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Published Date: 2008-09-15 17:00:31
Subject: PRO/EDR> Cholera, diarrhea & dysentery update 2008 (36)
Archive Number: 20080915.2882

CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (36)
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In this update:
Asia
[1] Cholera - Iraq: IRIN report
[2] Cholera - Iraq: WHO report
[3] Cholera - Iraq
[4] Cholera - Iraq (Karbala)
[5] Cholera - Iraq (Babil)
[6] Cholera - Philippines (Pangasinan)
[7] Diarrhea, fatal - Nepal (Midwestern Region)
Africa
[8] Cholera - Nigeria (Kano)
[9] Cholera - Tanzania (Mara)
[10] Cholera - Guinea-Bissau

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[1] Cholera - Iraq: IRIN report
Date: Mon 15 Sep 2008
Source: UN Integrated Regional Information Networks (IRIN) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SID/RMOI-7JGK6C?OpenDocument>

The Iraqi Ministry of Health continues to fight a recent outbreak of
cholera as it spreads through Iraq's southern provinces, bringing the
total number of confirmed cases to 68, a health ministry spokesman
said on 13 Sep 2008.

"So far we have diagnosed 68 cholera cases in Baghdad and other
southern provinces: Babil 40 cases; Baghdad 22 cases; Karbala 4
cases; Najaf one case; and another in Maysan," Ihssan Jaafar,
director-general of the public health directorate and spokesman for
the ministry's cholera control unit, told a press conference in Baghdad.

Jaafar said that 5 people had died from the disease but all in the
early days of the outbreak, in late August 2008, as the victims had
not gone to any hospital quickly enough.

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ProMED-mail <promed@promedmail.org>

[As can be seen in the various postings in this report, the number of
cholera cases and related deaths in the ongoing outbreak in the
southern provinces is quite variable. The affected areas of Iraq can
be found on a map of the country at:
<http://www.un.org/Depts/Cartographic/map/profile/iraq.pdf>.
- Mod.LL]

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[2] Cholera - Iraq: WHO report
Date: Wed 10 Sep 2008
Source: WHO [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SID/EGUA-7JCLJ5?OpenDocument>

On 20 Aug 2008, cases of acute watery diarrhea from Baghdad and
Maysan Province were laboratory confirmed as cholera. They constitute
the 1st cholera cases detected in Iraq in 2008. By 28 Aug 2008, 7
cases had been laboratory confirmed, and a further 174 cases were
suspected as cholera, bringing the total number of reported cases to
181 (128 in Maysan and 53 in Baghdad). In the 1st week of September
2008, the outbreak spread to Babil Province, south of Baghdad, where
116 suspect cases have now been identified. The presence of _Vibrio
cholerae_, the bacterium causing the disease, has been confirmed in
21 cases. To date, there have been 10 fatalities, 3 of whom tested
positive for _Vibrio cholerae_.

The reemergence of cholera in 2008 is not unexpected: in September
2007, the country was affected by a large outbreak (4696 cases with
24 deaths). The outbreak occurred mainly in northern Iraq, but
sporadic cases were also detected in other provinces.

The government of Iraq has mobilized a multi-sector 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. Building on last year's [2007]
experience, the Ministry of Health, together with WHO, have put in
place an effective surveillance system that was able to capture the
very 1st cases of cholera, enabling a timely response and
facilitating the containment of the outbreak.

However, the overall quality of water and sanitation remains very
poor, a factor known to greatly facilitate cholera contamination.
Experience has shown that long term-prevention of cholera depends on
access to safe water and adequate sanitation to prevent exposure and
interrupt transmission. Improving water and sanitation
infrastructures is, therefore, a long-term goal of WHO and its
partners in Iraq and, in times of outbreaks, it is essential that
immediate measures, such as water treatment at the household level,
health education and proper case management, are implemented rapidly.
To this end, the government of Iraq is providing chlorine tablets to
families and is intensifying social mobilization activities.

