Cholera outbreak in Iraq

[Gert van der Hoek]

Cause of north Iraq cholera outbreak unclear-WHO

Tue Sep 4, 2007

.GENEVA, Sept 4 (Reuters) - The World Health Organisation said on Tuesday thousands of people had fallen ill with cholera in northern Iraq, but the cause of the outbreak had not been identified.

"The source of infection is very unclear so far," said Claire Lise Chaignat, head of the United Nations agency's global task force on cholera control.

She said the northern Iraqi province of Sulaimaniya had recorded a "three- to four-fold increase" in acute watery diarrhoea -- cholera's main symptom -- between Aug. 23 and Sept. 2. There have been 2,930 cholera cases and 9 related deaths in Sulaimaniya over that 11-day period, she said.

Nearby Kirkuk first detected cholera on Aug. 19 and has since had 1 death and 2,968 cases of acute watery diarrhoea, Chaignat said. She cautioned it was not yet possible to say whether all those cases were cholera.

Health officials in Iraq's semi-autonomous Kurdistan region said last week that a Sulaimaniya water treatment plant had tested positive for the bacterium that caused cholera, and that its filters would be cleaned. Polluted well water was also cited as a possible infection source.

In Kirkuk, cracked water pipes allowing contamination by sewage were blamed for the outbreak.

According to the WHO Web site, sudden large outbreaks of cholera are usually caused by a contaminated water supply. The diarrhoeal disease, which also causes severe vomiting, is rarely transmitted by direct person-to-person contact.

Chaignat said it appeared that the number of cases in Sulaimaniya may have been decreasing over the past week, but stressed it was possible that cholera would continue to spread.

She said health workers in the region "so far" have had the resources they need to confront the outbreak. Most cholera cases are treated with oral rehydration salts, though some patients require intra-venous fluids or antibiotics.

http://www.reuters.com/article/latestCrisis/idUSL04796616

[Theresa42]

Re: Cholera outbreak in Iraq

Northern Iraq battles cholera 'epidemic'
Sept 11, 2007

GENEVA (AFP) ? The World Health Organisation said Tuesday that Iraqi authorities were dealing with an "epidemic" of nearly 7,000 suspected cholera cases in three northeastern provinces.

Only 290 cases have been confirmed in laboratory tests, but WHO spokeswoman Fadela Chaib said the agency considered all cases of acute watery diarrhoea should be considered as carrying the "vibrio cholerae" bacteria.

At the end of August, authorities in Sulaimaniyah had reported 2,000 suspected cases and six deaths, while the WHO said another source was found in Kirkuk.

Chaib said Tuesday that six laboratory confirmed cases were also reported in Erbil.

"It is unclear what is the cause of the epidemic," Chaib told journalists.

"There is some evidence in Sulaimaniyah... that polluted water on which the local people were forced to rely on may have been to blame, and in Kirkuk a cracked water pipe."

"We are confident that it can be contained," she told journalists.

The WHO has sent two truckloads of antibiotics to the region, while the Iraqi government and provincial authorities have also taken measures to combat the disease.

The agency is not recommending any special travel or trade restrictions for the affected area, it said in a statement.

Previous cholera outbreaks hit northern Iraq in 1999 and southern areas around Basra shortly after the US-led invasion in 2003.

http://afp.google.com/article/ALeqM5g2b_n6Z4zipBkR-SamdWeMoIDLJA

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

Cholera infects 16,000 people in northern Iraq: WHO


GENEVA (AFP) ? The cholera outbreak in northern Iraq has infected some 16,000 people since late August, of whom at least 10 have died, the World Health Organisation said on Friday.

Since August 23, at least 6,000 people have been reported with diarrhoeal diseases in Sulaymaniyah province, almost 7,000 in Kirkuk province and at least 3,000 in Erbil province, WHO spokeswoman Fadela Chaib told journalists.

The outbreak has so far remained confined to the three northeastern provinces, which have a population of three million people.

A UN team is working on the ground to help Iraqi authorities fight the epidemic and inspect water sources in the affected areas since the end of August.

The source of the epidemic remains unclear but the WHO remains confident it can be brought under control, Chaib said.

Naeema Al-Gasseer, the WHO's representative in Iraq, warned however that delays in ensuring access to safe water, safe food and enhanced hygiene practices could all lead to the further spread of cholera.

