Gorilla’s Guides

Cholera Sitrep_13

Overview:

As of 20th of September 2007, 23 districts of Northern Iraq and 4 districts in the south and center have reported laboratory-confirmed cases of cholera. The outbreak appears to be spread to the neighbouring governorates:

• Only one district of Sulaymaniyah governorate does not have reported laboratory-confirmed cases of cholera
• All five districts of Kirkuk governorate.
• 4 out of seven districts of Arbil governorate,

are now affected by this cholera outbreak.

4 districts in the southern and central governorates have reported laboratory-confirmed cases of cholera. One district in each of:

• Baghdad.
• Basra.
• Mosul.
• Tikrit.

are now affected by this cholera outbreak. A total of 1652 laboratory confirmed cholera cases have been officially reported of which:

• 1644 are of the inaba serotype. have been officially reported.
• 8 are of the ogawa serotype  have been officially reported.

Spread of the outbreak 1:

• 99% of cases were reported from Sulaymaniyah and Kirkuk governorates in northern Irak. The out break seems to be slowly spreading to the adjacent governorates of Arbil and Diyala 74 cases have been reported during the last week.
• Sporadic cases with definite history of travel and food consumption in Kirkuk were reported from both Mosul in Ninawa governorate and Tikrit in Salah ad Din governorate.
• Isolated cases with no epidemiological link to northern Irak have been confirmed in both Baghdad and Basrah.

Spread of the outbreak 2:

Apart from:

• The three affected provinces of Northern Irak.
• Baghdad.
• Basrah.
• Diyala.
• Mosul.

There is no sign that the disease has spread to any other part of Iraq.  However, as the weather cools and become more favourable for transmission, the organism is expected to spread to other provinces.

New focus of the outbreak:

One of the important features in this outbreak is that most of the cases seen have mild to moderate signs and symptoms. The traditional signs and symptoms of severe dehydrating diarrhea were seen only very occasionally, out of the 1652 lab confirmed cases; only 10 deaths were reported. All of the deceased had another serious underlying cause.

However during the last 72 hours WHO received reports of a new focus in Diyala governorate which lies to the south of the original focus.

In this new focus 6 patients from Al Muqdadiya district, presented to Baladruz district hospital with severe dehydrating diarrhea with renal shut down in one of them. Unfortunately, specimens collection was done late after patients received antibiotics and culture results -done by inexperienced staff in Baquba general hospital, one of the hottest areas of Iraq- were found negative for V cholera. It is not yet clear whether the organism is becoming more virulent or the population in this new focus is more susceptible to the disease. (Editor’s note: See Maryam’s posting ” Cholera Update September 22nd 2007.”

WHO is working closely with the Ministry of Health  to send 10% of the positive isolates to the NAMRU3 reference Lab in Cairo for phenotypic characterization.

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. (See Sitrep_10 for full details.)

Reports By Governorate Developments:

Al Anbar

All specimens collected since the beginning of the month were negative for Cholera organism (No change.)

Arbil Governorate

4 out of the 7 districts in Erbil governorate have reported 78 (an increase of 10) laboratory-confirmed case of Vibrio cholerae. The total number of cases of diarrhoeal disease reported from this province from 1st of September to 20th of September stands at 15134 with no death;

At-Ta’mim (Kirkuk) Governorate

No change from previous reports.

Baghdad:

WHO has no confirmed reports of new Cholera cases in Baghdad since yesterday’s case was reported.

Basrah:

WHO has no confirmed reports of new Cholera cases in Basrah since yesterday’s case was reported.

Diyala:

In addition to the 4 clinically diagnosed cases reported in the previous 3 reports. An additional 4 suspect cholera cases from the same village in Al- Muqdadiya district were notified today. All males; 3 adults and a 12 year old child. Patients were admitted to Balad Ros district Hospital as suspected Cholera. The 4 patients consulted Balad Ros hospital because of deteriorating security condition in the road to Al- Muqdadiya hospital .

A health team from Balad Ros visited that village to investigate the situation and implement preventive measure. The team collected 26 stool samples from the contacts. 2 out of the 5 districts of Diyala province, where half a million people live (representing 36% of Diyala population) are still beyond the full control of the local health authorities.

The stool samples of 3 out of the 4 patients (reported on sitrep 10) tested negative for cholera organism in Baquba general hospital, however, all patients were on antibiotics before collection of specimens. All are diagnosed by treating doctors as Cholera on clinical grounds. The 4th cases is a 9 month child admitted to Al- Batool pediatric hospital in Diala, stool specimen results expected tomorrow.

Ninawa:

Mosul:

1. A new cases of V cholera was locally diagnosed today, the case will not be officially notified till confirmation by the Central Public Health Lab in Baghdad. However, CDC Mosul once notified deployed the rapid response team to investigate the case. The visit revealed the followings: The new case is a 60 years old female living with a family of 9 in Aymen district of Mosul City.
2. Date of onset of the disease 17th Sep. as abdominal pain, nausea and watery diarrhea. No vomiting, no fever and no blood in stool.
3. No history of diarrhea or vomiting between the nine members of her family in Mosul.
4. The patient traveled to Kirkuk on 11th Sep. and returned to Mosul on 13th Sep.
5. No cases of diarrhea or vomiting among members of the host family.
6. Investigation of diarrhea cases in neighbourhood families was negative as well.

Salah ad Din:

Tikrit:

2 additional cases were confirmed the total confirmed cases is now  3 all are adults, the first was a definite importation while the following 2 cases seems to have acquired the infection from a visiting relative who came from Kirkuk suffering from diarrhea.

Sulaymaniyah Governorate

20 new cases were confirmed.

Indexed under: Arbil (Erbil), Baghdad, Baghdad (Governorate), Baghdad Hospitals, Baqubah, Basrah, Briefings, Cholera Situation Reports, Disputed Areas, Diyala, Follow Up, Khalis, Kirkuk, Kirkuk (At-Ta'mim) Governorate, Mosul, Ninawa (Governorate), Salah ad Din (Governorate), Sulaymaniyah, Tikrit, Water, Water Borne Disease, Water Crisis (Iraq), World Health Organisation, الكوليرا