In response to a request from the Ministry of Health, WHO is
providing technical support, particularly in the area of laboratory
testing. A joint Ministry of Health/WHO mission will be deployed shortly.

WHO does not recommend any restrictions to travel or trade to or from
affected areas as a means of controlling cholera outbreaks.
Neighboring countries are encouraged, however, to reinforce their
active surveillance and preparedness.

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[3] Cholera - Iraq
Date: Mon 15 Sep 2008
Source: Azzaman [edited]
<http://www.azzaman.com/english/index.asp?fname=news%5C2008-09-15%5Ckurd.htm>

At least 1000 people have died as a result of the recent outbreak of
cholera in Iraq, Iraqi members of parliament said. Nawzad Rifaat,
chairman of parliament's Health Commission, accused the government of
hiding the "the real figure of cholera cases," urging the Health
Ministry to provide detailed statistics on deaths and cases without delay.

Parliamentary sources said they feared the disease was already out of
control and the government had failed in efforts to have it contained.

"Hospitals are crammed with the patients who may exceed 10 000 who
have already been afflicted with the disease," one member of
parliament, refusing to be named, said.

Officials say thousands of cases have been reported in other
provinces in addition to Babil. Hospitals in the provinces of Diyala,
Najaf and Karbala were strapped for resources to treat patients.

[Byline: Kadhem Ali]

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[4] Cholera - Iraq (Karbala)
Date: Fri 12 Sep 2008
Source: Associated Press [edited]
<http://ap.google.com/article/ALeqM5i9kvheUr1rKeZ1YpvHjHAFg_350wD935BGOG1>

Iraqi and UN officials say 4 cholera cases have been confirmed in
Karbala, a holy Shiite city south of Baghdad that draws masses of
pilgrims. The new cases come in addition to 36 previously announced
by the Iraqi Health Ministry and show that the latest outbreak of the
gastrointestinal disease has spread to a new area.

The head of the Karbala health directorate, Alaa Badir, said Friday
[12 Sep 2008] that the 4 people with cholera have been hospitalized.
Naeema al-Gasseer, a doctor with WHO, confirms that figure and says
the UN group is working with Iraqi authorities to contain the spread
of the waterborne disease.

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[5] Cholera - Iraq (Babil)
Date: Wed 10 Sep 2008
Source: Agence France Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5hGNZsU7uNL0mwmsEE_mapx_1pstw>

At least 20 people have died of cholera and hundreds more are
suspected of suffering from the disease in the central Iraqi province
of Babil, a local official said on Wednesday [10 Sep 2008].

"In the past 3 days, 20 people have died from cholera in several
regions of Babil," provincial council member Mohammed al-Jafari told
AFP. He said the victims included 7 children and 2 women. "The
region's hospitals have received hundreds of cases showing symptoms
of cholera," Jafari added.

--
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[6] Cholera - Philippines (Pangasinan)
Date: Thu 11 Sep 2008
Source: ABS-CBN News [edited]
<http://www.abs-cbnnews.com/nation/regions/09/11/08/cholera-cases-pangasinan-increasing>

Pangasinan province is now being threatened by a possible outbreak of
cholera disease. Health officials said cholera is now the major
concern due to the "dramatic" increase in the number of cases of the
disease in the western and central areas of the province.

Provincial health office records show that cholera victims have
increased to 57, with one death in Bayambang town. Bayambang town has
the largest number of cholera cases, followed by Aquilar and Bolinao.
Unofficial records show that there are already 6000 cases of acute
gastroenteritis or AGE in the province.

The provincial health office is now providing chlorine solution to
barangays with contaminated shallow tube wells to alleviate the
number of cholera cases.