Northern Iraq suffered an earlier cholera outbreak in 1999, while the disease struck the southern province of Basra shortly before the US-lead invasion of 2003.

http://afp.google.com/article/ALeqM5iGX8VqU_NnLKk6gup8TLPFBD_29A

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

WHO

Cholera in Iraq - update

14 September 2007

Between 23 August and 10 September 2007, the cumulative number of cases of acute watery diarrhoea reported from Sulaymaniyah province stands at 6,142 including 9 deaths (case fatality rate, CFR: 0,14%). Of these reported cases, Vibrio cholerae has been laboratory confirmed in 392 stool specimens.

From 29 July to 12 September 2007, the health authorities of Kirkuk province reported a total of 6,749 cases of acute diarrhoeal disease including 1 death (CFR: 0,01%). The first index case of cholera, confirmed by laboratory test, was reported on 14 August 2007.

The outbreak continues to spread into Erbil province, where, between 1 and 10 September 2007, 11,641 cases of diarrhoeal disease with no deaths were reported. Among samples tested, 33 were identified as positive for V. cholerae.

Until now, there is no confirmed information that cholera has spread to other parts of Iraq. A stool sample collected from a suspect case in Baghdad has tested negative for V. cholerae. Another suspect case detected in Mosul is currently being investigated.

The Government of Iraq has mobilized a multi-sectoral response to the outbreak. A high-level National Committee on Cholera Preparedness and Outbreak Response has been established.

The health authorities of affected provinces are implementing public health control measures, including regular water quality testing, to contain the outbreak and to mitigate its effect on the population.

WHO, along with other UN agencies, the International Committee of the Red Cross (ICRC), and international NGOs, continue to support the Ministry of Health and local health authorities in ongoing response operations.

WHO is procuring emergency supplies such as chlorine tablets, rapid diagnostic tests and interagency diarrhoeal diseases kits, as well as disseminating technical guidelines on case management.

Social mobilization campaigns are being implemented with the participation of religious and community leaders.

In controlling the spread of cholera, WHO does not recommend any special restrictions to travel or trade to or from affected areas.

http://www.who.int/csr/don/2007_09_14/en/index.html

[Niko]

Re: Cholera outbreak in Iraq

Situation report on cholera outbreak in northern Iraq, 16 Sep 2007
<!--docTitle--><!--Attention ligne utilis?e pour l'impression--> <!--Attention ligne utilis?e pour l'impression-->
1. OVERVIEW
As of 12th of September 2007, twenty-three districts of Northern Iraq have reported laboratory-confirmed cases of cholera. All the sixteen districts of Sulaymaniyah governorate, all five districts of Kirkuk governorate and two out of seven districts of Erbil governorate are now affected by this cholera outbreak.

This outbreak, first unfolded in Kirkuk province on 14 August spread to Sulaymaniyah governorate on 23 August and then to Erbil governorate on 6th of September. The outbreak has so far caused 10 deaths and continues to be a major threat to public health in the region. Over 3.4 million people living in these areas are presumed to be exposed to this epidemic risk.

Although, accurate data on number of cholera cases reported from these three affected governorates are not yet available, the disease surveillance system of these three governorates, since the outbreak started, showed that between 23 August and 10 September, a total of 6,142 cases of diarrhoeal disease with 9 deaths (CFR: 0.14%) were reported from Sulaymaniayh governorate while between 29 July to 14 September a total of 6,879 cases of diarrhoeal disease with 1 death (CFR: 0.01%) were reported from Kirkuk governorate. On the other hand, 11,641 cases of diarrhoeal disease with no death (CFR: 0%) were reported from Erbil governorate from 01 to 10 September 2007. Of these reported cases, 1,150 laboratory confirmed cases of cholera have been reported so far.

Table-1: Cases of diarrhoeal diseases reported from three provinces of Northern Iraq

<table border="1"> <tbody><tr valign="top"><td width="78">

Province

</td><td width="85">

No of districts
affected

</td><td width="91">

Date outbreak
started

</td><td width="72">

No of DDs
reported

</td><td width="89">

No of deaths
reported

</td><td width="58">

CFR (%)

</td><td width="161">

No of laboratory-
confirmed case of cholera

</td></tr> <tr valign="top"><td width="78">Sulaymaniyah</td><td width="85">

16

</td><td width="91">

23/08/07

</td><td width="72">

6,142

</td><td width="89">

9

</td><td width="58">

0.14

</td><td width="161">

392

</td></tr> <tr valign="top"><td width="78">Kirkuk</td><td width="85">

5

</td><td width="91">

14/08/07

</td><td width="72">

6,879

</td><td width="89">

1

</td><td width="58">

0.01

</td><td width="161">

717

</td></tr> <tr valign="top"><td width="78">Erbil</td><td width="85">

2

</td><td width="91">

06/09/07

</td><td width="72">

11,641

</td><td width="89">

0

</td><td width="58">

0

</td><td width="161">

41

</td></tr> </tbody></table>

Specific control measures to contain this ongoing outbreak and limit its spread to other areas have been reinforced by the health authorities of the affected provinces with technical support from WHO.

