Gorilla’s Guides

Cholera Sitrep_24

Overview:

39 districts in Irak are now affected by this cholera outbreak an increase of 6 since since October 1st 2007.

WHO report 3770 laboratory-confirmed cases of cholera This represents an increase of 967 laboratory confirmed cases of cholera since our last report in this series and an increase of 455 laboratory confirmed cases of cholera reported by WHO in sitrep 22. (Sitrep 23 is not available.)

16 deaths have now been reported an increase of 2 since our last posting in this series.

North Irak:

• 13 out of the 14 districts of Sulaimaniyah governorate
• All five districts of Kirkuk governorate
• 6 out of the seven districts of Arbil governorate
• one district in Dahuk.

Are affected by this cholera outbreak.

Central and Southern Irak:

• 3 districts in Salah ad Din (Tikrit)
• 3 districts in Ninawa (Mosul)
• 3 districts in Diyala.
• 2 districts in Basra
• 1 district in Wassit,
• 1 district in Baghdad
• 1 district in Anbar .

Are affected by this cholera outbreak.

Of the cholera cases reported by WHO 96% were reported from Sulaymaniyah and Kirkuk, the out break seems to be slowly spreading to the neighboring provinces of Arbil and Diyala. Arbil now has 147 laboratory confirmed cases. While in Diyala there are 3 laboratory confirmed cases and 41 diagnosed on clinical and epidemiological grounds.

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 3770 laboratory confirmed cholera cases; only 16 death were reported, most of the deceased have another serious underlying cause.

Apart from the affected governorates there is no sign as yet that the disease has spread to any other part of Iraq. However, as the weather cools and become more favorable for transmission, the organism is expected to spread to other provinces. Preventive measures have been taken to reduce the risk of transmission of cholera to other high
risk areas. Epidemic preparedness for cholera has been geared up in all provinces. Surveillance system for diarrhoeal disease has been intensified in all governorates. During the period 01 to 04 October 10778 diarrhea cases were reported from the 16 no-epidemic Directorates of health; 9067 stool samples were collected from these diarrhea cases and 19 cases were found positive for vibrio cholera.

Table-1 below and map figure 1 show the distribution of confirmed cholera cases by district in Irak.

Table-1: Reported laboratory confirmed cholera Cases, Irak, 23/08-30/10/2007

Governorate/ Province	No of districts affected	Date outbreak started	No: of deaths reported	laboratory- confirmed case of cholera
Sulaymaniyah	13	23/08/07	11	761
Kirkuk	5	14/08/07	3	2635
Arbil	6	06/09/07	0	147
Dahuk	1	23/09/07	0	1
Ninawa (Mosul)	3	15/09/07	0	3
Salah Ad Din (Tikrit)	3	12/09/07	0	5
Baghdad-Resafa	1	19/09/07	1	4
Wasit	1	20/09/07	0	1
Basra	2	19/09/07	0	2
Anbar	1	03/10/07	1	1
Diyala	3	03/10/07	0	3
Total	39		16	3770

*219 cases included in previous reports as confirmed cholera case were found to be for carriers they have therefore been subtracted from the previous total for Kirkuk

Map figure 1 below. is a clickable thumbnail showing the distribution of cases throughout Irak. The link will open in a new window or tab depending on your browser’s configuration.

Detailed reports by governorate/district are below the fold:

Al Anbar

• The death of a 5 year old child in Hit that we reported in Cholera Sitrep_20 (Corrected) has now been confirmed.

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 break.
• Unlike the situation in both Kirkuk and Sulaimaniyah there is a definite downward trend in reported diarrhea cases. The number of cases in week 38 and 39 is almost the same as the pre-out break figure. In figure 1 below 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 Sulaimaniyah.

  Figure 1: Diarrhoeal cases by age group & international weeks, Arbil 03/09/2007 to 30/09/2007

  

• This success in Arbil is mainly due to the fact that key departments (water and sanitation) have recognised their important and vital role in the fight against cholera unlike the situation in Kirkuk where key departments are just watching the situation and making a minimal or no contribution.
• Figure 2 below shows show the number of confirmed V cholera by date of onset for the period 05 September to 5th of October 2007. Although it is too early to detect any pattern but the general trend shows slight down trend in the number of the daily confirmed cases.

  Figure 2: Confirmed cholera cases and contacts, by date of onset, Arbil Governorate, Sep. & Oct. 2007

  

• The infected 6 districts in Arbil governorate have reported up 5th of October 147 laboratory-confirmed case of O1 El Tor Inaba. The total number of cases of diarrhoeal disease reported from this province from 1st of September to 5th of October stands at 19,677 with no death; 516 stool samples were collected out of which 159 were positive; 147 for cases and 12 from contacts.

At-Ta’mim (Kirkuk) Governorate

• As figure 3 below shows between weeks 33 and 39 (ending 30th October) there was a fourfold increase in the number of diarrhea cases among adults.
• The figure also shows that there was a twofold increase in the number of diarrhea cases among children under the age of 5 in the same period.

