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Published Date: 2007-10-04 18:00:11
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2007 (43)
Archive Number: 20071004.3286

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2007 (43)
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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 report
[2] Cholera - Iran
[3] Cholera - Iran (Kordestan)
Africa
[4] Cholera - Sierra Leone (Northern, Western Areas)
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[1] Cholera - Iraq: WHO report
Date: Wed 3 Oct 2007
Source: World Health Organization (WHO) Epidemic and Pandemic Alert
and Response (EPR) disease outbreak news [edited]
<http://www.who.int/csr/don/2007_10_03/en/index.html>

Since the cholera outbreak was 1st detected in Kirkuk, Northern Iraq,
on 14 Aug 2007, it has spread to 9 out of 18 provinces across Iraq.
It is estimated that more than 30 000 people have fallen ill with
acute watery diarrhea, among which 3315 were identified as positive
for _Vibrio cholerae_, the bacterium causing the disease. A total of
14 people are known to have died of the disease. The case-fatality
rate has remained low throughout the outbreak indicating that those
who have become sick have been able to access adequate treatment on time.
The disease is continuing to spread across Iraq and dissemination to
as yet unaffected areas remains highly possible. Epidemiological
curves are still rising in the provinces from which the majority of
laboratory-confirmed cases have originated, Kirkuk (2309) and
Sulaymaniyah (870). An increasing number of cases of acute watery
diarrhea has also been reported in Diala, a province neighboring
Baghdad. Although _V. cholerae_ has not yet been laboratory
confirmed, the clinical symptoms indicate the presence of cholera.
The numbers of cases are remaining stable in Basra, Baghdad, Dahuk,
Mosul, and Tikrit. However, a case has now been confirmed in Wasit, a
province that has previously been unaffected by the outbreak.
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, the overall quality of water
and sanitation is very poor, a factor known to greatly facilitate
cholera contamination. WHO is in the process of procuring 5 million
water-treatment tablets and 2 international WHO epidemiologists are
being deployed to support the Ministry of Health in Iraq.
WHO does not recommend any restrictions to travel or trade to or from
affected areas as a means to control the spread of cholera. However,
neighboring countries are encouraged to reinforce their active
surveillance and preparedness systems. Mass chemoprophylaxis is
strongly discouraged, as it has no effect on the spread of cholera,
can have adverse effects by increasing antimicrobial resistance and
provides a false sense of security.
Use of the current internationally available prequalified oral
cholera vaccine is not recommended once an outbreak has started due
to its 2-dose regimen and the time required to reach protective
efficacy, high cost and the heavy logistics associated with its use.
The use of the parenteral cholera vaccine has never been recommended
by WHO due to its low protective efficacy and the high occurrence of
severe adverse reactions.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[A map of Iraq can be found at
<http://www.un.org/Depts/Cartographic/map/profile/iraq.pdf>.
The total number of confirmed cholera cases in this report is 3315
with 15 deaths. This 15th death was not mentioned in the last
Situation Report on the outbreak on 1 Oct 2007, posted on 2 Oct 2007.
The case in Anbar province in western Iraq noted in ProMED-mail
20071002.3254 is also not mentioned in the above report. - Mod.LL]
******
[2] Cholera - Iran
Date: Thu 4 Oct 2007
Source: Reuters Foundation AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/L0430463.htm>