http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-775DJH?OpenDocument

[Snowy Owl]

Re: Cholera outbreak in Iraq

CHOLERA OUTBREAK IN NORTHERN IRAQ REMAINS MAJOR HEALTH THREAT, UN REPORTS

The cholera outbreak in northern Iraq continues to be a major threat to public health in the region with over 3.3 million people presumed to be exposed to the risk of an epidemic, according to an update by the United Nations health agency.

Severe diarrhoea cases now top 24,500, although confirmed laboratory cases of cholera number about 1,050, with 10 deaths, the same mortality figure reported a week ago when the diarrhoea cases stood at 16,000.

?Case fatality remains very low (less than 1 per cent) which indicates good access as well as improved case management of cholera patients at all treatment centres in the affected area,? the UN World Health Organization (WHO) said.

?Provision of safe water and food, establishment of adequate sanitation services for the community at risk and implementation of personal and community hygiene constitute the main public health interventions to contain the outbreak,? it added.

The outbreak first unfolded in Kirkuk province on 14 August, spread to Sulemaniya governorate on 23 August and then to Erbil governorate on 6 September.

It is unclear what caused the outbreak, but initial investigations show some evidence that, in Sulemaniya, polluted water that residents were forced to rely on due to a shortage of drinking water may have been to blame. In Kirkuk, cracked water pipes allowed contamination by sewage, and because of the close geographic proximity the outbreak spread to Erbil. <script><!-- D(["mb","\u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>The continuous movement of people and cargo,\nbad sanitary conditions and high temperatures may increase the possibility\nof spreading the disease rapidly to other areas such as Baghdad and the\ncentral provinces, health officials have warned. \u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>Cholera is an acute intestinal infection\ncaused by ingestion of food or water contaminated with the bacterium Vibrio\ncholerae. It causes watery diarrhoea that can quickly lead to severe dehydration\nand death if treatment is not promptly given. About 80 to 90 per cent of\ncases are mild or moderate and are difficult to distinguish clinically\nfrom other types of acute diarrhoea. Less than 20 per cent of ill people\ndevelop typical cholera with signs of moderate or severe dehydration. \u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>* * *\u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>UN RUSHING AID TO 1.5 MILLION FLOOD VICTIMS\nIN SUB-SAHARAN AFRICA\u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>United Nations World Food Programme (WFP)\nteams are fanning out across a wide arc of sub-Saharan Africa, from Mauritania\nin the west to Kenya in the east, bringing in helicopters and boats where\nnecessary to help an estimated 1.5 million people hit by some of the worst\nfloods in decades. \u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>?Funds, especially cash, are urgently needed,?\nWFP said today in its latest update on the situation. Just yesterday, the\nagency appealed for nearly $65 million to feed 300,000 flood victims as\nwell as refugees and other displaced people in Uganda for the next six\nmonths. \u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>WFP is working together with Governments\nand other aid agencies to assess needs and respond swiftly throughout the\nregion, drawing on emergency stocks. \u003c/font\>\n\u003cbr\>\n\u003cbr\>\u003cfont size\u003d\"2\" face\u003d\"Arial\"\>West Africa is experiencing some of its worst\nfloods in 10 years, affecting 500,000 people in 18 countries, according\nto the UN Office for the Coordination of Humanitarian Affairs (OCHA). WFP\nrapid assessment missions are currently evaluating needs in Ghana and Togo\nwhere heavy rains and flooding have caused widespread damage to crops and\ninfrastructure and forced large numbers of people to flee their homes.\n",1] ); //--></script>

The continuous movement of people and cargo, bad sanitary conditions and high temperatures may increase the possibility of spreading the disease rapidly to other areas such as Baghdad and the central provinces, health officials have warned.

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It causes watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. About 80 to 90 per cent of cases are mild or moderate and are difficult to distinguish clinically from other types of acute diarrhoea. Less than 20 per cent of ill people develop typical cholera with signs of moderate or severe dehydration.

[Theresa42]

Re: Cholera outbreak in Iraq

Google-translated from Arabic:

Iraqi health official: the discovery of cases of cholera in southern Iraq
Sept 22, 2007

High health official said on Saturday that the situation confirmed cases of cholera in southern Iraq, which raised fears of the spread of the disease, which turns water pollution in various parts of the country.

