ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

[alert]

http://promedmail.org/pls/apex/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82576

Archive Number 20100505.1464
Published Date 05-MAY-2010
Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever - Iraq: (NI), RFI


UNDIAGNOSED HEMORRHAGIC FEVER - IRAQ: (NINAWA), REQUEST FOR INFORMATION
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******
[1]
Date: Wed 5 May 2010
Source: Aswat al Iraq [machine translation, abbrev. & edited]
<http://ar.aswataliraq.info/?p=220487>


Hemorrhagic fever deaths after eating contaminated meat
-------------------------------------------------------
The director-general of health of Nineveh, on Mon 5 May 2010, announced
that the deaths of 4 people in Mosul during the past 2 days were due to a
"haemorrhagic fever" as a result of eating contaminated meat.

Dr Salah al-Din told the Voices of Iraq Agency that 4 people "had died in
the past 2 days after contracting a haemorrhagic fever that has spread in
Mosul", indicating that a virus had been contracted from contaminated red
meat slaughtered in an unhealthy way.

He reported that the Mosul Health Department "had closed a number of shops
selling meat in the Jerusalem district (Mosul east), the area where the
victims resided which had sold meat slaughtered in an unhealthy way". He
stated that the Health Department "had sprayed the butcher's shop and the
homes of the victims with pesticide [disinfectant?]."

[It was announced that] the burial of the dead with the disease "should be
deep enough underground for fear of transmission of the virus". The people
of Mosul were warned only "to purchase red meat from licensed premises and
to avoid purchasing meat from street vendors for their own safety."

Mosul is the capital city of Ninawa (Nineveh) province, situated 405 km
[252 miles] north of Baghdad.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Wed 5 May 2010
Source: Alesbuyia [machine translation, abbrev. & edited]
<http://www.alesbuyia.com/inp/view_printer.asp?ID=10202&AUTHOR=%E4%ED%E4%E6%EC%20-%20%C7%C8%D1%C7%E5%ED%E3%20%DD%C7%C6%DE>


A total of 4 people have died and another 3 are under observation in the
Al-Salam Hospital in Mosul, suspected to have contracted a viral
haemorrhagic fever. An employee of a hospital [stated] that 7 patients
suffering from a viral haemorrhagic fever had been admitted to the
emergency department of the hospital on 29 Apr 2010. The employee said that
4 of these 7 affected people had died in hospital and the 3 others remained
in isolation.

The employee explained that the hospital administration had closed the
emergency department of the hospital for 3 days and only reopened it after
thorough disinfection. The source added that all the victims had purchased
meat from a private butcher who had not slaughtered animals in an abattoir
inspected by the Health Department [perhaps "had slaughtered animals in an
abattoir not inspected..." - Mod.SH].

The source stated that the patients exhibit symptoms compatible with viral
haemorrhagic fever, with extensive bleeding that resulted in death within
36 hours of exposure.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Viral haemorrhagic fevers contracted from exposure to raw meat are likely
to be caused by either Crimean-Congo haemorrhagic fever virus (CCHFV) or
Rift Valley fever virus (RVFV). CCHFV is endemic in the region and the
favoured candidate for this outbreak in northern Iraq. In 2009 an outbreak
of Crimean-Congo haemorrhagic fever was recorded among abattoir works in
neighbouring Iran.

Rift Valley fever has never been recorded as far north as Mosul. The only
previous outbreaks of Rift Valley fever outside of the African continent
occurred in the south of Saudi Arabia and in Yemen. Currently the only
known cases of Rift Valley fever are occurring in South Africa. Further
information is awaited.

