Gorilla’s Guides

Cholera Sitrep_29

WHO report 4356 laboratory-confirmed cases of cholera This represents an increase of 585 laboratory confirmed cases of cholera since the last situation report on this cholera outbreak from the WHO (Sitrep 25).

As of 21 October 2007 (week 42), 24 districts of Northern Iraq and 15 districts in the south and centre have reported laboratory-confirmed cases of cholera.  The following are the affected governorates/districts that are affected by this cholera outbreak.:

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.

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 .

99% of Iraq’s cholera cases were reported from Kirkuk, Sulaymaniyah and Arbil, northern Iraq. Sporadic cases with definite history of travel and food consumption in Kirkuk were reported from Tikrit province; however, isolated cases with no epidemiological link to northern Iraq were also confirmed in Mosul, Wassit, Baghdad, Anbar and Basra.

New Laboratory-Confirmed Cholera Cases Reported During 15-21 October 2007 (Week 42):

• Kirkuk: 94 (of 697 samples tested)
• Sulaymaniyah: 49 (of 519 samples tested), 3 deaths.
• Erbil: 33 (of 713 samples tested)

Province/ Governorate	No of districts affected	Date outbreak started	No: of deaths reported	laboratory- confirmed case of cholera
Sulaymaniyah	13	23/08/07	14	1187
Kirkuk	5	14/08/07	4	2936
Arbil	6	06/09/07	0	211
Dahuk	1	23/09/07	0	1
Ninawa (Mosul)	3	15/09/07	1	3
Salah Ad Din (Tikrit)	3	12/09/07	1	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	5
Total	39		21	4356

Pattern Of Transmission In Kirkuk Governorate:

• 69% of the total confirmed cholera cases reported from Irak, are from Kirkuk governorate.
• 90% of Kirkuk governorate cases are from the city.
• During 15-21 October 2007 (week 42), 1,296 new diarrhoea cases were reported of those 748 were in children under 5 and 548 in were in people aged 5 and over.
• 94 were confirmed cholera-positive; the cumulative number of confirmed cholera cases is 2,936.

Figure 1 below shows an 8-fold increase in the number of diarrhoea cases among adults between week 33 and week 40, the week ending 07 October 2007, followed by a sharp decrease in reported diarrhoea cases in week 41.

• It should be noted that some of this decrease in diarrhoea during the last 4 days of week 42 especially among adults can safely be attributed to Eid holidays and population movement from urban to rural areas. 

  

• The figure shows that laboratory-confirmed cholera cases peaked at the level of 722 and 742 during weeks 38 (ending 23 September) and 39 (ending 30 September).
• This was followed by a sharp decrease during weeks 40 and 41 in the number of confirmed cholera. As noted in the last situation report it is not known whether this is a real decrease in cholera cases or an apparent decrease due to the new strategy of collecting stools from only 10% of cases, rather than 100% of cases in order to decrease the load on the laboratory and reduce the probability of contamination.
• As was also noted in the last situation report this new policy seems to have been implemented without a similar change in the case definition of confirmed cholera to include all watery diarrhoea cases.

Monitoring laboratory-confirmed cases

Monitoring the laboratory-confirmed cases there is:

1. A remarkable decrease in positives in Azadi lab during weeks 38-41.
2. A slow decline in Kirkuk PHL, Pediatric hospital, and total province positives.
3. An increase in positives of samples taken at Kirkuk Hospital lab.

The authorities in Kirkuk have made the following observations:

1. In Kirkuk city, the highest attack rate was in Arafa while the contamination in the area was the lowest, at the same time, the lowest attack rate in Kirkuk city, was in areas with highest degree of contamination. Therefore in Kirkuk city, other reasons for spread of cholera apart from water contamination need to be considered
2. In Dibbis District and at Taza PHCCC, there is correlation between cholera cases and water contamination, attributed to low chlorine level in the water projects, as well as the condition of pipe and storage of drinking water reservoirs.

Pattern Of Transmission In Sulaymaniyah Governorate:

Figure 2 below shows the hospital admissions for diarrhoea in the 2 main hospitals in Sulaymaniyah city vs. laboratory-confirmed cholera, Sulaymaniyah province, (27/08/07-21/10/07):

• During 15-21 October 2007 (week 42), there 49 were confirmed cholera-positive and 3 deaths (14 total since begin of the outbreak);

   

• The total number of confirmed cholera cases is 1,187 (figure 2).
• 90% of cases were reported from Sulaymaniyah city, indicating spread of the disease to other districts outside Sulaymaniyah city
  with relative good control inside the city.

Fig 3 below shows the Diarrhoea cases admitted to the 2 main hospitals in Sulaymaniyah city by date of onset the date range for the data is 01/09-21/10/2007 the figure shows that:

• There was sustained increase between 2 and 6 October
• There was sharp downward trend in the number of admitted patients after that date.

  

Pattern Of Transmission In Arbil Province

During 15-21 October 2007 (week 42), 33 were confirmed cholera-positive. The total number of confirmed cholera cases in 6 affected districts is 211 (figure 4). Unlike Kirkuk and Sulaymaniyah, the data of reported cases show a definitive downward trend in reported diarrhoea cases. For diarrhoea the number of cases in week 38 (-23 September) and 39 (-30 September) is almost the same as the pre-outbreak figure. The very high number of cases in week 36 (-9 September) is most likely due to the feeling of panic following the declaration by MoH of the occurrence of cholera in Kirkuk and Sulaymaniyah. This success in Arbil is mainly due to the fact that key departments (water and sanitation) have recognized their important and vital role in the fight against cholera, unlike the situation in Kirkuk where as noted in the last report key departments are just watching and making a minimal contribution.

• Fig. (4) below combines the data for total diarrhea, laboratory confirmed cholera, Arbil governorate by international weeks. The figure shows that the number of confirmed cases peaked in weeks 38 and 39 and then plateaued at the level of 27-33 cases per week during the last 4 weeks.

   

Indexed under: Cholera Situation Reports, Water Borne Disease, Water Crisis (Iraq), World Health Organisation, الكوليرا