. mesopotami- cus and O. fomichevi, while Scorpionidae and Hemiscorpiidae each have a single species: S. kruglovi and H. lepturus, respectively (Table 3, Fig. 2). Among all the collected samples, 102 (61.4%) were male and 64 (38.6%) females. The most abundant species were H. saulcyi 93 (56.0%), S. kruglovi 46 (27.7%) and A. cras- sicauda 15 (9.0 %), which were collected from various sites in this survey. The lowest fre- quency was from C. matthiesseni 4 (2.4%), M. mesopotamicus 3 (1.8%), H. lepturus 3 (1.8%) and O. fomichevi 2 (1.2%) (Fig. 2). Orthochirus fomichevi was collected only from Zakho Dis- trict in Duhok Province, while C. matthies- seni, M. phillipsii were collected only from Erbil Province. Fig. 1. Seasonal average rate of scorpion stings in three cities north of Iraq during 2019–2020 http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 254 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Table 1. Age distribution for scorpion stings in Erbil, Duhok and Sulaymaniyah Provinces during 2019–2020 Year City Age (Years) 1–4 5–14 15–49 50 over Total 2019 Erbil 98 201 150 98 1990 Duhok 129 399 593 164 Sulaimaniyah 9 23 97 29 Average 236 623 840 291 2020 Erbil 102 128 124 87 1736 Duhok 155 316 412 105 Sulaimaniyah 16 57 219 15 Average 273 501 755 207 Total (%) 509 (13.6) 1124 (30.2) 1595 (42.8) 498 (13.4) 3726 (100) Table 2. Monthly gender-based scorpion sting cases recorded in the Kurdistan Region provinces from 2019 to 2020 Month 2019 2020 Male Female Total % January 9 13 11 11 22 0.6 February 12 4 7 9 16 0.4 March 10 25 17 18 35 0.9 April 42 68 70 40 110 3 May 146 166 158 154 312 8.4 June 320 349 403 266 669 18 July 316 196 314 198 512 13.7 August 388 319 341 366 707 19 September 221 312 286 247 533 14.3 October 283 170 257 196 453 12.1 November 181 78 155 104 259 7 December 62 36 60 38 98 2.6 Total (%) 1990 (53.4) 1736 (46.6) 2079 (55.8) 1647 (44.2) 3726 100 Fig. 2. Scorpion species composition collected in this survey in Kurdistan Region, 2020–2021 http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 255 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Table 3. Species of scorpions collected in different survey sites in Kurdistan Region provinces 2020–2021 Collection site (District) Topography Altitude (m) Latitude and Longitude Scorpion species (N.) Total collected Sulaymaniyah Province Qaladze (Pishdar) Plain 882 36° 10' 51.2" N 45° 7' 26.9" E H. saulcyi (10) S. kruglovi (15) A. crassicauda (3) 28 Kele Border (Pishdar) Mountain 849 36.18 66 N 45.3243 E S. kruglovi (12) A. crassicauda (1) 13 Bawze (Pishdar) Mountain 1138 36.0878 N 45.3133 E H. saulcyi (16) S. kruglovi (1) A. crassicauda (1) 18 Swne (Pishdar) Mountain 890 36° 14' 53.2" N 45° 7' 34.6" E H. saulcyi (3) 3 Makok mountain (Ranya) Mountain 882 36° 17’ 29.2” N 44° 47’ 29.3” E H. saulcyi (3) 3 Chaqizh lower (Sulaymaniyah) Plain 912 35.626307ºN 45.199277ºE H. lepturus (3) A. crassicauda (1) C. matthiesseni (1) H. saulcyi (3) O. fomichevi (1) 9 Duhok Province Telkabar (Zakho) Plain 487 37°16′28″N 42°71′78″E H. saulcyi (25) A. crassicauda (1) C. matthiesseni (1) 27 Sheransh (Zakho) Mountain 1439 37°13′48″N 42°50′40″E H. saulcyi (5) 5 Betas (Zakho) Mountain 678 37° 3' 39" N 42° 44' 7" E H. saulcyi (4) O. fomichevi (1) 5 Demka (Zakho) Mountain 873 37° 13' 10" N 43° 4' 36" E H. saulcyi (7) 7 Bani nan (Bardarash) Plain 298 36° 30′ 12.2″ N 43° 35′ 14″ E A. crassicauda (2) 2 Erbil Province Efraz (Khabat) Plain 291 36°21'51.37"N 43°48'24.84" E A. crassicauda (2) 2 Rawanduz (Rawanduz) Mountain 658 36°35'28.79"N 44°23'32.99" E S. kruglovi (10) 10 Choman (Choman) Mountain 2407 36°38'14.67"N 44°53'21.52"E H. saulcyi (3) 3 Pirdawd (Erbil) Plain 360 36.024650 N 43.927116 E H. saulcyi (2) M. mesopotamicus (3) 5 Ankawa (Erbil) Plain 413 36° 13' 42.1" N 43° 59' 43.2" E H. saulcyi (2) 2 Rezan (Mergasur) Mountain 882 