Gorilla’s Guides

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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:

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Yesterday’s bombing at the al-Shifa bridge (overpass) in Mosul is a worse development than it looks. The bombing was a tanker bombing of the overpass itself  and destroyed it completely. It also caused 20 people to be wounded mostly by flying glass it also caused severe damage to nearby buildings. (There was an attempted second bombing targeting the security forces responding to the bridge bombing. That device was in a booby trapped car it was detected and detonated remotely.)

The overpass that has been destroyed is on the west of Mosul. It linked Mosul to the outlying districts of Sinjar and Kaz Izir. It also linked Mosul to Tal Afar.

At present there are several ethnic cleansing campaigns going on in the vicinity of Mosul. The campaigns involving concerted death squad activity and massive bombings (such as the August 14th bombings)  against the Yezhidi and the Turkmen are the two best known, however there are also concerted attempts being made to drive out Christians and Fayli. The area has a mixed population and is scheduled to vote on accession to the Kurdish region in December 2007.  The effect of this bombing is to further isolate the city from its hinterland, to drastically reduce the number of routes available to security forces responding to incidents in  Al-Shikhan, Tal Kaif, Sinjar, and the Qahtaniyah district and to increase the freedom of movement of armed groups operating in the districts west of Mosul and to facilitate the ethnic cleansing campaigns being conducted in the area.

Omar

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:

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