The focus of the vast majority of the incidence of the disease in the 1500 case of the North, but confirmed the existence of cases of infection in Baghdad last week and now the situation appeared near Basra in the south.

He said the Inspector General of the Ministry of Health Adel Mohsen Reuters that the latest case was seven months old girl in the nearby city of Basra. The hit by the disease transmission through drinking water.

http://www.alwafd.org/v3/News/news_description.php?news_id=3275

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

WHO - update

Cholera in Iraq - update 2

25 September 2007

Since late August 2007, an outbreak of cholera has spread to 25 districts of Northern Iraq and 4 districts in Southern Iraq and across the centre of the country. It is estimated that more than 30 000 people have fallen ill with acute watery diarrhoea, among which 2 116 were identified as positive for Vibrio cholerae.

The case fatality rate is 0.52% and has remained low throughout the outbreak, although it continues to spread across Iraq and dissemination to as yet unaffected areas remains highly possible.

The outbreak was first detected in Kirkuk province, where 68% of laboratory-confirmed cholera cases have so far been reported, and then spread to Sulaymaniah and Erbil provinces.

Additional isolated cases of Cholera have also been identified in other parts of the country, including Tikrit (6 cases confirmed), Mosul (2 cases confirmed), Basra (1 case confirmed), Baghdad (2 cases confirmed) and Dahuk (1 case confirmed).

The Government of Iraq has mobilized a multi-sectoral response to the outbreak. Specific control measures have been reinforced and preventive measures to reduce the risk of transmission to unaffected areas have been put in place.

However, a severe shortage of chlorination products has been noted and replenishment is urgently needed to enable water supplies to be treated to render it safe for human consumption. Provision of safe water is the highest priority in controlling an outbreak of cholera.

WHO continues to support the National and local health authorities in the ongoing response operations. Ten interagency diarrhoeal disease kits, each sufficient to treat 400 moderate and 100 severe cases, arrived in Erbil International airport on 16 September.

Rapid diagnostic tests are being pre-positioned in remote health care facilities. In addition, 10% of all positive stool samples are being sent to NAMRU 3 reference laboratory(US Navy Advanced Research Unit) in Cairo for further confirmation and phenotypic characterization.

In controlling the spread of cholera, WHO does not recommend any special restrictions to travel or trade to or from affected areas.

http://www.who.int/csr/don/2007_09_25/en/index.html

[Theresa42]

Re: Cholera outbreak in Iraq

From the Egyptian newspaper, Al Wafd...

Google-translated from Arabic:

Panic cholera ravaging Iraq
The deaths of 12 patients in 2939 and the injury .. The fears of abandonment of the epidemic
Oct 2, 2007

Spread a state of alarm and panic in parts of Iraq for fear of turning to the cholera epidemic, after the deaths of 12 people and injured 2939 others infected. Dr. Amer الخزاعي senior agent of the Ministry of Health and spokesman for the Higher Committee to combat the cholera cases and 9 deaths recorded in Sulaymaniyah in the Kurdistan region and one case in Baghdad, Kirkuk and Mosul.

The source confirmed the high incidence of the disease, especially in the province of Kirkuk, north of Baghdad, where some 2069 injured satisfactory condition according to the last census, while the number of patients last Tuesday 1671 case. He pointed out that this means that injured about 100 people per day. It warned Naima short WHO representative of the United Nations in Iraq that any delay in providing water, food and health improved hygiene measures would lead to the spread of cholera considerably.

The first recorded cholera cases in the Kurdistan region late August. The regions of northern Iraq widespread cholera in 1999, as the disease spread in the governorate of Basra before the American invasion in March 2003.

http://www.alwafd.org/v3/News/NewsDetail.php?id=724&type=main&PHPSESSID=14896895bf28e85e5458257bd41b9f7a

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

Cholera spreading through Iraq

october 01, 2007

Cholera, the contagious bacterial disease spreading through Iraq, is reportedly claiming 100 new victims a day in this war torn country.

Doctor Amir al-Khuzai, the health ministry's point man in tackling the crisis, said the number of infections in Kirkuk had risen to 2,069 at the weekend from 1,671 earlier in the week.

Twelve Iraqis are confirmed to have died of cholera since the outbreak was first detected on August 23, but the disease struck in Baghdad last week and a mass awareness campaign has been launched.

A mass awareness campaign has been launched in Baghdad to combat the disease, that has claimed the lives of twelve Iraqis so far.

Khuzai said that the latest health ministry statistics up to Sunday indicated that a total of 2,839 people had now become infected with the disease.