44.1294069" N 36.8551834" E H. saulcyi (2) 2 Harir (Shaqlawa) Mountain 699 44.3467706 " N 36.552188 " E H. saulcyi (3) A. crassicauda (2) S. kruglovi (8) 13 Qushtapa (Erbil) Plain 390 36° 00' 2.0639" N 44° 01' 57.077" E H. saulcyi (4) A. crassicauda (2) 6 Bestana (Erbil) Plain 646 36° 2' 45.6" N 44° 11' 57.2" E C. matthiesseni (1) 1 Koysinjaq (Koysinjaq) Plain 594 36°4'30.33"N 44°37'11.77"E C. matthiesseni (1) 1 Dashty Hawler (Dashti Hawler) Plain 419 36° 9' 11.5" N 44° 6' 0.3" E H. saulcyi (1) 1 Total 166 http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 256 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Table 4. Comparison of scorpion species distribution in previous and current study in Kurdistan Region provinces (Duhok, Erbil and Sulaymaniyah) in Iraq divided into 32 districts: Duhok (1- Zakho, 3- Duhok, 4- Amedi, 5- Shikhan, 6- Akre, 7- Bardarash), Erbil (8- Mergasur, 9- Soran 10- Choman, 11- Rawanduz, 12- Shaqlawa, 13- Khabat, 14- Erbil, 15- Dashti Hawler, 16- Koysnjaq, 17- Makhmur), Sulaymaniyah (18- Ranya, 19- Pishdar, 25- Sulaymaniyah, 26- Said Sadiq, 29- Halabja,). Green indicates report only in this study, Blue indicates report in only previous studies and Red indicates report in both current and previous stud studies District per Province in Kurdistan Region of Iraq Duhok Erbil Sulaymaniyah Scorpion Family-Species 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 25 26 29 Buthidae A. crassicauda B. tadmorensis C. matthiesseni H. mesopotamicus H. salucyi M. mesopotamicus O. fomichevi Hemiscorpiidae H. lepturus Iuridae C. anlasi Scorpionidae S. kruglovi Species number per district 6 1 1 2 4 1 6 1 1 1 6 2 5 4 8 2 1 3 6 3 2 Fig. 3. Kurdistan Region provinces divided into 32 districts Duhok (1- Zakho, 2- Sumel, 3- Duhok, 4- Amedi, 5- Shikhan, 6- Akre, 7- Bardarash), Erbil (8- Mergasur, 9- Soran 10- Choman, 11- Rowanduz, 12- Shaqlawa, 13- Khabat, 14- Erbil, 15- Dashti Hawler, 16- Koysnjaq, 17- Makhmur), Sulaymaniyah (18- Ranya, 19- Pishdar, 20- Dukan, 21- Mawat 22- Sharbazher, 23- Penjwin, 24- Chamchamal, 25- Sulaymaniyah, 26- Said Sadiq, 27- Qaradagh, 28- Sharazur, 29- Halabja, 30- Kalar, 31- Darbandikhan, 32- Khanaqin). The study sites surveyed represented by black dots http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 257 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Fig. 4. General overview of scorpion species collected in this study in the Kurdistan Region of Iraq A. Androctonus crassicauda; B. Hottentotta saulcyi; C. Compsobuthus matthiesseni; D. Mesobuthus mesopotamicus; E. Orthochirus fomichevi; F. Scorpio maurus; G. Hemiscorpus lepturus (Photos by Authors) Fig. 5. The distribution map of the known scorpion species in 22 out of 32 districts of the Kurdistan Region of Iraq: Duhok (1- Zakho, 2- Sumel, 3- Duhok, 4- Amedi, 5- Shikhan, 6- Akre, 7- Bardarash), Erbil (8- Mergasur, 9- Soran 10- Cho- man, 11- Rawanduz, 12- Shaqlawa, 13- Khabat, 14- Erbil, 15- Dashti Hawler, 16- Koysnjaq, 17- Makhmur), Sulaymani- yah (18- Ranya, 19- Pishdar, 20- Dukan, 21- Mawat 22- Sharbazher, 23- Penjwin, 24- Chamchamal, 25- Sulaymaniyah, 26- Said Sadiq, 27- Qaradagh, 28- Sharazur, 29- Halabja, 30- Kalar, 31- Darbandikhan, 32- Khanaqin) http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 258 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Discussion The current checklist study showed that the Kurdistan region had 10 scorpion species belonging to nine genera and four families: Buthidae, Hemiscorpiidae, Iuridae and Scor- pionidae. This diversity in the region's scor- pion fauna indicates scorpions' preferred liv- ing habits and climate. Seven species (Fig. 4) of the 10 known in Kurdistan were collected in the current survey and three scorpion spe- cies were previously recorded in Kurdistan but not in this study: B. tadmorensis, H. mes- opotamicus, and