Cholera has jumped the border from Iraq to Iran, highlighting the
need for neighboring countries to boost their defenses against the
deadly disease, the World Health Organisation (WHO) said on Thu 4 Oct 2007.
Cholera has struck at least 3315 people in Iraq since mid-August
2007, killing at least 15. WHO global cholera coordinator Claire-Lise
Chaignat said that up to 10 cases have also been confirmed in Iran,
near the Iraqi border. It was not clear whether these were Iraqi
refugees or local Iranians, according to the Swiss expert, who warned
the epidemic could threaten refugee camps in the region if not controlled.
"Some cases, around 9 or 10, have been confirmed in Iran. The
situation seems contained," in the Islamic Republic, Chaignat told
Reuters in Geneva. Cholera, which is continuing to spread within
Iraq, can be carried by refugees and pilgrims, and through normal
trade, she said. "Borders are permeable, closing them won't stop the germ."
Iraq shares borders with Iran, Turkey, Syria, Jordan, Kuwait, and
Saudi Arabia. Some 60 000 Iraqis flee their homes each month and 2.2
million Iraqis have crossed into neighboring countries, mainly Syria
and Jordan, according to the UN.
"We are particularly worried about countries with Iraqi refugees
where they don't always have access to good water and sanitation and
hygienic conditions," Chaignat said. "It is important to catch the
1st cases and treat them correctly." Iraq's Health Ministry said on
Mon 1 Oct 2007, that 15 people had died of cholera to date.
Chaignat said cholera normally thrives in lower temperatures and
warned it could spread further in Iraq as the strong sun and heat,
which kill the germ subside. "That is our fear," she said.
[Byline: Stephanie Nebehay]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
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[3] Cholera - Iran (Kordestan)
Date: Thu 4 Oct 2007
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5im1oAXzkiMbwuO6j6Dl52QZPEAeQ>

Iran stifled a potential cholera outbreak 3 weeks ago, after the
infection was probably carried there from Iraq, the WHO revealed Thu
4 Oct 2007. "There were a few cases in Iran about 3 weeks ago, it's
under control," WHO cholera coordinator Claire-Lise Chaignat told AFP.
"Iran reacted very well, they dealt with the cases rapidly," Chaignat
said, underlining that there was no spread from the less than 10
known cases. The cholera cases were 1st recorded in Iran's western
province of Kordestan, next to Iraq, on 19 Sep 2007, she added. The
WHO was not aware of any other cases elsewhere in Iran.
Chaignat said the infection was probably carried into Iran by
travelers from Iraq. "There's a link, that's for sure," she added.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The 1st of the 2 Iranian reports does not state the area involved or
the time period when the cases occurred, which are found in the 2nd
report. It is of interest that the cases began to be found more than
2 weeks ago and are only being reported now.
A map of Iran can be found at
<http://www.un.org/Depts/Cartographic/map/profile/iran.pdf>.
The location of the Iranian cases in Kordestan is in the northwestern
part of the country, which borders on the most affected areas of
Iraq. - Mod.LL]
******
[4] Cholera - Sierra Leone (Northern, Western Areas)
Date: Wed 3 Oct 2007
Source: AllAfrica, UN Integrated Regional Information Networks (IRIN)
report [edited]
<http://allafrica.com/stories/200710031132.html>

A deadly cholera epidemic has broken out in several regions of Sierra
Leone. Since the 1st week of September 2007, at least 523 people have
been infected in Kambia district in northern Sierra Leone, close to
the border with Guinea, and in the eastern town of Kenema, and Newton
on the outskirts of the capital Freetown, according to the Ministry of Health.
"We have the personnel and enough drugs to quickly and professionally
intervene," The Kambia District medical officer Joseph Kandeh told
IRIN. Nonetheless, 30 people died from the disease in September
[2007], the Ministry said.
The district medical officer for Kenema, Yankuba Bah, said that
people are reluctant to seek treatment when they get sick as they do
not have confidence in public hospitals. "Most patients only visit
government hospitals when they are in a precarious condition," he
said. Bah also said that most of the people infected are women. They
are more exposed to the disease, he said, because they fetch water
from streams and work in crowded markets.
Cholera and other waterborne diseases occur each year during the
rainy season as heavy rains lead to the contamination of streams and
wells from uncollected garbage and effluent. In 2006, 2560 cholera
cases were recorded in Sierra Leone during the rainy season between
August and October, with 77 deaths.
Less than 50 percent of people outside Freetown have access to clean
water and toilets, according to the UN, and most depend on streams
and rainfall for their drinking water.
--
Communicated by:
Otavio da Silva
<otavio_uff104@yahoo.com.br>
[A map of Sierra Leone showing the reported areas can be found at
<http://www.un.org/Depts/Cartographic/map/profile/sierrale.pdf>. - Mod.LL]

See Also