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Published Date: 2007-09-25 23:50:00
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2007 (41)
Archive Number: 20070925.3175

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (41)
**********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
Asia
[1] Cholera - Iraq: WHO situation report
[2] Cholera - Iraq: WHO outbreak report
Oceania
[3] Cholera, 2006 - Australia (New South Wales)
******
[1] Cholera - Iraq: WHO situation report
Date: Sun 23 Sep 2007
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), ReliefWeb, WHO report [edited]
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/YSAR-77CQY6?OpenDocument>

New developments
-----------------
- Dahuk: On 23 Sep 2007, Dahuk health authority reported the 1st
laboratory confirmed _Vibrio cholerae_ in a 5-year-old female child
from Bardarash district in Dahuk governorate. It is important to note
that the 1st index case for 1999 outbreak (over 900 cases) started in
the same area, which the WHO requested to visit during the last
mission to north Iraq, however, the request was denied. 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 the _V. cholerae_ organism.
- Baghdad and Basra: The only confirmed cholera case from Baghdad
died on 22 Sep 2007; bringing the total deaths from cholera to 11 cases.
- Diala: [See full report commentary below. - Mod.LL]
- Babil and Wassit: There are reports of 2 suspect cases of cholera,
one each in Wassit and Babil, confirmatory laboratory test is
expected within 48 hours.
Overview
--------
As of 23 Sep 2007, 25 districts of Northern Iraq and 4 districts in
the south and center have reported laboratory-confirmed cases of
cholera. 13 out of the 14 districts of Sulaymaniyah governorate, all
5 districts of Kirkuk governorate, 6 out of 7 districts of Erbil
governorate; as well as one district in each of Dahuk, Mosul, Tikrit,
Baghdad, and Basra are now affected by this cholera outbreak. A
representative sample of the _V. cholerae_ isolates from Sulaymaniyah
was sent by WHO today to the US Navy Advanced Research Unit
Laboratory in Cairo [NAMRU-3] for further confirmation and phenotypic
characterization. Up to this day [23 Sep 2007], 2105 lab confirmed
cholera cases (all of the Inaba serotype except 16 isolates of the
Ogawa serotype) were officially reported from Iraq.
95 percent of cases were reported from Sulaymaniyah and Kirkuk in
north Iraq, the outbreak seems to be slowly spreading to the
neighboring provinces of Erbil and Diala with 105 cases (out of which
12 cases from Diala diagnosed on clinical grounds) are reported.
Sporadic cases with definite history of travel and food consumption
in Kirkuk were reported from Mosul and Tikrit provinces; however,
isolated cases with no epidemiological link to north Iraq were also
confirmed in Baghdad and Basra.
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 2105 lab confirmed cases; only 11 deaths
were reported, all the deceased have another serious underlying cause.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The full report can be found at
<http://www.reliefweb.int/rw/RWB.NSF/db900SID/YSAR-77CQY6/$File/Full_Report.pdf>.
The relevant information extracted from the full report:
Province / Districts Affected / Date of 1st Case / Deaths / Confirmed Cases
Sulaymaniyah / 13 / 23 Aug 2007 / 9 / 630
Kirkuk / 5 / 14 Aug 2007 / 1 / 1375
Erbil / 6 / 6 Sep 2007 / 0 / 93
Dahuk / 1 / 23 Sep 2007 / 0 / 1
Tikrit (Salah ad Din) / 1 / 12 Sep 2007 / 0 / 3 (and one pending confirmation)
Mosul (Ninawa governorate) / 1 / 15 Sep 2007 / 0 / 1 (and one pending
confirmation)
Baghdad / 19 Sep 2007 / 1 / 1
Basra / 1 / 19 Sep 2007 / 0 / 1
New provinces in this report: Tikrit, Dahuk
Total confirmed cases: 2105 (was 1633 in last posting 21 Sep 2007)
Reports of a new focus in Diala province, which is south of the
original focus in Sulaymaniyah and Kirkuk. In this new focus, 12
patients presented to Baladruz, Salah ad Din, and Baqubah hospitals
with severe dehydrating diarrhea with renal shut down in one case.
Unfortunately, specimen collection was done late after patients had
received antibiotics for the majority of cases. Laboratory tests were
done by inexperienced staff in Baqubah General Hospital, as expected
cultures were negative for 7 suspect _V. cholerae_ cases, the results
for 3 cases are still pending. It is not clear whether the organism
is becoming more virulent or the population in this new focus is more
susceptible to the disease.
A map of Iraq can be found at
<http://www.un.org/Depts/Cartographic/map/profile/iraq.pdf>. Diala is
located between Sulaymaniyah and Baghdad. Dahuk is in the extreme
north, and Tikrit in Tikrit (in Salah ad Din governorate) is north of
Baghdad and west of Diala. - Mod.LL]
******
[2] Cholera - Iraq: WHO outbreak report
Date: Tue 25 Sep 2007
Source: World Health Organization (WHO) Epidemic and Pandemic Alert
and Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2007_09_25/en/>