C. anlasi (12, 15–16). The Buthidae family had the highest frequency of seven species, with a single species for each of the other families. The highest number of scorpion species in this checklist was reported from Erbil province, with 9 species, followed by 6 different species in each of Duhok and Sulaymaniyah provinces. When compared to a recently published checklist of Iraq scor- pions, the species richness and diversity rose by four scorpion species in each of Erbil and Sulaymaniyah, and one scorpion species in Duhok (1, 12). So, following Baghdad Prov- ince, which had 10 species, Erbil Province has the second greatest number of scorpion spe- cies variety in Iraq, followed by Diyala Prov- ince with 7 species, while the scorpion num- bers recorded in the other fifteen provinces range from 0 to 6 species (1). The geographical distribution checklist of scorpion species identified in the Kurdistan Region is shown in table 4 and figure 5 based on the 32 districts of the Kurdistan Region. The most abundant species, in terms of both species and distribution, was H. saulcy, which was found in sixteen distinct districts across Kurdistan's three provinces. It was collected for the first time in four districts (two in Erbil and two in Sulaymaniyah), and it had previ- ously been reported in 12 districts (11–12). In the Iraq scorpion checklist, Kachel and his col- leagues (1) reported H. saulcy in seven prov- inces of Iraq from three different geographical regions of the country (MR= Mountainous and highland region (17), UR= Undulated and hilly region, DR= Desert region). Androctonus crassicauda, one of Iraq's most dangerous scorpion species, was the second most widely distributed species in Kurdistan and the first in Iraq. The distribution of A. crassicauda in Kurdistan has been document- ed in thirteen districts, two of which are new. Androctonus species can adapt to a wide range of environmental conditions (18). According to the most recent Iraq scorpion checklist (1), A. crassicauda has been found in 14 provinc- es across the country, in all four geographical conditions (MR, UR, DR, AR= alluvial re- gion). Several incidences of mortality from this species' stings have been documented in Iran's southern provinces of Hormozgan and Khuzestan (19–20). Orthochirus fomichevi and C. matthiesseni have been found in 8 and 7 districts, respec- tively, in Kurdistan's three provinces. Comp- sobuthus matthiesseni has been found in three different geographical conditions in Iraq (MR, UR, AR regions), while O. fomichevi has only been found in the MR region (1). Other Buthi- dae species' distribution were restricted to specific provinces. M. mesopotamicus and B. tadmorensis were only found in Erbil Prov- ince districts (12), while H. mesopotamicus was only recorded previously in Duhok prov- ince's Zakho District (15). In Iraq, the distri- bution of Razianus zarudnyi was also limited to the province of Baghdad (21). The Hemiscorpiidae family was the sec- ond to be detected in the Kurdistan Region. The only species of this family found in Kur- distan was H. lepturus, which was found in three districts: one in Erbil and two in Sulay- maniyah Province. Hemiscorpus lepturus is the most dangerous scorpion species, its enven- omation causing severe complications and the main cause of death in Khuzestan Province in Iran (22–24). The key feature for identifying http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 259 http://jad.tums.ac.ir Published Online: Sep 30, 2022 this species was its small, thin stings. People's and health-care workers' lack of knowledge about this scorpion species can be hazardous to residents in their area (18). Other non-medically important scorpion families found in Kurdistan are the Iuridae and Scorpionidae, each of which has one spe- cies, C. anlasi and