[Byline: Cris Zuniga]

--
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[Pangasinan province is on the island of Luzon and can be found on a map at:
<http://en.wikipedia.org/wiki/Pangasinan>.
- Mod.LL]

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[7] Diarrhea, fatal - Nepal (Midwestern Region)
Date: Wed 10 Sep 2008
Source: The Rising Nepal [edited]
<http://www.gorkhapatra.org.np/detail.php?article_id=6569&cat_id=8>

Diarrhea has claimed the lives of 2 locals in the Katkaiya VDC, which
lies across the Rapti river, because they were not treated in time,
according to the local police. According to the police report sent to
the police station at Laxmipur by the district police office of
Banke, diarrhea had spread across the VDCs on Saturday [6 Sep 2008];
over 200 people had been affected, and, out of them, 2 died.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Banke district is located in the southern part of the Midwestern
Region and can be found on a map at:
<http://ncthakur.itgo.com/map04.htm>.
- Mod.LL]

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[8] Cholera - Nigeria (Kano)
Date: Mon 15 Sep 2008
Source: This Day [edited]
<http://www.thisdayonline.com/nview.php?id=122522>

No fewer than 5 people were feared dead as a result of an outbreak of
cholera in some local government areas of Kano state. Although the
disease is yet to assume epidemic status, the State Commissioner for
Health, Hajiya Aishatu Isyaku Kiru, said her ministry had swung into
action to tackle the situation. She attributed the development to the
consumption of unhygienic foods or drinks, describing such foods to
include vegetable salads and fruits and contaminated food and water,
which, if not properly prepared, could become vehicles for the
infection and spread of cholera.

[Byline: Ibrahim Shuaibu]

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[A map of Nigeria showing the north-central state of Kano can be found at:
<http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf>.
- Mod.LL]

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[9] Cholera - Tanzania (Mara)
Date: Wed 10 Sep 2008
Source: UN - Integrated Regional Information Networks (IRIN) [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SID/ASAZ-7JCHDR?OpenDocument>

Four people have died of cholera, and dozens were admitted to health
centers in the northern Tanzanian region of Mara, according to health
officials. Mara Regional Medical Officer Stephen Kebwe said 4
patients died in the 1st week of September 2008 in Tarime district,
which borders Kenya.

Kebwe said cholera cases were 1st reported in Tarime on 16 Aug 2008.
The officer said so far 180 cases have been reported in Tarime and
Rorya districts. Kebwe said 164 cases were treated at various health
centers and discharged. Kebwe said 16 patients were still admitted at
health centers in the 2 districts as of 10 Sep 2008 morning.

--
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[Mara is located in extreme northern Tanzania and can be found on a map at:
<http://www.un.org/Depts/Cartographic/map/profile/tanzania.pdf>.
- Mod.LL]

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[10] Cholera - Guinea-Bissau
Date: Thu 11 Sep 2008
Source: Missionary International Service News Agency (MISNA) [edited]
<http://www.reliefweb.int/rw/rwb.nsf/db900SID/KLMT-7JD8L7?OpenDocument>

The toll continues to rise in a cholera outbreak since the end of May
2008 in Guinea-Bissau. Based on the latest estimates of the United
Nations Office for the Coordination of Humanitarian Affairs (OCHA),
as of 1 Sep 2008, the outbreak claimed 110 lives with over 5000
people suffering from the disease. The capital of Guinea-Bissau
[Bissau] remains the worst-affected with 3500 cases, although the
outbreak is spreading in the provinces of Quinara (south), Biombo
(west), and new cases were reported also in Sao Domingo (north-west)
and the Bijagos Islands.

The government recently defined the situation as "difficult" and
called for urgent international help in containing the epidemic,
specifying that, due to the "alarming proportions" of the outbreak,
the national authorities were no longer able to contain it. UN
agencies and top international health organizations are already on
the scene in an attempt to contain the spread.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[The areas mentioned can be found on the map of Guinea-Bissau at:
<http://www.un.org/Depts/Cartographic/map/profile/guineabi.pdf>.

The outbreaks discussed in this update can also be found on the
HealthMap/ProMED-mail interactive map at
<http://www.healthmap.org/promed>.
- Mod.LL]

See Also