Situation report on cholera outbreak in northern Iraq, 04 Nov 2007


Sitrep no. 32; week 44 ending 04 November 2007.


a. Kirkuk: 22 (of 410 samples tested) 5.4%

b. Sulaymaniyah: 07 (samples tested not reported)

c. Erbil: 10 (of 408samples tested) 2%

d. Baghdad: 13 (The number of stool samples tested not reported)

e. Total new cases 51


The most important development this week is the steep increase in the number of cholera cases reported from Baghdad compared to last week. The number of laboratory confirmed cases jumped from 11 to 24 cholera cases representing an increase of 227% in the cumulative cases. 26% of new confirmed cholera cases this week were reported from Baghdad Resafa; mainly from the highest risk areas in the 3 most disadvantaged districts in Baghad (Sadder City, Me'dain and Resafa districts). Data provided from Baghdad is neither complete nor timely; therefore what is reported may be an underestimation of the real situation.

As of 04 November 2007 (week 44), 45 districts, 28 in northern Iraq and 17 in the centre and South have reported laboratoryconfirmed cases of cholera. In northern Iraq, 13 out of the 14 districts of Sulaymaniyah governorate, all 5 districts of Kirkuk governorate, 6 of 7 districts of Erbil governorate, 4 districts in Dahuk. As for the centre and South; the affected districts are: 3 districts in each of Baghdad, Tikrit; Mosul and Diyala, 2 districts in Basra as well as one district in each of Wassit and Anbar. The results of the samples of vibrio cholerae isolates from Sulaymaniyah; kirkuk, Erbil and Central Public Health Laboratory in Baghdad were received by the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) laboratory, Cairo. NAMRU-3 results confirmed Sulaymaniyah- and Central Public Health Laboratory (CPHL) results, confirming that the out break was caused by vibrio cholerae O1 El Tor Inaba, which is sensitive to the commonly used antibiotics, the isolated strains were found resistant to trimethoprim-cotrimoxazole.

99% of Iraq's cholera cases were reported from Kirkuk, Sulaymaniyah and Erbil, 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.

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 diarrhoea were seen only very occasionally, out of the 4,527 laboratory-confirmed cholera cases; 22 deaths were reported, most of the deceased had other, serious underlying morbidity.

Specific control measures to contain this ongoing outbreak and limit its spread to other areas have been reinforced by the concerned governmental departments of the affected provinces, with technical support from WHO. In non-epidemic provinces, during the period 14 August - 04 November 2007, 53 cholera cases were discovered.