S. kruglovi, respectively. Because both species' venoms are weak, they must rely on their powerful chelicerae to cap- ture prey. Calchas anlasi's distribution is lim- ited to Turkey, with a solitary occurrence in the Kurdistan District of Soran, it requires fur- ther verification in Iraq (16). While S. kruglovi has a greater geographic range, it has been re- ported in all of Iraq's neighbouring countries except Turkey (25). In Iraq, it has been re- ported from six provinces from all four geo- graphical conditions (1, 26). In the current study, S. kruglovi was shown to be the second most common and third most distributed in 13 districts across Kurdistan's three provinces. The current study's epidemiological data in the Kurdistan Region revealed that the num- ber of scorpion stings was lower in the year 2020 than in 2019. The current study's find- ings over a two-year period are slightly lower than earlier studies conducted in Kurdistan (9), which might be due to Covid-19's restriction laws or people's fear of visiting hospitals to re- ceive sting treatment. According to the data, men (55.8%) are more likely than women to be stung (44.2%). This conclusion is consistent with findings from In- dia (27) and Argentina (28). In contrast, prior re- search in Iran (18, 29) found that the number of female patients presenting with scorpion stings was higher than the number of male patients. Overall, scorpion sting epidemiology is related to the victim's gender, study year, and study ar- ea. However, cultural factors such as gender disparities in behaviour may be considered. Our findings revealed that in Kurdistan, an- nual epidemiological determinants of scorpion stings follow a similar trend. In the summer, the highest rate of scorpion sting cases was re- ported. The current study's findings are con- sistent with those of prior research conducted in Iraq's Kurdistan (7, 10) and Iran (30, 31). Ac- cording to this data, scorpion stings are most common during the hotter months of the year (May to September). As the temperature rises, scorpion activity rises, and their contact with humans increases the number of stings (32). According to our findings, scorpion stings were most common in people aged 15 to 49 years old, followed by the age group of 4 to 14 years. This finding is consistent with find- ings from a previous study in the Kurdistan Region (9, 12). This age group has been iden- tified as being at high risk in related studies, which could be due to outdoor work and ac- tivity outside the home. According to an Ira- nian study, scorpion stings occur most fre- quently among young people aged 15 to 24 years old (33). Likewise, scorpion stings are more common in people aged 20 to 29 in in the northeast region of Brazil (34). Conclusion According to the latest research, Scorpion- ism is a severe health problem in Iraq's Kur- distan Region, impacting people of all ages and genders, as well as many stung patients. How- ever, because Kurdish society and public health agencies are unaware of the problem and po- tentially deadly scorpion species, more infor- mation on scorpion diversity and sting pre- vention techniques should be provided. Acknowledgements The authors appreciate the collaboration and assistance of the staff of the provincial health centres in Erbil, Duhok, and Sulaymaniyah. Conflict of interest statement The authors declare not to have conflicts of interest. http://jad.tums.ac.ir/ J Arthropod-Borne Dis, Sep 2022, 16(3): 251–261 F Hussen et al.: Epidemiological Characterizations … 260 http://jad.tums.ac.ir Published Online: Sep 30, 2022 Ethical considerations Not applicable. References 1. Kachel H, Al-Khazali A, Hussen F, Yağmur E (2021) Checklist and review of the scorpion fauna of Iraq (Arachnida: Scor- piones). Arachnol Mitt. 61 (1): 1–10. 2. 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