A map of the provinces of Iraq, showing the location of the province of
Ninawa (Nineveh; formerly Mosul province), can be accessed at
<http://www.goalsforamericans.org/gallery/v/maps/1-17-05ColorizedIraqMap.jpg.html>.
The HealthMap/ProMED-mail interactive map of Iraq is available at
<http://healthmap.org/r/01g8>. - Mod.CP]

 

[Ronan Kelly]

Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

Dr. Feras Ismail
10th May. 2010 WHO Medical Officer; Ninawa

Country: IRAQ Governorate: Ninawa
Emergency situation: Hemorrhagic Fever (HF) outbreak in Mosul Report: 3
Reported cases of HF
 Old reported cases: 9 cases, 7 (5 old + 2 new) are confirmed to be positive (3 deaths) by Central Public Health Laboratory CPHL in Baghdad. 2 cases confirmed negative by the same lab. and one cancelled by the reported site as the clinical presentation and investigations done at the hospital was not fit with HF.
 New suspected cases: 3 cases, 1 case confirmed to be positive and another one as negative by CPHL today 10th May. Blood sample of a new case was sent to CPHL.
Total: 8 positive, 2 negative, 1 pending, 1 cancelled. See Epicurve and map of HF cases in Ninawa downward
Current situation
On 6th of May, 40 years female presented with abdominal pain, malaise and coffee color vomits. She was resident in Al Qudis sector and had no history of contact to animals or to previous confirmed cases but history of buying meat from local butchers (could be the same butcher of the previous cases). She consulted Ibn Sena hospital on 1st of May and was diagnosed as peptic ulcer after doing endoscope for her and referred to Al Shifaa fever hospital for sampling and isolation as a suspected case of HF as well based on address and contact with suspected meat. Blood sample was collected on 9th May and lab. result was positive on the next day. On 8th May, Al Salaam hospital reported one suspected cases. She was 30 years female presented with fever, GIT symptoms and brown black vomits. Her address was Ayser district, Al NAbi Younis inside Mosul and she had no history of contact with animals or confirmed case or suspected meat. Blood sample was collected for her and sent to Baghdad on 9th May and the result received today as a negative case. On 10th May, a 23 years butcher from Aymen district consulted Al Shifaa fever hospital complaining from fever for the last few days and heamaturia for the last day. His platelets count showed decline in the titer and blood sample was collected and will be send to Baghdad tomorrow.
Interventions
 Governor of Ninawa headed a meeting this evening 10th May to discuss the interventions taken to control this outbreak. The meeting attended by the mayor of Mosul, DG of Mosul DoH, Director of police, managers of Al Shifaa hospital, PHC Department, CDC, veterinary hospital, food inspection and WHO focal point in Mosul. The meeting recommended the followings:
- the veterinary hospital and veterinary units in the districts to continuo their
campaign of dipping sheep, treat cattle with pesticides and spraying animal
farms with pesticides in coordination with the directorate of agriculture.
- Control the movement of animals across the boarders.
- Banning of unofficial slaughtering and direct observation from the
veterinary side on the slaughtering house and on the butchers.
- Re-checking the license of all the butchers and to put a penalty on each one
proved to have slaughtering outside slaughter house.
- Provision of kits to test suspected animals using PCR technique in the
veterinary collage.
- Concentrate on social mobilization and health education measures to rise the
awareness among livestock harbors, butchers and the community using all
the available tools including TV, Radio, posters and flix and cloth
announcement (already 40 out of 100 were printed and distributed in
different locations inside Mosul City .
 All cases were managed properly.
 Tomorrow there will be a training meeting for the laboratory technicians in the
hospitals on the epidemiology of the disease, lab. investigation and safe
dealing with the patients using proper PPEs.
 All reported cases were deeply investigated and their relatives and contacts
were investigated and monitored by teams from PHCCs in their catchments
area.
Needs  Support the displaying of health messages in the local satellites and radio.

http://ocha-gwapps1.unog.ch/rw/rwb.nsf/db900sid/MYAI-85K7RN/$File/full_report.pdf

 

[alert]

Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

Amazing find, RoRo. That article claims to be report #3, but I can't find reports #1 or #2 anywhere, which might illuminate exactly which hemorrhagic fever was confirmed.

