Gorilla’s Guides

Cholera Sitrep_21

Overview:

As of October 1st 2007, 33 districts in Irak are affected by this cholera outbreak.

A total of 33 districts are affected. 26 districts of Northern Iraq and 7 districts in the south and center.

• 13 out of the 14 districts of Sulaymaniyah governorate.
• All five districts of Kirkuk governorate
• All seven districts of Arbil governorate
• One district in Dahuk
• 3 districts in (Salah Ad Din) Tikrit
• One district in Ninawa (Mosul),
• One district in Baghdad
• One district in Basrah
• One district in Wasit

are now affected by this cholera outbreak.

There are 2803 laboratory-confirmed cases of cholera in all together with a number of cases diagnosed on clinical grounds.

The total of 2803 cases represents an increase of 45 laboratory confirmed cases since the last situation report. .

• 96% of Iraq’s cholera cases were reported from Sulaymaniyah and Kirkuk.
• The out break seems to be slowly spreading to the neighbouring governorates of Arbil and Diyala.

  - Arbil has  111 laboratory confirmed cases.

  - Diyala has 31 cases diagnosed on clinical grounds.

• There appears to be a developing upward trend in Sulaymaniyah governorate.
• In Kirkuk the daily reported diarrhea cases, confirmed cholera cases and severity of the disease seems to be on the increase.
• One of the important features in this out break 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 2803 lab confirmed cases; only 14 death were reported, most the deceased have
  another serious underlying cause.
• Apart from the affected governorates there is no sign that the disease has spread to any other part of Irak. However, as the weather cools and become more favorable for transmission, the organism is expected to spread.

Table-1: Cases of laboratory confirmed cholera cases reported from Iraq

Detailed reports by governorate/district are below the fold:

Al Anbar

• No change since last sitrep.

Arbil Governorate

• Arbil seems to have a fairly sensitive diarrhea disease surveillance system that was able to pick up cholera cases very early a swift response seems to have succeeded in halting and limiting the spread and magnitude of the out breakout.
• Unlike the situation in both Kirkuk and Sulaimaniyah there  a definite downward trend in reported diarrhea cases. The number of cases in week 38 is almost the same as the pre-out break figure. The very high number of cases in week 36 is most likely due to the feeling of panic following the declaration by MoH of the occurrence of cholera in Kirkuk and Sulymania. (See figure below)

  .

• There appears to be downward trend in cholera cases. The below figure show the number of confirmed V cholera by date of onset for the period 05-29 September 2007. It is too early to detect any pattern but the general trend shows a slight downwards trend in the number of the daily confirmed cases.

   

• The 7 districts in Arbil governorate have reported 111 laboratory-confirmed cases.
• The total number of cases of diarrhoeal disease reported 1st of September to 27th of September stands at 17906 with no deaths.
• 4361 stool samples were collected out of which 123 were positive 111 for cases and 12 from contacts.

At-Ta’mim (Kirkuk) Governorate

• The data for the period 27/08 up to 23/09 show a step wise increase in the number of reported diarrhea cases. This which may be a reflection of better reporting and community awareness.
  
  

   

• The number of confirmed cholera cases as expected is showing a similar trend. However, WHO do not have the complete data for weeks 38 & and 39 to reach any plausible conclusion.
• 68% of the total confirmed cholera cases reported from Iraq, are from Kirkuk province. 90% of Kirkuk province cases are from the city of Kirkuk.
• Despite the effort exerted by the DoH authorities; the daily reported diarrhea cases, confirmed cholera cases and severity of the disease seems to be on the increase.
• It is worth noting that despite assurances that the public water supply is safe and repeated efforts by local health authorities that the source of this outbreak is still untraced for the cases in Kirkuk city.

Babil Governorate

• No reported change in latest sitrep.

Baghdad

• No change since last sitrep.

Basra Governorate

• No change since last sitrep. There are reports of further deaths however we do not regard them as from a reliable source team members in Basrah are trying to find get reliable data. They say that there are many rumours but so far the outbreak seems to have been contained. It is worth noting that even for health professionals living and working in the governorate it can be very difficult to get reliable information.

Dahuk Governorate

• This governorate has so far reported one laboratory confirmed case in a 5 year old female child from Bardarash district. The case was detected during the routine testing of cases presenting to health facilities with watery diarrhea.
• Further investigation of contacts and water supply was negative for V cholera organism.

Diyala Governorate

• 31 cases from Diala have been diagnosed on clinical grounds.
• The results of 22 cases tested negative to V cholera while 9 are still pending.

Ninawa Governorate

• Mosul : No change since previous sitrep.

Salah ad Din Governorate

• Tikrit: Three districts are affected in Tikrit. During the period 11-27 September 1438 diarrhea cases were reported; 1031 stool specimens collected, 8 of them were positive for 01 vibrio cholera, 4 were for cases and 4 for healthy carriers.

Sulaymaniyah Governorate

• The total number of laboratory confirmed cases up to the 30th of September reached 806 an increase of 45 since the last sitrep.

  Fig 1 below shows that confirmed cases peaked in week 36 and then showed a slight down trend during weeks 37 & 38 however; a definite upward trend is seen during week 39.

  Figure 1: Weekly laboratory confirmed cholera cases, Sulymania governorate, 27 August - 29 September 2007

  

• 70% of confirmed cholera cases in this governorate were reported from the capital of Sulaymaniyah. The chart below shows admitted diarrhea cases to the pediatric and teaching hospitals during the period 1-29 September 2007. It is clear that there is slight upward trend the number of admitted below 5 children in the last 2 days, as for above 5 cases there is a clear upward trend.  (For purposes of comparison see  sitrep 18  and sitrep 20 Sulaymaniyah Section of the posting.)

  

 

Wasit Governorate

• WHO report one confirmed case reported from this governorate. Two deaths have been reported from normally reliable sources but have yet to appear in WHO’s figures.

Indexed under: Al Anbar (Governorate), Arbil (Erbil), Babil (Governorate), Baghdad, Baghdad (Governorate), Baghdad Hospitals, Basrah, Briefings, Dahuk (Dohuk) (Governorate), Disputed Areas, Diyala, Follow Up, Hit, Kirkuk, Kirkuk (At-Ta'mim) Governorate, Mosul, Salah ad Din (Governorate), Sulaymaniyah, Wasit, Water Borne Disease, Water Crisis, Water Crisis (Iraq), الكوليرا