Iraq: cholera update 2
----------------------
Since late August 2007, an outbreak of cholera has spread to 25
districts of northern Iraq and 4 districts in southern Iraq and
across the center of the country. It is estimated that more than 30
000 people have fallen ill with acute watery diarrhea, among which
2116 were identified as positive for _Vibrio cholerae_. The case
fatality rate is 0.52 percent and has remained low throughout the
outbreak, although it continues to spread across Iraq and
dissemination to as yet unaffected areas remains highly possible.
The outbreak was 1st detected in Kirkuk province, where 68 percent of
laboratory-confirmed cholera cases have so far been reported, and
then spread to Sulaymaniyah and Erbil provinces. Additional isolated
cases of cholera have also been identified in other parts of the
country, including Tikrit (6 cases confirmed), Mosul (2 cases
confirmed), Basra (one case confirmed), Baghdad (2 cases confirmed),
and Dahuk (one case confirmed).
The Government of Iraq has mobilized a multi-sectoral response to the
outbreak. Specific control measures have been reinforced and
preventive measures to reduce the risk of transmission to unaffected
areas have been put in place. However, a severe shortage of
chlorination products has been noted and replenishment is urgently
needed to enable water supplies to be treated to render them safe for
human consumption. Provision of safe water is the highest priority in
controlling an outbreak of cholera.
WHO continues to support the National and local health authorities in
the ongoing response operations. 10 interagency diarrheal disease
kits, each sufficient to treat 400 moderate and 100 severe cases,
arrived in Erbil International airport on 16 Sep 2007. Rapid
diagnostic tests are being pre-positioned in remote health care
facilities. In addition, 10 percent of all positive stool samples are
being sent to NAMRU 3 reference laboratory (US Navy Advanced Research
Unit) in Cairo for further confirmation and phenotypic characterization.
In controlling the spread of cholera, WHO does not recommend any
special restrictions to travel or trade to or from affected areas.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[This report includes 66 more confirmed cases including 3 more in
Tikrit (Salah ad Din governorate), one each in Mosul (Ninawa
governorate) and Baghdad. No new districts or governorates are
included. - Mod.LL]
******
[3] Cholera, 2006 - Australia (New South Wales)
Date: Tue 25 Sep 2007
Source: Australian Broadcasting Corp. [edited]
<http://abc.net.au/news/stories/2007/09/25/2042245.htm?section=justin>

A health conference in Alice Springs has been told how taste-testing
fish frittatas caused a mini-cholera outbreak in Sydney in 2006.
When 3 Italian grandmothers came down with cholera, the Sydney South
West Area Health Service was left with few clues about what had
caused Australia's 1st cholera cluster in more than 30 years.
Service spokesman Bradley Forssman says interviews with the women's
families showed they had all made whitebait frittata on the same
weekend, and had tasted the mix before cooking it. He says the fish
were sold from 2 stores in the same area of Sydney.
Dr Forssman says the case raises questions about Australia's food
classification laws, which assume most seafood will be cooked before
it is eaten.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the original report on ProMED-mail (Cholera, diarrhea &
dysentery update 2006 (47) 20061128.3377), the women became ill after
buying raw whitebait, which is believed to have come from China, from
fish shops in the inner city. - Mod.LL]
[See photo of whitebait, aka smelt, at:
<http://www.die-antwort-auf-alle-fragen.de/blog/wp-content/uploads/2007/03/800px-whitebait.JPG>
- Mod.JW]

See Also