 

[alert]

Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

I have been searching all over the internet for more information on this outbreak, and found an Arabic language site with the word "gorillia" in the name (that should let others find it) that I will not link to because it is covered in racist anti-Arab slurs, which identifies this disease as something that translates to "dengue" hemorrhagic fever. I know there was a previous incident in Saudi Arabia (http://promedmail.org/pls/apex/f?p=...CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,77793) in which the translator interchanged RVF and dengue, so that might tend toward RVF, but the higher fatality rate here also makes me suspect CCHF. Dengue itself is simply epidemiologically wrong here.

Of note also is that "gorilla" site does refer to the virus as the same one that caused two cases ten years ago, but I can't find a link to the earlier outbreak either.

 

[alert]

Re: ProMED: Undiagnosed hemorrhagic fever in Iraq after eating contaminated meat

This is almost certainly CCHF.

http://promedmail.org/pls/apex/f?p=..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82818

Archive Number 20100520.1669
Published Date 20-MAY-2010
Subject PRO/AH/EDR> Undiagnosed hemorrhagic fever - Iraq (02): (NI, DA) RFI

UNDIAGNOSED HEMORRHAGIC FEVER - IRAQ (02): (NINAWA, DAHUK) REQUEST
FOR INFORMATION
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<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 19 May 2010
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA)
ReliefWeb, NGO Coordination Committee in Iraq (NCCI) report [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db900sid/MUMA-85M3YF?OpenDocument&RSS20&RSS20=FS>


Iraq: brief emergency report on hemorrhagic fever
------------------------------------------------------------------
The MoH [has issued an order] to prevent movement of cattle coming
from Ninawa [Ninevah] governorate to Dohuk [Dahuk governorate] and
has imposed strict [controls] at entry points to prevent cattle
smuggling and the transport of meat and dairy produce from Mosul
because of the spread of [infection] in that city. The MoH earlier
announced that lab tests on 2 [fatal] cases and 4 suspected cases
[indicated that the outbreak was the result of infection by [a]
hemorrhagic fever [virus], and that the spread of [infection] was a
consequence of consumption of [contaminated] meat sold by street
traders. The MoH has instituted an awareness campaign in this regard.

[Veterinary officials] in Dohuk within the next few days will
implement a campaign in the area [around] Ninawa to sterilize animals
and cattle by showering anti intrusions [that is, carry out tick
disinfestation measures?] and vaccinating cattle. Also, there will be
mobile teams from MoH to ensure compliance. They have asked people to
cooperate with them in the face of this contagion and to follow
health instructions to prevent this disease from spreading.

Symptoms of viral hemorrhagic fever include fever, tiredness,
inappetence, sickness, sweating, flushing, and in severe cases might
include internal or external bleeding. Children may possibly have
spasms or go into a coma ending in death.

This pandemic disease previously [occurred] in Erbil and Dohuk in the
years 1994-1996 killing one person who was working as a veteran
assistant in Erbil; there were other infected cases.

--
Communicated by:
Shamsudeen Fagbo, DVM
<oloungbo@yahoo.com>

[Previously (see ProMED-mail archived report: Undiagnosed hemorrhagic
fever - Iraq: (NI), RFI 20100505.1464) it was inferred that the viral
hemorrhagic fever responsible for the deaths and infections in Ninawa
governorate was Crimean-Congo hemorrhagic fever virus. The identity
of the agent responsible for this outbreak of disease and the
consequent controls of livestock movements remains to be confirmed.
Further information from the region, verifying the identity of the
etiologic agent would be welcomed.

A map of the provinces [governorates] of Iraq, showing the location
of the adjacent provinces of Dohuk and Ninawa (Nineveh; formerly
Mosul province), can be accessed at
<http://www.goalsforamericans.org/gallery/v/maps/1-17-05ColorizedIraqMap.jpg.html>.
The HealthMap/ProMED-mail interactive map of Iraq is available at
<http://healthmap.org/r/01iG>. - Mod.CP]

[see also:
Undiagnosed hemorrhagic fever - Iraq: (NI), RFI 20100505.1464]
...................................cp/mj/mpp