WHO Representative’s Office in

Mid-week Situation Report on Cholera in Iraq

Sitrep no. 31; Date of Reporting: 31 October 2007 (week 44).

1. NEW LABORATORY-CONFIRMED CHOLERA CASES REPORTED DURING 29-31 OCTOBER 2007 (WEEK 44): a. : 7 (of 122 samples tested) 6% b. : 1 (number of samples tested not yet reported) NA c. : 2 (of 184 samples tested) 1% d. Ninawa: 0 (of 396 samples tested) 0%

2. OVERVIEW As of 31 October 2007 (week 44), 45 , 28 in northern Iraq and 17 in the centre and South have reported laboratory-confirmed cases of cholera. In northern Iraq, 13 out of the 14 districts of , all 5 districts of , 6 of 7 districts of , 4 districts in Dahuk. As for the centre and South; the affected districts are: 4 districts in Baghdad, and 3 districts each of ; and Diyala, 2 districts in as well as one in each of Wassit and Anbar. The results of the samples of vibrio cholerae isolates from Sulaymaniyah 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, showing vibrio cholerae O1 El Tor Inaba.

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 4,479 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 - 31 October 2007, 36 cholera cases were discovered.

Table 1: Laboratory confirmed cholera Cases, Iraq, 14/08-31/10/2007

Province No. districts Date first case Date most recent No. deaths laboratory-confirmed affected reported case reported reported cholera cases Kirkuk 5 14/08/2007 30/10/2007 5 2,977 Sulaymaniyah 13 23/08/2007 29/10/2007 14 1,227 Erbil 6 05/09/2007 31/10/2007 0 237 Dahuk 4 07/09/2007 28/10/2007 0 6 Tikrit 3 12/09/2007 07/10/2007 0 5 Ninewa-Mosul 3 15/09/2007 25/10/2007 1 3 Baghdad-Resafa 4 19/09/2007 28/10/2007 1 12 Basra 2 19/09/2007 02/10/2007 0 2 Wasit 1 20/09/2007 20/09/2007 0 3 Anbar 1 03/10/2007 03/10/2007 1 2 Diyala 3 03/10/2007 03/10/2007 0 5 Total 45 22 4,479 1/2 Cholera Affected Di s ZAKHOMap showing Cholera affected Districts of Iraq, DahukAMEDI BARZAN SUMELDAHUK SHEKHAN asSORAN of 31 October 2007 CHOMAN TELAFAR TILKAIF BARDARASH Erbil AYMEN AL-SHIKHAN AL-HAMDANIYA RANIAPSHDAR ERBIL CENTER GAYARA DASHTE HAWLERKOISNJAQ Ninewa DOKAN MAKHMUR SHARAZOOR AL DIBIS SULAYMANIYA AL-BA'AJ AL-SHIRQATAL-HAWIGA1 ZIMNAKO Sulaymaniyah Legend Kirkuk BAZYAN KIRKUK AL-HAWIGA2 One confirmed Cholera case TIKRIT GARMIANDARBANDIKHAN TOOZ Governorate boundary AMIRYA Salah al-Din AL-DAUR The boundaries and names shown AL-KA'IM AL-KHALIS designations used on this map do n the expression of any opinion wha t AL-MUQDADIYA BALAD Diyala on the part of the World Health Or g HEET DIJEL concerning the status of any count TARMIABA'QUBA city, or area,or of its authorities, or BALADROOZ the delimitation of its frontiers or b o Dotted lines on maps represent ap RAMADI1 ABU GHRAIB Resafa border lines for which there may n o FALLUJA KarkhKADHMIYAMADA'IN full agreement @WHO Iraq, 2007 MAHMOUDIYADORA AZIZYIA Anbar AL-MUSAYAB AL-SUWAIRA AL-HINDIYAAL-MAHAWIL Wassit World Health Organization KERBALA Country office for Iraq HUSAINYA Kerbala 26, Yanbu' St., Um Uthaina P.O B o RAMADI2 Babylon ALI AL-GHARBI HILLAHASHIMIYA AL-NA'MANIYA Amman 11181 Jordan T: +962 6 55 10 438 AL-HAI F: +962 6 55 10 437 DIWANIYA [email protected] AFAQ AMARA Diwaniya AL-SHAMIYA Missan AL-RIFA'I AL-MANATHERA HAMZAAL-RUMAITHA QAL'AT SALEH AL-MEJAR AL-KABIR AL-SHATRA AL-KHIDHIR Thi-QarNASSRIYA2 Najaf NASSRIYA1 AL-MIDAINA AL-QURNA ® SUQ AL-SHOYOKHAL-CHIBAYISH SHATT AL-ARAB BASRAH2

Basrah

Muthanna AL-ZUBAIR ABUBASRAH1 AL-KHASEEB AL-SAMAWA

2/2