  Figure 3: Reported diarrhoea for the period 13/08 to 30/09 by age group and international weeks, At-Ta’mim (Kirkuk) Governorate

• This increase which is most probably a real increase in diarrhea cases can be partly explained by better reporting and better community treatment seeking behavior. However, there are indications that some patients may be seeking treatment in more than one health facility and the same patient is reported as a new case from 2 or more health facilities.
• It is not certain whether this sustained increase in reported diarrhea will continue during the upcoming weeks
• Figure 4 below shows that laboratory confirmed cholera cases have peaked at the level of 120 case per day during the period 16-27/09 and then decreased and leveled at 100 cases per day during the period 28/09 to 03/10/2007.

  Figure 4: Daily confirmed cholera cases, At-Ta’mim (Kirkuk) Governorate, 20/08-03/10/2007

  

• 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.
• It is also worth noting that unlike in Arbil in Kirkuk the water and sanitation departments appear not to have recognised their important and vital role in the fight against cholera and are just watching the situation and making a minimal or no contribution. Sending green zone government MoH deputy minister Dr. Isam Mamiq and CDC/Baghdad and Central Public Health laboratory staff on a mission to lead the cholera containment activities in Kirkuk appears to have had little if any effect in this regard.

Babil Governorate

• No reported change.

Baghdad

• The total number of laboratory confirmed cholera cases jumped to 4 including one death. The 4 cases were reported from Al- Madain district in Baghdad Resafa.
• A team from CDC/Baghdad Baghdad-Resafa DoH and WHO visited the 2 hospitals in Madain districts and came to the conclusion that much need to be done in terms of surveillance and environmental sanitation.

Basra Governorate

• A second cholera case was confirmed on October 4th 2007, bringing the number of cholera cases to 2 from 2 different districts.

Dahuk Governorate

• No change since last WHO sitrep. There has been one 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

• There are 2 laboratory confirmed cases from two different districts, Baqubah and al-Khalis. Both are adults both were admitted to Baqubah general hospital suffering from acute watery diarrhea and extreme dehydration.
• Between September 15th 2007 and October 4th 2007 44 suspect cholera cases were reported from Balad Roz, Salahaddin, Hibhib, Al-Udhem and Baqubah hospitals and PHCs suffering from extreme dehydration with renal shut down in one of them. Since the remaining 42 cases were clinically diagnosed as cholera and epidemiologically linked (in time and place to the confirmed cases) these 42 cases can safely be classified on epidemiological and clinical basis as confirmed cholera cases; brining the total cholera cases in this province to 44.

Ninawa Governorate

• (Mosul) : There are 3 confirmed cases (no change since last sitrep. ) However 3 districts are now confirmed as being affected by this cholera outbreak. An increase of 2 since out last posting.

Salah ad Din Governorate

• (Tikrit) During the period September 11th to 3rd October; 2012 diarrhea cases were reported - an increase of 574 since our last report.
• 1408 stool specimens were collected, 8 of them were positive for 01 vibrio cholera, 5 were for cases and 3 for healthy carriers.
• 5 districts are confirmed as being affected by this cholera outbreak an increase of 2 districts.

Sulaymaniyah Governorate

• The total number of laboratory confirmed cases up to the 6th of October reached 968 an increase of 162 since our last posting in this series and and an increase of .
• Fig 5 below shows that confirmed cases peaked in week 36 and then showed a slight down trend and leveled during weeks 37 to 39 however; an increase is seen in week 40 indicating another wave of cases.

  Figure 5: Changing proportion of confirmed Cholera cases, between Sulaymaniyah city and areas outside side the city by week of onset, Sulaymaniyah governorate 26 August to 6 October.

  

• The increase seen in week 40 seems to be related to reporting of more and more cases from out side Sulaymaniyah city, during the early phase of the out break (week 35) , 90% of cases were reported from Sulaymaniyah city, by week 40 only 39% of cases were reported from within the city This could indicate indicating either:

  1) Improved surveillance out side Sulaymaniyah city or;

  2) Spread of the disease to other districts outside Sulaymaniyah city implying that there is relatively good control inside the city and relatively poor control outside of it.

• Fig 6 below shows admitted diarrhea cases to the pediatric and teaching hospitals in Sulaymaniyah during the period 01/09 to 05/10/2007. It is clear that there is slight down trend the number of admitted of below 5 years old and above 5 years old in the last 3 days.

  

Wasit Governorate

• WHO report one confirmed case reported from this governorate. However as we noted in our last report two deaths have been reported from normally reliable sources but have yet to appear in WHO’s figures.

Technorati : Cholera, Iraq, Water, Water Borne Diseases, cholera

Indexed under: Al Anbar (Governorate), Babil (Governorate), Baghdad, Baghdad Hospitals, Baqubah, Basrah, Cholera Situation Reports, Dahuk (Dohuk) (Governorate), Dhi Qar (Governorate), Disputed Areas, Diyala, Follow Up, Hit, Khalis, Kirkuk, Mosul, Ninawa (Governorate), Salah ad Din (Governorate), Sulaymaniyah, Tikrit, Water Borne Disease, World Health Organisation, الكوليرا