WHO spokeswoman Fadela Chaib has said that the spread of cholera in Baghdad was not unexpected, due to the wave of people and goods moving between the Northern provinces and the capital.

http://www.entekhabnews.net/ASIA-NEWS/Society/3909.html

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

Cholera in Iraq - update 3

3 October 2007

Since the cholera outbreak was first detected in Kirkuk, Northern Iraq, on 14 August 2007, it has spread to 9 out of 18 provinces across Iraq.

It is estimated that more than 30 000 people have fallen ill with acute watery diarrhoea, among which 3 315 were identified as positive for Vibrio cholerae, the bacterium causing the disease.

A total of 14 people are known to have died of the disease. The case-fatality rate has remained low throughout the outbreak indicating that those who have become sick have been able to access adequate treatment on time.

The disease is continuing to spread across Iraq and dissemination to as yet unaffected areas remains highly possible. Epidemiological curves are still rising in the provinces from which the majority of laboratory-confirmed cases have originated, Kirkuk (2309) and Sulaymaniah (870). An increasing number of cases of acute watery diarrhoea has also been reported in Diala, a province neighbouring Baghdad.

Although V. cholerae has not yet been laboratory confirmed, the clinical symptoms indicate the presence of cholera. The numbers of cases are remaining stable in Basra, Baghdad, Dahuk, Mosul and Tikrit. However, a case has now been confirmed in Wasit, a province that has previously been unaffected by the outbreak.

The Government of Iraq has mobilized a multi-sectoral response to the outbreak. Specific control measures have been reinforced and preventive measures to reduce the risk of transmission to unaffected areas have been put in place.

However, the overall quality of water and sanitation is very poor, a factor known to greatly facilitate cholera contamination. WHO is in the process of procuring 5,000,000 water-treatment tablets and two international WHO epidemiologists are being deployed to support the Ministry of Health in Iraq.

WHO does not recommend any restrictions to travel or trade to or from affected areas as a means to control the spread of cholera. However, neighbouring countries are encouraged to reinforce their active surveillance and preparedness systems.

Mass chemoprophylaxis is strongly discouraged, as it has no effect on the spread of cholera, can have adverse effects by increasing antimicrobial resistance and provides a false sense of security.

Use of the current internationally available prequalified oral cholera vaccine is not recommended once an outbreak has started due to its 2-dose regimen and the time required to reach protective efficacy, high cost and the heavy logistics associated with its use.

The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the high occurrence of severe adverse reactions.

http://www.who.int/csr/don/2007_10_03/en/index.html

[Gert van der Hoek]

Re: Cholera outbreak in Iraq

Iraq sees "catastrophe" with new cholera cases

Thu Nov 22, 2007 10:19am EST

By Aseel Kami

BAGHDAD (Reuters) - Iraq is facing a health "catastrophe" in the capital Baghdad, with reports of cholera rising sharply over the past weeks to more than 80 new cases, the Health Ministry said on Thursday.

Most of the new cases have been reported in the eastern part of Baghdad, especially in poor areas routinely deprived of water and other basic services, an official at the ministry said.

One cholera death was recorded in November, in addition to another death in September, said the official, who asked not to be named. "We have a catastrophe in Baghdad," she said.

In western Baghdad, six people at a government home for the disabled were confirmed to have the disease, she said. Another girl at the al-Hanan Institute for the Severely Disabled died from the disease.

The Health Ministry official blamed a lack of proper sanitation for the cholera cases at the institute.

Cholera, which is normally caused by consuming water or food containing the Vibrio cholerae bacterium, causes diarrhea and can swiftly kill its victims.

The official said that six governmental hospitals suffer from unsafe water supplies, including Yarmouk, one of Baghdad's chief hospitals.

A November 13 report from the United Nations reported 22 deaths from cholera this year, and 4,569 laboratory-confirmed cases, almost exclusively in northern Iraq.

But the United Nations also warned that the illness is on the rise in Baghdad. It reported 49 laboratory-confirmed cases in the capital as of November 11.

The ministry spokeswoman said that Kirkuk province in northern Iraq was the epicenter of this year's outbreak, with 3,006 cases and five deaths.

In neighboring Sulaimaniya province, 14 people have died and 1,234 cases have been recorded. Arbil province, also in the north, has seen 275 cases, she said.

The ministry was trying to educate Iraqis about how to avoid the disease with advertisements on television and in newspapers and with leaflets handed out at checkpoints, she said.

http://www.reuters.com/article/newsOne/idUSKAM24764720071122?sp=true