Gorilla’s Guides

Summary:

As of 12th of September 2007, twenty one districts of Northern Iraq have reported laboratory-confirmed cases of cholera putting over 3.5 million people exposed to risk from this ongoing outbreak.

Fourteen out of sixteen districts of Sulaymaniyah province, all five districts of Kirkuk province and two out of seven districts of Arbil governorate  are now affected by this cholera outbreak in Northern Iraq. A map showing the affected districts together with statistical tables and charts can be found in the WHO Sitrep_8 which can be downloaded from here as a PDF.

There have been 10 deaths so far. The outbreak continues to be of major threat to public health in the region.

The source of the outbreak is still not known.

Rest of Irak

There is no sign that the disease has spread to any other part of Irak. See Cholera Sitrep_7 for the situation in Dhi Qar, Diyala, and Salah ad Din.

Baghdad

• A stool sample collected from a suspected case in Baghdad has tested negative for Vibrio Cholerae.

Ninawa Governorate

• One stool sample collected from Mosul has shown positive growth for Vibrio Cholera at the local public health laboratory and is now being retested at the National Public Health Laboratory in Baghdad.

The remainder of this posting deals with the affected governorates and the measures being taken to contain the outbreak:

Arbil Governorate

The outbreak spead to Arbil governorate on September 6th 2007. Apart from Arbil centre and Koisnjaq district, no other district in the province has, so far, reported any laboratory-confirmed case of Vibrio cholerae. The total number of cases of diarrhoeal disease reported as of 10th of September stands at 11,641 with no deaths.

At-Ta’mim (Kirkuk) Governorate

The outbreak first started in this governorate on August 14th 2007. The greatest number of cases are from Kirkuk city. The weekly progression of cases clearly indicates an increase in caseload over recent weeks. This could be because of:

1. Improved reporting.
2. Increased public awareness resulting in more cases seeking consultation in health centres.
3. An actual increase of case load as the outbreak keeps unfolding and more and more people are being exposed to the source of infection.
4. Some combination of the above.

Of the 6,749 cases reported from Kirkuk province from 29th July to 12th of September 2007, it is still not clear how many of these reported cases of diarrhoeal diseases are attributable to cholera since the first index case of cholera, confirmed by laboratory test, was reported on 14 August 2007. So far only aggregate data on case counts of all diarrhoeal diseases are available. As the surveillance systems for cholera improves throughout the province with more comprehensive surveillance data on cholera available from the field, the real extent of the burden of cholera in the province could be recognised.

Sulaymaniyah Governorate

The outbreak spread to Sulaymaniyah province on 23 August 2007.  As of 10th of September, the outbreak has spread to eight out of eleven districts in the province exposing over 1.3 million people living in this governorate to this epidemic risk. The majority of cases reported belong to the over 5 year age group. 4,289 cases of acute watery diarrhea were reported in the above 5 year age group compared to only 599 cases reported in the below 5 year age group.

Ongoing Control Measures For Containment Of Outbreak:

• The health authorities of Sulaymaniyah and Kirkuk governorates have initiated a number of public
  health control measures to contain the current wave of cholera outbreak.
• Coordination and Information management measures are now in place in every governorate in Irak.
• Operations rooms have been set up at the governorate level ministry of health in order to better manage information flow.

Surveillance for cholera:

WHO-Iraq office is helping the health authorities strengthen their surveillance system for generating better quality comprehensive data on the current outbreak.

• Necessary surveillance guidelines, case definitions and reporting forms have been distributed to all hospitals and health centres for notifying cases.
• A number of training courses have also been organized for the surveillance officers on data management.
• Five training courses are being organized for the laboratory technicians to improve the competency of the local laboratory technicians on cholera diagnostic assay.
• A laboratory based surveillance system has been established in all the districts of the provinces which are in geographic proximity to the affected areas.
• Stool samples are being collected regularly from suspected cases and tested in order to  detect any cholera case early as well as to provide an early alert for an impending outbreak.
• A daily reporting system for diarrhoeal diseases has been introduced in all the potentially high risk districts.

Risk communication:

• Religious leaders, community heads, medical, nursing and pharmacy students have been involved in organising health education campaigns in the affected areas in order to raise public awareness for maintaining minimum hygiene standards and food safety at household level.
• WHO-Iraq office has reproduced 7,000 posters on WHO’s Key Food safety messages in the Kurdish language.

Improving environmental management:

• All the public water supply systems (Piped water supply, household tanks, deep wells, private wells, deep tubewells, etc).in the affected governorates have been chlorinated by the governorate authorities.
• Water samples from the public water supply sources are being collected and tested routinely to detect water contamination.
• In Sulaymaniyah province, several field teams have been formed and logistical support provided by the authority for water quality surveillance and control programme. 
• The chlorination teams have been trained by WHO on treating contaminated water using chlorination before
  deployment.
• Chlorine powders and chlorine tablets have been made available in all the affected areas. More than 1100 families who were without public water supply have been distributed family hygiene kits containing soap, bucket and chlorine tablets. 
• Clean and safe water are also being distributed to the families living in the affected areas through water tankers.
• Improving the sanitation situation of the affected families have been promoted though hygienic disposal of sewage.

Indexed under: Arbil (Erbil), Baghdad, Disputed Areas, Follow Up, Kirkuk, Kirkuk (At-Ta'mim) Governorate, Ninawa (Governorate), Sulaymaniyah, الكوليرا

Posted on September 16th, 2007 under Cholera, Health, Iraq, Series. Tags: Arbil (Erbil), Baghdad, Disputed Areas, Follow Up, Kirkuk, Kirkuk (At-Ta'mim) Governorate, Ninawa (Governorate), Sulaymaniyah, الكوليرا. RSS 2.0 feed. Leave a response, or trackback.